Do I need a C-Section?

Too Many Caesarean Sections

Introduction: Caesarean section, often abbreviated as C-section, has become a common surgical procedure worldwide, accounting for a significant proportion of births in many countries. Initially reserved for emergencies, C-sections can be lifesaving in certain situations, this procedure has evolved over time, raising concerns about their overuse and the potential risks associated with unnecessary surgical interventions. In this article, we delve into the history, evolution, benefits, risks, and controversies surrounding Caesarean sections.

Caesarean delivery is the most commonly performed surgical procedure in the United States. It may be a safe alternative to vaginal delivery when necessary but its use in 1 of 3 women giving birth in the US seems too high. American College of Obstetricians and Gynecologists (ACOG) 2017 Annual Meeting. “About half the C-sections we do in the United States today are probably avoidable.” In the United Kingdom in 2021 the rate – 34%

What is a Caesarean Section?

A Caesarean section is a surgical procedure used to deliver a baby through an incision made in the mother’s abdomen and uterus. It can be planned in advance or performed as an emergency procedure if complications arise during labour.

History and Evolution: The origins of Caesarean section date back to ancient times, with historical records suggesting its practice as early as 320 BCE in Roman civilization. The name “Caesarean” is derived from Julius Caesar, although there is historical debate about whether he was born through this method. In ancient times, the procedure was primarily performed when a pregnant woman died or was dying to attempt to save the baby.

Over centuries, the perception and practice of Caesarean section have evolved significantly. In the early modern era, the procedure was associated with high mortality rates for both mothers and infants due to lack of anesthesia, poor surgical techniques, and postoperative infections. However, advancements in medical science, particularly in anesthesia, antiseptic practices, and surgical techniques, revolutionized the safety and efficacy of Caesarean deliveries.

Indications and Techniques: Today, Caesarean sections are performed for various medical reasons, including fetal distress, breech presentation, multiple pregnancies, maternal health complications, and elective requests. The procedure involves making an incision in the mother’s abdomen and uterus to deliver the baby safely. Different techniques exist, including the traditional lower abdominal incision (classical C-section) and the more common lower transverse incision (low transverse C-section), which offers faster recovery and reduced risk of uterine rupture in subsequent pregnancies.

When is a C-section Necessary?

Medical Reasons: Certain medical conditions may necessitate a C-section, such as placenta previa, where the placenta partially or completely covers the cervix, or fetal distress, where the baby’s health is at risk.
Previous C-section: Women who have had a previous C-section may require a repeat C-section due to concerns about uterine rupture during a vaginal birth after caesarean (VBAC).
Fetal malpresentation, most commonly breech presentation at term, is seen in approximately 4% of pregnancies. Currently, the vast majority of such pregnancies are delivered via caesarean. When I first went to Canada I was amazed that a consultant obstetrician could not conduct a breech vaginal delivery, which had been common practice in England. The mother wanted a vaginal delivery and I delivered the baby. Of course morbidity in untrained hands will be higher. The current primary approach to reducing caesareans in breech presentation is the use of external cephalic version (ECV). In general, ECV will be effective in approximately 70% of attempts and the majority of women with a successful ECV will go on to deliver vaginally.
Multiple Births: In cases of twins, triplets, or more, depending on the stage of pregnancy, a C-section may be safer than vaginal delivery due to the increased risks associated with multiple births.
Maternal Health Concerns: Maternal health issues, such as high blood pressure or certain infections, may make vaginal delivery risky, prompting a C-section.
Experience of the Doctor: If the doctor does not have the required experience for a vaginal delivery in specific circumstances but is experienced in Caesarean Section then that would be the safer option. Shorter training times, reduced working hours and reliance on C-section has meant that even in the UK doctors don’t have the experience of the previous generation.

Risks and Complications:

While C-sections are generally safe, they do carry certain risks, including:

Infection: As with any surgical procedure, there is a risk of infection at the incision site or within the uterus.
Bleeding: Excessive bleeding during or after the procedure can occur, requiring further medical intervention.
Injury to Organs: There is a slight risk of accidental injury to nearby organs such as the bladder or intestines during surgery.
Respiratory Issues for the Baby: Babies born via C-section may be at a slightly higher risk of respiratory problems, such as transient tachypnoea (rapid breathing), due to lack of exposure to labour hormones that help clear fluid from the lungs.

