Hail Caesarean

Since I read this on another blog just after Christmas, the words of this woman have haunted me. Here is a woman, already having experienced her first cesarean iatrogenically because of her physician's impending vacation, pregnant and wanting a vaginal birth. I remember those shoes, I was in them not so long ago after my primary caesarean for the very same reason and so wanting a vaginal birth. I was almost assuming it would be so because I couldn't accept the fact that my body was broken, unable to birth my own child. Denial is not a good thing, especially when you have not given yourself time to grieve.

Now this woman is faced with the financial burden of a possible repeat cesarean following a trial of labour vs. the much lower cost of an elective repeat caesarean section. Couple this with her physician's admitted bias (emphasis mine),

That said, my gynae confesses that he is pro-Caesarean himself. Why? Because it is safer for the mother and the child. However, for first time births, he usually discourages it unless the baby is breach (positioned wrongly) et al. For mothers who have gone under the knife, such as myself, he recommends another Caesarean simply because of safety.

"Honestly speaking, it poses less stress for the doctor as well because we are worried for you, if your wound might rupture, which is very messy. The decision is ultimately still up to you to go elective or vaginal," he told me.

What the hell?! So let me see, I would rather risk mine and my baby's life to give my physician less stress? Let us look at the consequences of an elective caesarean from ICAN shall we?

Risks to the baby from elective cesarean section

• Babies delivered by elective cesarean have an increased risk of neonatal respiratory distress syndrome (RDS), a life-threatening condition, and other respiratory problems that may require NICU care.
• Babies delivered by elective cesarean have a five-fold increase in persistent pulmonary hypertension (PPH) over those born vaginally.
• Babies delivered by elective cesarean are at increased risk of iatrogenic (physician caused) prematurity, usually related to failure to conform to protocols for determining gestational age prior to delivery, or errors in estimating weeks of gestation even with the use of clinical data. Prematurity can have life-long effects on health and well-being, and even mild to moderate preterm births have serious health consequences.
• Babies delivered by elective cesarean are cut by the surgeon’s scalpel from two to six percent of the time. Researchers believe these risks to be underreported.

Risks to the mother from elective cesarean section

• Up to 30% of women who have a cesarean acquire a postpartum infection. Infections are the most common maternal complication after cesarean section and account for substantial postnatal morbidity and prolonged hospital stay.
• Other serious complications for women undergoing cesarean include massive hemorrhage, transfusions, ureter injury, injury to bowels, and incisional endometriosis.
• Women who undergo cesarean report much lower levels of health and well-being at seven weeks postpartum than women who have vaginal births.
• Women who undergo cesarean section have twice the risk of rehospitalization for reasons such as infection, gallbladder disease, surgical wound complications, cardiopulmonary conditions, thromboembolic conditions, and appendicitis. Rehospitalization has a negative social and financial effect on the family.
• Women who undergo cesarean section report less satisfaction than women having vaginal births.
• Women undergoing cesarean are at increased risk of hysterectomy in both the current and future pregnancies.
• The maternal death rate is twice as high for elective cesarean as for vaginal birth.
• In subsequent pregnancies, women with a prior cesarean have higher rates of serious placental abnomalities which endanger the life and health of the baby and the mother.
• Women are rarely told that a cesarean places future babies at higher risk.
• After cesarean section, women face higher rates of secondary infertility as well as higher rates of miscarriage and ectopic pregnancy.

The only true risk of a vaginal birth after a caesarean is the risk of uterine rupture which is 0.7%. Messy indeed for the physician but rarely life-threatening to either mother or baby. From ICAN's white paper, Issues and Procedures in Women's Health Vaginal Birth After Cesarean (VBAC), "The chance of death for a mother is 7 times higher when delivered by c/section versus vaginally." This alone is why I chose, chose, to have a vaginal birth with each of my children. Though I did end with a caesarean with the next two for different reasons, my fourth was indeed a vaginal birth with no complications at all.