Risks of Planned C-Sections

Cesarean section (C-section) is a surgical delivery in which an incision is made in a

woman's abdomen in order to remove the neonate from their mother’s womb (U.S. Department

of Health and Human Services [HHS], 2017). This surgical procedure is quite common in many

countries. The most popular for example, “Brazil is among the leaders with 51.9% of Brazilian

births using C-sections” (Prado et al., 2018, p. 2). Many women choose this option due to a

medical emergency with either mother or neonate, but some opt for other personal reasons. It is

important for mothers or future mothers to be educated about C-sections, because although this

procedure is quite common, risks are nearly inevitable. The most common possible risks include

sexual dysfunction, postpartum mental health, breastfeeding and urinary incontinence, etc (Prado

et al., 2018). Despite that, I do believe that c-sections can be necessary although the patients

should be knowledgeable on all options. In the near future, I aspire to be a labor and delivery

nurse, therefore I hope to educate women on all of their choices and lead them to what is in their

as well as their infant’s best interest.

This procedure has been around for years although it is a newer idea in comparison to

other delivery options. Despite that, C-sections are the most common procedure in fertile women

(Prado et al., 2018). Therefore, many women around the world go through the beauty of

pregnancy and with that comes the decision making of the safest choice for both the mother and

neonate. Besides C-sections, there are other options of deliveries such as vaginal birth after

C-section (vbac). C-sections are most commonly used in a state of emergency for mother or

neonate. The number of emergencies can include risk of extreme bleeding, umbilical cord

causing suffocation for the infant and much more (Brazier, 2015). Although C-sections are very
necessary in some cases, other women may plan on C-sections for reasons such as the neonate

may be big for their petite mother, they have never experienced vaginal birth before, are not fully

educated on all their options, simply mislead or any form of miscommunication between the

patient and their medical provider (​Ahmed, & Mohammad, 2018). In the research studies I

observed, they explained that about 15% of births being C-sections are reasonable but the rate is

currently much more than that and is growing.

The immediate risks of C-sections are possibly preventable, but overall, risks remain as a

common worry throughout the labor and delivery experience. Depending on where you’re

located, the risks may be different in another country or perhaps similar (Prado et al., 2018). In

one of the three studies researched, the researchers conducted a ten month long study in which

they interviewed 358 women from Sergipe. During these ten months, they proceeded to check up

on the women almost immediately after birth, then consistently once every month and a half to

two months, with a total of three visits overall. In the first round of interviews the researchers

acquired the mother and infant’s outcomes and records. Not much data was collected but from

what was collected, many women who had a C-section had common answers. For the infants, the

common immediate risks included lack of immediate skin-to-skin contact, lack of immediate

breastfeeding, low apgar scores (the overall scoring of the infant’s immediate health), and low

birth weight. All of these are worrisome, because they may affect the infant later in life. For

example, breastfeeding has shown to give infants more nutrients than formula and it also builds a

close bond between a mother and her child. As for the women, the common immediate risks

included excessive bleeding, lack of breastfeeding incentives, lack of skin-to-skin contact, and

pain. For the same reason as infants, immediate skin-to-skin contact creates a bond between a
mother and their child, but it has also been proven to increase an infant’s health. Along with

these risks, almost all women face intrapartum complications. Intrapartum is the time period

from when the mother goes into labor until the neonate is delivered. The complications could

include dystocia and stress, all in which the infant feels as well.

The postpartum risks of C-sections are similar to that of the prepartum and, or immediate

risks. Postpartum risks are anything that the infant and mother could be in danger with after the

delivery of the infant. One of the most common risk is for the patient to hemorrhage, meaning

excessive bleeding (Prado et al., 2018). Hemorrhaging typically happens after a patient delivers

their placenta during vaginal birth, but since a patient undergoes surgery there is a possibility for

an increase in blood loss. Some blood loss is normal, but if not controlled it could lead to

unfortunate events. Other risks include high fever, urinary inconsistency and, or sexual

dysfunction. High fever usually occurs soon after delivery, but experiences with urinary

inconsistency and sexual dysfunction comes months after or not at all. Another major postpartum

risk of delivery of a child overall is that it can affect your mental health. Now that all the focus

has shifted towards the infant, the patient’s hormones are trying to level out, and overall having a

new lifestyle, it can affect the parent’s mental health. Mental health is important to acknowledge

and understand to continue a healthy lifestyle.

