Caesarian section increasing, partly because some women want it

Special to the Herald-LeaderDecember 30, 2012 

Dr. Elizabeth Case, Central Baptist

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Over the past three decades, the number of babies born by Caesarean section (c-section) has increased. Some of the increase has been from elective c-sections, a choice to have a surgical birth when it is not a medical necessity.

Some women choose Caesarean birth because they fear the pain associated with childbirth and a vaginal delivery. Others choose it to have more control over their delivery. Some choose an elective c-section to eliminate the possibility of damage to the pelvic floor that could result in urinary incontinence or sexual dysfunction.

There are many arguments supporting vaginal delivery. There is less risk of maternal blood loss, infection, blood clots and damage to organs. For the baby, there is less risk of breathing difficulties at birth, allergies, asthma and lactose intolerance. After a vaginal delivery there is a shorter hospital stay and breast-feeding is more effective.

There are also cons to vaginal delivery, including an increased risk of oxygen deprivation from cord compression or complications during delivery. There is an increased risk of tearing of the perineum (area between the vagina and the rectum) resulting in the need for stitches. There can be an increased risk of trauma to the baby if a vacuum or forceps are required for delivery. Finally, there is the pain associated with childbirth.

Some of the pros for elective c-section include an increased sense of control because the woman can choose the date of her delivery. There is also a decrease in the stress associated with the anticipation of labor. Some studies show a decreased risk of oxygen deprivation to the baby and possibly decreased risk of trauma associated with the need to deliver with a vacuum or forceps.

Arguments against an elective c-section include a longer hospital stay, a higher incidence of blood clots and infections and an increase in blood loss by the mother. The mother is also at increased risk of damage to the bowel and bladder and a slower return of bowel function. There also is a delay in producing breast milk, which can hinder breast feeding. C-section babies have twice the infant mortality rate within the first year of life than babies delivered vaginally.

The American Congress of Obstetricians and Gynecologists has concluded that there is no right answer and recommended that obstetricians and their patients should decide based on each patient's unique circumstances whether to deliver vaginally or by Caesarian section.

Dr. Elizabeth Case, an OB/GYN with Lexington Women's Health, practices at Central Baptist Hospital.

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