In the United States today, about one in three women gives birth by cesarean section. In some situations, including when the baby is positioned side-to-side (transverse lie) or the placenta is covering the cervix (placenta previa), cesarean sections are the safest way of giving birth. However, in most situations, spontaneous vaginal births (births that are not induced and do not involve the use of forceps, vacuum extraction, or a cesarean) are safest for both women and babies.
While most mothers and babies who have cesarean births do fine, cesarean sections involve more risks than spontaneous vaginal births.
Women who have cesarean sections have more infections after the birth (usually in the uterus, bladder, or incision, and including infections resistant to antibiotics), more pain, longer recovery periods, and a greater chance of being rehospitalized. Women who have cesareans are also at a slightly increased risk of rare complications such as blood clots and bowel obstructions.
A woman who has had a cesarean section is more likely to have a cesarean section in future pregnancies. As the number of cesareans increases for a woman, the risk of complications in future pregnancies also increases.
Potential complications include ectopic pregnancy (pregnancy that develops outside the uterus), placenta previa (when the placenta attaches near or over the opening of the cervix) and other placental problems, and, during birth, rupture of the uterus.
With each cesarean section, it is common to encounter more scar tissue in the area of the previous incision. This can lead to greater blood loss and a longer operating time for the next cesarean.
A rare complication of repeat cesarean sections that is being seen more often because more cesareans are being performed in the United States is an abnormal attachment of the placenta, in which the placenta grows deeply into or through the wall of the uterus in the area of the previous scar. The placenta may even grow into the wall of the bladder. It then becomes difficult to remove, resulting in blood loss that is difficult to control and possible injury to the bladder. In cases such as this, a hysterectomy may be needed at birth to prevent severe hemorrhage.
In addition to helping women avoid potential problems, labor and vaginal birth also have health benefits for babies. The hormones that cause labor to start and progress help the baby get ready to be born, reducing the chance of problems like breathing difﬁculties. Babies that are born vaginally have lower rates of some illnesses, including asthma, diabetes and allergies. Researchers think these beneﬁts have to do with healthy bacteria in the vaginal canal that babies are exposed to during birth.
In certain circumstances, cesarean sections are clearly needed for the safety of the mother and/or the baby. In other circumstances, it can be difficult to determine whether or not a cesarean is best. Unless there is a clear, compelling medical reason for you to have a cesarean section, having a vaginal birth is likely to be the safest option for both you and your baby.
The following tips can help you lower your chances of having a cesarean section:
- Choose a care provider who follows the midwifery model of care (see Choosing a Maternity Care Provider).
- If you’re healthy and haven’t had complications in your pregnancy, consider giving birth at home or in a birth center (see Choosing a Place to Give Birth).
- Ask what the cesarean rate is for your provider and birth setting. If the cesarean rate is above 15 percent, the provider or setting probably uses cesareans in women who could safely birth vaginally.
- Be proactive in your health habits. Eating well and exercising regularly may reduce the risk for complications such as gestational diabetes that often lead to cesareans.
- Don’t induce labor unless there is a clear medical need. Concern that the baby is big is not a medical reason to in-duce, nor is being up to a week beyond your estimated due date.
- Don’t go to the hospital until you are in active labor. If you go to the hospital and have not yet dilated to four centimeters, return home or go for a walk nearby.
- Have continuous labor support from a companion who trusts your ability to give birth. This can be a friend, a volunteer doula, or a doula you hire. (For more information, see Doulas.)
- Avoid routine medical interventions during labor, especially continuous electronic fetal monitoring, unless clearly needed.
- Resist any pressure to have a cesarean if there is no good rationale.
Understanding Why the Cesarean Section Rate is So High
Many factors contribute to the rise in cesarean births, including the failure of hospitals to support normal physiologic labor, providers’ fear of malpractice suits, the increasing tendency of hospitals to induce labor and use electronic fetal monitoring, the myth that cesarean sections are safer than vaginal birth, and a lack of awareness of the harms that are more likely with cesarean sections. For an excellent analysis of why the cesarean rate has skyrocketed, see Childbirth Connection’s Why Is the National U.S. Cesarean Section Rate So High?
The information above is adapted from the Childbirth Connection booklet “What Every Pregnant Woman Needs to Know About Cesarean Section.” The booklet provides an extensive review of the best available research on cesarean sections and is available for free download.