In the United States and Canada almost one in four babies is born by an operation called cesarean section. Consumer and medical groups alike have expressed concern over the rising numbers of cesarean sections. Yet many families seem to believe that a cesarean is just another way to have a baby. Are there definite disadvantages to a surgical birth? It’s time to look at some important facts about cesareans.
Why are there so many cesareans?
Researchers have listed many reasons for the high number of cesarean sections. These include a difficult or long labor, fetal distress, a breech presentation (when the baby is not arriving head first), placental problems, and other conditions in the mother such as toxemia, diabetes and severe bleeding, a greater use of technology such as electronic fetal monitoring and one or more previous cesareans. Some reasons are valid; others are not necessarily beneficial for the mother or the baby.
But cesareans save lives, don’t they?
Of course they do, when they are absolutely medically necessary. They also have risks and side effects that can physically affect the mother and her baby right away and can change the relationship among mother, infant and family by adding more and different stresses than those following a normal vaginal birth.
But a cesarean can prevent the pain of labor and birth.
That’s an interesting thought, but cesarean mothers usually have much more pain after their babies are born. After all, a cesarean is major surgery where several layers of body tissue are cut open and then repaired. This certainly makes it difficult to move, walk, urinate, and to hold and feed a newborn for at least several days or even weeks afterward. Mothers often need much medication to cope with the constant pain following a cesarean. Gas pains, which can be severe, and a sensation of one’s insides failing out are also quite common. Other discomforts include an itching or oozing at the incision area and a general feeling of exhaustion.
In addition, cesareans carry all the same risks of major abdominal surgery including:
- Infections of:
- the uterus
- the bladder
- the wound (incision)
- Excessive loss of blood
- Blood clots
- Adhesions (scar tissue) within the abdominal cavity
- Injury to nearby organs (bladder, bowel)
- Blood transfusion complications
- Death related to surgery
- Injury to baby
Major complications such as death following a cesarean are rare. Others such as infections are more common. When a cesarean is a possibility, you need to know about these risks. You should also find out about the possibility of even suspected long-term risks such as infertility due to scar tissue. At the very least, recovery from a cesarean section takes longer since mothers are usually in more pain and more tired afterward. Mothers also need more support physically and emotionally than those who give birth vaginally.
Well, then, aren’t cesareans better for babies?
Once again, that is sometimes true, when the risks associated with a cesarean are outweighed by the benefits of having a baby born surgically. Sometimes a cesarean is performed before labor begins. However, even with advanced techniques (ultrasound or amniocentesis), there is a greater risk of respiratory problems even in term infants than when the start of labor determines the baby’s birthday. Truly premature infants are subject to breathing and other physical difficulties of low birth weight, whether they are born surgically or vaginally. In addition, cesarean babies can also have anesthesia complications and may be sluggish and slow to start breathing. They may also suffer from some neurological problems. Such a start can impair relationships with the new baby, including a more difficult beginning to breastfeeding.
I never knew such a simple procedure could have such effects.
Oh, but the point is, as cesareans have become more commonplace, we’ve accepted them as simple procedures. But, although cesarean sections are safer than ever and, when necessary, a true blessing, a cesarean is clearly not a simple procedure. And we haven’t even talked about those other side effects that are harder to measure.
What does that mean?
Well, there is no doubt that the immediate relationship between the cesarean mother and her baby is different from the relationship after a natural birth. The mother may be groggy and unable to hold her baby and baby is often moved out of sight and touch for an examination during the important introductory moments following birth. Infant and parents may be separated for a time while the baby is observed in a central nursery. After a cesarean, mothers often describe a wide range of feelings that include failure, anger, disfigurement, inadequacy and resentment, while at the same time feeling glad that their babies are born. Such opposite feelings can sometimes lead to an uneasy and confusing start for parenting. It’s harder to care for a baby when you need so much care yourself. Fathers and other companions may feel frustrated at having to give so much more physical and emotional support. After all, besides learning to care for her newborn and/or taking care of other children, a cesarean mother is recovering from surgery. The time following a baby’s birth is tiring. As sleep, housekeeping and general life patterns change to meet the needs of the new family, the additional needs of the cesarean mother may increase the typical difficulties of adjusting to the new baby.
If I really don’t need a cesarean, how can I avoid one?
Education is the key word in preventing unnecessary cesareans and having a safe and memorable birth experience. Find out about birth practices in your area. Why and how often do caregivers recommend and perform cesareans? Choose a supportive caregiver and birthplace with the lowest possible rate of cesarean sections. Contact local childbirth educators, midwives and consumer groups such as childbirth education or breastfeeding associations for their information. Even before you become pregnant, look for the many available publications and resources to help you find ways to have a more natural pregnancy, labor and birth. Find out about how you can naturally cope with labor and about trained labor support persons who can help you avoid pain medication and anesthesia. Read Unnecessary Cesareans – Ways to Avoid Them. If you have had a previous difficult birth (whether cesarean or not), you will want to consider what happened and why. Was the difficulty caused by a chain of events that changed the natural process? Unpleasant memories of events and interventions in labor can make it painful to look forward to another birth. It can be helpful to work through such past experiences before you become pregnant again.
Develop a confidence and belief that birth is a safe and natural process that generally succeeds without intervention. Recognize that when a cesarean section is necessary, it can be truly life-saving, but that giving birth naturally is the way it is meant to be.
Copyright 1992 International Childbirth Educators Association (used with permission)
Common Feelings After Unexpected Cesarean Birth
- Combination of relief, fear, shock – if labor has been long or difficult, if there has been anxiety for the mother or baby – a sense of not knowing what to expect, or having lost control.
- Disappointment – especially common when parents have expected and prepared for a more active participation in the birth.
- Loneliness – being separated at a time when support, closeness, and the need to be together occurs.
- Failure – feelings of inadequacy because delivery was not vaginally. Support person may feel that she/he let the mother down by not being present for the birth.
- Anger – “Why” and “why me”, anger at the doctor, nurses, baby’s father, and/or the family.
- Resentment – towards the baby for the cause of her pain, discomfrot, and trouble. Cesarean mothers often have less energy at first and may resent the demands and responsibilities of child care.
- Self blame and depression – turning anger inward – “if only I hadn’t gained so much weight, if only I didn’t do this, or had done that.”
- Self esteem – sometimes suffers because they couldn’t do it “right” and that they are failures as women.
- Body Image – may suffer. Not only have their bodys not worked “right”, but the scar is an ever present reminder. Some women may feel rejection from their mate due to the scar.
- Depression – a period of the “blues” may be common after any mothod of childbirth. Cesarean parents may feel that the birth was a “let down”.
- Mixed feelings of future births – many dread the anxiety and pain of another cesarean. Others may see it as a relief from the labor.
- Guilt – over having negative feelings at a time when a mother (or parents) is (are) to be happy with their new baby.