Caesarean section is recommended when vaginal delivery might pose a risk to the
mother or baby. Caesarean section is a relatively safe operation; however, some
of the possible complications include infection, damage to your internal organs,
and an increased risk of respiratory distress for your baby, and complications
with future pregnancies.
Caesarean sections can be performed under general anesthesia, regional
anesthesia or local infiltration. Caesarean section generally is safe, but the
risk of major complication and death during Caesarean delivery is three to five
times higher than with vaginal birth. Caesarean section is major abdominal
surgery, after which the new mother has to care for her baby.
Caesarean Birth statistics
Caesarean section rates have been increasing ever since the 1970's.
Caesarean section rates are progressively rising in many parts of the world.
Statistics from the 1990s suggest that less than one woman in 2,500 who has a
caesarean section will die, compared to a rate of one in 10,000 for a vaginal
delivery.
The World Health Organisation estimates the rate of caesarean sections at
between 10% and 15% of all births in developed countries. Concerns have been
raised in recent years that caesarean section is performed for reasons other
than medical necessity. Studies of US women have indicated that married white
women giving birth in private hospitals are more likely to have a caesarean
section than poorer women even though they are less likely to have complications
that may lead to a caesarian section being required.
Reasons for Caesarean Sections
Some of the conditions that may require birth by a caesarean section include
breech or transverse presentations of the baby, placenta praevia, or maternal
conditions (such as high blood pressure). Women with primary genital herpes
simplex virus infection occurring in the third trimester of pregnancy should be
offered planned caesarean section because it decreases the risk of neonatal HSV
infection.
Most women remain in hospital for 5-7 days following a caesarean section. They
are usually advised not to drive for at least four weeks following a caesarean
section and some insurance companies have certain guidelines so check these
before driving again.
Risks of Caesarean Sections
Some of these risks and possible complications include: Infection of the
mother’s wounds, damage to the mother’s bladder and other internal organs and
blood vessels, damage to the baby inflicted by surgical instruments, increased
risk of the baby experiencing respiratory distress, increased time in hospital,
increased abdominal (tummy) pain, increased risk of having a caesarean section
in the future.
Women who delivered their first child by cesarean delivery had increased risks
for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta,
prolonged labor, emergency cesarean, uterine rupture, preterm birth, low birth
weight, small for gestational age and stillbirth in their second delivery.
Along with this is a similar rise in the risk of emergency hysterectomies at
delivery. A caesarean section is a major operation, with all that it entails,
including the risk of post-operative adhesions. A prior caesarean section
increases the risk of uterine rupture during subsequent labour. The patient's
stomach may not be empty, increasing the anesthesia risk. The risks of general
anesthesia for mother and baby are still extremely small overall.
Approximately 75% of women who have caesarean sections for their first baby go
on to have a normal vaginal delivery for subsequent pregnancies. The risks and
benefits of vaginal birth after caesarean section compared with repeat caesarean
section are uncertain.
Emergency caesarean
An emergency caesarean section is a caesarean performed once labour has
commenced. Reasons for caesarean delivery include prolonged labour or a failure
to progress, apparent fetal distress, apparent maternal distress, complications
(pre-eclampsia, active herpes) catastrophes such as cord prolapse or uterine
rupture, multiple births, abnormal presentation (breech or transverse
positions)failed induction of labour, failed instrumental delivery (by forceps
).
In most cases, doctors do caesarean sections because of problems that arise
during labour. If a pregnant women goes into spontaneous labour, they should
have about an 80% chance of having a normal delivery. If however the labour
needs to be induced, then the chances of having a normal delivery is around 50%.
Choices
When this risk is weighed against other circumstances, a caesarean can
sometimes be the better choice, however, sometimes it is a choice of
convenience, or a matter of lack of information. Before the operation, women
need to discuss a range of issues with their doctor or surgeon, including:
general health, as some things may affect the doctor’s decisions about surgery
and anaesthetics. They will also need to have some blood tests to check if they
are anaemic, and to make sure there is some blood ready in case it is needed
during the operation.
When a caesarean section is scheduled, or even when it is just a possibility,
mothers can still make some choices about the way their child will be born, and
supportive midwives can make a great difference to the mother's feelings about
the birth. People need to have the procedure explained carefully beforehand, and
partners should be given the choice to be present.
Although midwives do not make decisions regarding caesarean sections, they have
a pivotal role in giving women clear and unbiased information regarding choices
for labour and delivery, and are also influenced by changes in the caesarean
section rate. Obstetricians should also be partners in the process of decision
making.
As a pregnant women, it make sense to be fully informed of all the options, to
be prepared as much as possible and to have plan A, B and C already organized
ahead of time.
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