C-sections: Friends or Foes?

Julia Clarke-Pounder Katie Hogan Jillian Gundersheim Dominique Antoine

According to the CDC, the rate of cesarean section in the United States in 2012 was 32.8%, a significantly high number compared to trends in the past. Women should have all the facts when it comes to making the decision about having a Csection. Society has a big impact on the increased rates of C-sections being performed in the US because women have this notion that they will recover faster, be in less pain, and that there is less risk to the baby. These notions, however, are not always true. There are many downsides to this procedure, but sometimes it is indicated. In an article published in Pediatric and Prenatal Epidemiology in 2013 there is a list of these indications: multiple gestation, rupture of the uterus, severe pregnancy complications, and fetal distress, among others. Socially, a C-section can seem like a better option because the woman gets more time off of work, doesnt have to worry about going through a painfully long labor, and can plan the date of delivery. Just because it is convenient, however, does not mean that it is an easier process. Lets start with the idea of less pain. In a C-section, an abdominal incision is made and muscles are cut and moved out of place major surgery. This also introduces the risk of infection and produces a great deal of pain. This pain is

distinct, and may take weeks to completely go away. Pain leads to decreased movement, inability to properly breastfeed (in some cases), and can delay contact with the infant (which can lead to decreased mother/baby bonding). The pain of childbirth is excruciating, yes, but the pain after a C-section is prolonged and the recovery period is more extensive. Recovery from a C-section is typically triple the amount of time than after a vaginal birth. Recovery involves the lungs (which can be compromised if the mother does not practice deep breathing exercises), the bowels (which fall asleep during surgery, and need to be awakened via movement and stool softeners), circulation (which needs to be maintained by movement in order to prevent blood clots and embolisms), and the urinary tract (which can be susceptible to infection from the urinary catheter placed during delivery). There are also long-term effects. Women who undergo C-sections increase their chances of complications in subsequent births by issues with the placenta, abruption of the placenta, and ectopic pregnancies. These effects can also affect a womans ability to get pregnant in the future, and often times result in hysterectomies and/or miscarriages. escalates, so does the chance of death. Many studies found a relationship between C-sections and issues adapting to outside the womb from birth and even afterwards. Because babies are not put through the full process of labor, C-sections may be the cause of reduced catecholamine production, which decreases lung function and adaptation outside the womb. Respiratory problems at birth such as respiratory distress syndrome When the risk of these complications

can lead to asthma later on. Babies delivered by C-sections also get admitted to the neonatal ICU more often. Babies born by C-section also have been shown to have significant differences in their gut colonization compared to babies born vaginally. These babies are more susceptible to allergic diseases because they have mediocre immune recognition of foods that should not create a reaction. Studies have shown that altered mechanisms with C-sections can cause things like type 1 diabetes. One study showed an increase of about 20% in the risk of type 1 diabetes in children delivered by C-section. Arguably the most compelling statistic is that babies born by C-section are shown to be at increased risk for numerous malignancies including neuroblastoma, acute leukemia, and cancers that form in the sperm and testicles. So, with all of this information, how are women to make a decision about their birth plan? There are a multitude of factors that go into the decision of a vaginal birth versus a cesarean. A woman should make an informed choice taking into account risks, benefits, and consequences of each procedure. When a woman is faced with making a decision, she is influenced by what the provider thinks is the best decision. C-sections are more convenient for physicians, and the risk of malpractice lawsuits drives many decisions about a womans birth plan. Fee-for-service healthcare and hospitals making more money also result in an increase in C-sections. A woman should effectively educate herself through a variety of sources. First, using her healthcare provider as a resource and asking meaningful questions about all of her options will give her the information she needs. Studies

have shown that early coaching about methods of delivery by providers truly has a strong impact on the womans decision, and encourages trust in her provider and confidence in her decision. Another way for women to inform themselves is through the internet. Websites like the March of Dimes, campaigns like AWOHNNs public health campaign to decrease cesareans, documentaries, and other resources can be extremely helpful in educating women and providing them with information that is easy to understand and most relevant to their situation. If a woman takes responsibility for her own care, and considers all information provided to her, then she is more likely to have favorable outcomes in the end. To make the right choices about C-sections, providers and women must work as a team to develop the best possible scenario for both mom and baby. In order to decrease the overall rate of C-sections, first society must change the way they portray C-sections to women, and women must learn to be their greatest advocates when choosing their plan of care.

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