The rise in C-sections has increased over the years more than it should. No country

should surpass a 10% rate of C-section deliveries (Bolten et al., 2016). Currently, there is “a

prevalence of 19% C-sections out of all deliveries” (Ahmed & Mohammad 2018). In the past and

even now, the procedure is typically used in case of an emergency although data has proven that

this procedure is planned accordingly or is an unnecessary medical intervention. In about a one

and a half year study done on low-risk pregnant women in the Netherlands, the researchers

proved that there were a number of unnecessary medical interventions used during deliveries in a

hospital setting versus a lower number of medical interventions used in an at home delivery with

midwives to support (Bolten et al., 2016). Midwives are medical personnel who support women

during birth and an obstetric and gynecologist (OB GYN) is a doctor where their specialty is

focused on women’s reproductive health, pregnancy and childbirth. According to the researchers

of this study, low-risk women have “good general health and an uncomplicated medical and

obstetric history,” as well as a choice to where they want to deliver their child. In the

Netherlands, the number of hospital versus home deliveries were about equal and they

interviewed women from all over Netherlands. The most important idea to take away from this

study is the fact that all of the at home deliveries were vaginal births and proven to be “more

spontaneous” than that of the hospital births which included C-sections. This goes to show that a

hospital setting which is loaded with drugs, and reachable procedures is not always the needed

route.

Along with interventions, lack of knowledge and medical indications may steer the

patient in the wrong direction. In a study of 364 women, the average age was 32 years and they

all planned for a C-section (Ahmed & Mohammad 2018). In this study they focused on the

reasons as to why these women all chose to go through with this procedure.The researchers

looked into their level of education, cultural background and considered all things pertinent to

support the fact that the majority of women who have planned on a C-section are not fully

educated on all the pros and cons of the procedure. Along with that, medical indications provided

by their doctor and, or nurse may lead them to a C-section. Also, no experience with vaginal
birth as well was a common answer in the interviews. Including women from all backgrounds is

important considering that pregnancy could happen to women from anywhere around the world,

therefore I greatly appreciated this aspect of the research study. As for repeat C-sections, ​“the

researchers calculated that one infant death or near death would be prevented for every 66

planned elective repeat caesarean sections performed in women who had a previous caesarean

section​” ​(Mother and Baby, 2012). T

​ herefore, make sure to plan accordingly to the individual as

every single pregnancy is unique in its own way.

In all three research studies, they prove to be reliable although accuracy in one of the

three articles lacked due to loss of participants as months went by, although it was

understandable that some patients would lose touch. With that said, a cross-sectional study may

have helped with the accuracy of the results, because the study would have been done in a certain

time period. Despite that, the research studies supported my thoughts regarding planned

C-sections and all came to the same idea that the cons to a C-section are risks not worth taking.

Along with that, the amount of time put into these studies created common and thought out final

outcomes. Although they are the best option in some cases, they are not the best option for a

majority of cases.

In the first study I observed, the researchers concluded the main risks and factors of

planned C-sections. They determined that the neonate’s overall health would be predicted to be

lower than normal and that bonding between the mother and her child would be lowered as well.

In the second study about unnecessary medical indications in a hospital setting, they came to the

conclusion that a full plan of where and what is the safest delivery to result in a spontaneous

birth is key to follow. For the third and final research study, they were able to find the most
common answers as to why women choose a C-section. Overall, the risks of planned C-sections

can be prevented so the main question now is why take the route if it is not necessary? With

consideration of the benefits to this procedure I acknowledge that for some patients it may be

best for them. To further educate future parents, perhaps providing a required free or low cost

class(es) about labor and delivery would decrease the risks of planned C-sections. The

importance of knowing all aspects of this procedure is vital as two lives are involved and there so

are many obstacles to keep in mind. As I venture and continue on my educational journey, I hope

to educate and experience healthy births as a nurse in the labor and delivery ward. To do this, I

would advise against planned C-sections unless it is completely necessary.

 References

Ahmed, A. E., & Mohammad, R. S. (2018). Cesarean sections: Associated factors and frequency

at King Abdulaziz Medical City in the Central Region of the Kingdom of Saudi Arabia.

Saudi Medical Journal, 39(11)​, 1154-1157. doi:10.15537/smj.2018.11.22499

Bolten, N., De Jonge, A., Zwagerman, E., Zwagerman, P., Klomp, T., Zwart, J. J., & Geerts, C.

C. (2016). Effect of planned place of birth on obstetric interventions and maternal

outcomes among low-risk women: A cohort study in the Netherlands. ​BMC Pregnancy

and Childbirth, 16(329)​, 1-13. doi:10.1186/s12884-016-1130-6

Brazier, K. (2015, December 1). WHO suggest new C-section recommendations. ​Medical News

Today.​ Retrieved from https://www.medicalnewstoday.com/articles/303326.php

Mother and Baby May Be Safer With a Planned Repeat Cesarean Section. (2012, March 15).

Medical News Today.​ Retrieved from

https://www.medicalnewstoday.com/releases/242861.php

Prado, D. S., Mendes, R. B., Gurgel, R. Q., Barreto, I. D. D. C., Cipolotti, R., & Gurgel, R. Q.

(2018). The influence of mode of delivery on neonatal and maternal short and long-term

outcomes. R
​ evista de Saude Publica, 52​(95), 1-11.

doi:10.11606/S1518-8787.2018052000742.

U.S. Department of Health and Human Services​ [HHS]. (2017, September 1)​.​ What is a

C-section? Retrieved from

https://www.nichd.nih.gov/health/topics/labor-delivery/topicinfo/c-section