Cesarean Section – What You Need to Know

Posted: 3. June, 2011 0

Cesarean section rate for all pregnancies is about 25 percent. The fact that this percentage represents all pregnancies is significant because it includes women who have had cesarean sections in the past and are electing to have a repeat C-section. So it is important for most women who have never had a child or have never had to have one by C-section to be informed of their chance of having a C-section. This means eliminating the number of elective repeat cesarean sections, which would be approximately 10 percent – a significant difference.

So why is the US national cesarean section rate 25 to 27 percent? We think there are a few reasons why: as one notable saying goes, “once a C-section, always a C-section.” Some experts think that more and more women are asking for a first-time, purely elective cesarean section. Yet in a survey that asked 1,600 women who had undergone cesarean section why they had the surgery, only one person admitted that it was because of a personal desire. This means that while women do request a primary C-section, meaning they have never had a C-section, the number is relatively insignificant. Perhaps there are more indications for C-sections and physicians are merely adjusting accordingly. The indications for a cesarean section are numerous, but there are some that might be more controlled by our current medical system than others. Data suggest, for example, that women who undergo induction of labor with a cervix that is not ripened have a higher rate of C-section. Some people claim that the invasive nature of hospital care also contributes to the rising cesarean rate, although there are minimal data to support this.

Fifteen years ago, it was common for physicians to offer women an attempt at vaginal birth after cesarean section (VBAC). Today, women who desire a VBAC may not be given the choice. Physicians and hospitals are less eager to perform VBACs because of the small but substantial risk of uterine rupture.

Rates of uterine rupture during VBAC range from 0.02 percent to 9 percent, depending on the type of uterine incision.23 Women who have a low transverse incision (side-to-side) have a rupture rate of 0.02 percent to 1.5 percent, while those with a classical incision on the uterus (up-and-down) have rates from 2 percent to 9 percent. In many cases of uterine rupture, the fetus will either die or be severely damaged by acute blood loss. When women learn there is an approximately 1 in 200 chance that their baby will be seriously injured during VBAC, many opt for the repeat cesarean section. The truth of the matter is that both physicians and mothers may be more cautious about performing VBAC deliveries simply because of this increased risk.

Women who desire a vaginal birth after cesarean section should also consider the reason for their cesarean section in the previous pregnancy. If a cesarean section was performed because the baby would not fit through the pelvis (cephalopelvic disproportion), this may indeed be the case in subsequent pregnancies. While some hospital statements show increased reimbursements for cesarean sections, some studies have shown that VBAC is actually more expensive.

Obviously, the concern for cesarean section is real and with rates close to 30 percent there is a need to investigate and at least consider its possible etiologies. The decision to perform a cesarean section should not be taken lightly, as all surgery has inherent risks. The decision to proceed with cesarean delivery is a decision made between the patient and her health¬care provider. In our experience, this decision is never made lightly, and we carefully consider the care of both mother and baby.

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