Recovery and Aftercare:

Recovering from a C-section typically takes longer than recovering from a vaginal birth. Here are some essential aspects of the post-C-section recovery process:

Hospital Stay: Most women stay in the hospital for 2-4 days after a C-section to ensure both they and their babies are stable.
Pain Management: Pain medication, both over-the-counter and prescription, can help manage discomfort during the initial recovery period.
Physical Activity: While rest is essential, gentle movement and walking can aid in recovery. However, strenuous activities should be avoided until cleared by a healthcare provider.
Incision Care: Keeping the incision clean and dry is crucial to prevent infection. It’s essential to follow any specific instructions provided by healthcare professionals regarding wound care.
Feeding: Women can usually start breastfeeding soon after a C-section, although finding a comfortable position may require some adjustments.

The Rise in C-section Rates:

Over the past few decades, there has been a significant increase in the number of C-sections performed worldwide. According to the World Health Organization (WHO), the ideal rate for C-sections in any country should range from 10% to 15% of births. However, many countries far exceed this threshold, with rates as high as 40% or more.

The Debate: Are There Too Many C-sections? The rising rates of C-sections have sparked a contentious debate among healthcare professionals, policymakers, and expectant parents. On one hand, proponents argue that C-sections can be a necessary and lifesaving intervention, particularly in cases of maternal or foetal complications. They emphasize the importance of ensuring access to safe surgical delivery when medically indicated.

On the other hand, critics raise concerns about the overuse of C-sections, citing potential risks and complications associated with the procedure. They argue that unnecessary C-sections may expose women and their babies to avoidable risks, including surgical complications, longer recovery times, and potential implications for future pregnancies.

Conclusion: While a Caesarean section may not be part of every woman’s birth plan, it’s essential to understand the procedure, its potential risks, and the recovery process. Whether planned or unexpected, a C-section is a medical intervention aimed at ensuring the health and safety of both mother and baby. By being informed and prepared, women can navigate the journey of childbirth with confidence, knowing that they have made the best decision for themselves and their families.

The rising rates of Caesarean sections raise important questions about the appropriate use of this surgical intervention in childbirth. While C-sections can be a vital tool in ensuring maternal and neonatal safety in certain cases, concerns about their overuse highlight the need for evidence-based practice and informed decision-making. By addressing the complex factors contributing to the prevalence of C-sections and implementing strategies to promote safe and appropriate maternity care, we can strive to achieve optimal outcomes for mothers and babies worldwide.

References:

World Health Organization. (2015). WHO statement on caesarean section rates. https://www.who.int/news/item/15-04-2015-who-statement-on-caesarean-section-rates
American College of Obstetricians and Gynecologists. (2019). Cesarean Birth. https://www.acog.org/womens-health/faqs/cesarean-birth
Betrán, A. P., Ye, J., Moller, A.-B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The increasing trend in caesarean section rates: Global, regional and national estimates: 1990-2014. PLoS ONE, 11(2), e0148343. https://doi.org/10.1371/journal.pone.0148343
Sandall, J., Tribe, R. M., Avery, L., Mola, G., Visser, G. H. A., Homer, C. S. E., & Gibbons, D. (2018). Short-term and long-term effects of caesarean section on the health of women and children. The Lancet, 392(10155), 1349–1357. https://doi.org/10.1016/S0140-6736(18)31930-5
Betrán, A. P., Ye, J., Moller, A. B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The Increasing Trend in Caesarean Section Rates: Global, Regional, and National Estimates: 1990–2014. PLoS ONE, 11(2), e0148343. https://doi.org/10.1371/journal.pone.0148343
Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S., & Willan, A. R. (2000). Planned Caesarean Section Versus Planned Vaginal Birth for Breech Presentation at Term: A Randomised Multicentre Trial. The Lancet, 356(9239), 1375–1383. https://doi.org/10.1016/s0140-6736(00)02840-3

What is a Caesarean Section?

When is a C-section Necessary?

Risks and Complications:

Recovery and Aftercare:

The Rise in C-section Rates:

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