What advice would you have for people giving birth in countries where medically unnecessary (and risky) C-sections are commonly pushed onto expectant parents?

You sound a little bit confused. Nobody ever says C-sections are bad choices in all cases. I'll leave you with some reading to ponder, as I refuse to get into an argument about things which are so clearly proven by medical scientists.

Risks to the mother[edit] In those who are low risk the risk of death for Caesarian sections is 13 per 100,000 and for vaginal birth 3.5 per 100,000 in the developed world.[4] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[11]

In Canada the difference in bad outcome in the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100 or three times the risk.[12]

Transvaginal ultrasonography of a uterus years after a Caesarean section, showing the characteristic scar formation in its anterior part. As with all types of abdominal surgeries, a Caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction) and wound infections.[13] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the anaesthesia risk.[14] Other risks include severe blood loss (which may require a blood transfusion) and postdural-puncture spinal headaches.[13]

Women who had Caesarean sections were more likely to have problems with later pregnancies, and it is recommended that women who want larger families should not seek an elective Caesarean. The risk of placenta accreta, a potentially life-threatening condition, is 0.13% after two Caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more. Along with this is a similar rise in the risk of emergency hysterectomies at delivery.[15]

Mothers can experience increased incidence of postnatal depression, and can experience significant psychological birth trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process.[16] Factors like pain in first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the development of birth trauma.[16]

Subsequent pregnancies[edit] Further information: Delivery after previous Caesarean section Women who have had a Caesarean for any reason are somewhat less likely to become pregnant or give birth again as compared to women who have previously only delivered vaginally.[17]

Women who had just one previous Caesarean section are more likely to have problems with their second birth.[4] Delivery after previous Caesarean section is by either of two main options:

Vaginal birth after Caesarean section (VBAC) Elective repeat Caesarean section (ERCS) Both have higher risks than a vaginal birth with no previous Caesarean section. Criteria for making VBAC include that the previous Caesarean section should be a low transverse one. VBAC (compared to ERCS) confers a higher risk for mainly uterine rupture and perinatal death of the child.[18] Furthermore, opting for VBAC results in 20-40% of times in that Caesarean section is performed eventually anyway, with greater risks of complications in an emergent repeat Caesarean section than in an ERCS.[19][20] On the other hand, VBAC confers less maternal morbidity and a decreased risk of complications in future pregnancies than ERCS.[21]


Suturing of the uterus after extraction.

Closed Incision for low transverse abdominal incision after stapling has been completed. There are number of steps that can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as the formation of adhesions. Such techniques and principles may include:

• Handling all tissue with absolute care • Using powder-free surgical gloves • Controlling bleeding • Choosing sutures and implants carefully • Keeping tissue moist • Preventing infection However, despite these proactive measures, abdominal or pelvic surgery can result in trauma that can lead to adhesions. In order to prevent adhesions from forming following a pelvic (gynecologic) surgery, such as hysterectomy, myomectomy or caesarean section, adhesion barrier can be placed during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis.

Adhesions can cause complications, such as:

• Infertility, which may result when adhesions twist the tissues of the ovaries and tubes, blocking the normal passage of the egg (ovum) from the ovary to the uterus. One in five infertility cases is estimated to be adhesion related (stoval) • Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50 percent of chronic pelvic pain cases are estimated to be adhesion related (stoval) • Small bowel obstruction – the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel. Risks to the child[edit] Non-medically indicated (elective) childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Complications from elective caesarean before 39 weeks include: newborn mortality at 37 weeks may be 2.5 times the number at 40 weeks, and was elevated compared to 38 weeks of gestation. These “early term” births were also associated with increased death during infancy, compared to those occurring at 39 to 41 weeks ("full term").[22] Researchers in one study and another review found many benefits to going full term, but “no adverse effects” in the health of the mothers or babies.[22][23]

The American Congress of Obstetricians and Gynecologists and medical policy makers review research studies and find increased incidence of suspected or proven sepsis, RDS, hypoglycemia, need for respiratory support, need for NICU admission, and need for hospitalization > 4–5 days. In the case of caesarean sections, rates of respiratory death were 14 times higher in pre-labor at 37 compared with 40 weeks gestation, and 8.2 times higher for pre-labor caesarean at 38 weeks. In this review, no studies found decreased neonatal morbidity due to non-medically indicated (elective) delivery prior to 39 weeks.[22]

For otherwise healthy twin pregnancies where both twins are head down a trial of vaginal delivery is recommended at between 37 and 38 weeks.[24][25] Vaginal delivery in this case does not worsen the outcome for the infant as compared with Caesarean section.[24] There is controversy on the best method of delivery were the first twin is head first and the second is not.[24] When the first twin is not head down a C-section is often recommended.[24] Regardless of birth by section or vaginally, the medical literature recommends delivery of dichorionic twins at 38 weeks, and monochorionic twins (identical twins sharing a placenta) by 37 weeks due to the increased risk of stillbirth in monochorionic twins who remain in utero after 37 weeks.[26][27] The consensus is that late preterm delivery of monochorionic twins is justified because the risk of stillbirth for post-37 week delivery is significantly higher than the risks posed by delivering monochorionic twins near term (i.e., 36–37 weeks).[28]

The consensus concerning monoamniotic twins (identical twins sharing an amniotic sac), the highest risk type of twins, is that they should be delivered by caesarean section at or shortly after 32 weeks.[29][30][31]

In a research study widely publicized, singleton children born earlier than 39 weeks may have developmental problems, including slower learning in reading and math.[32]

Other risks include:

Wet lung: Retention of fluid in the lungs can occur if not expelled by the pressure of contractions during labor.[33] Potential for early delivery and complications: Preterm delivery is possible if due-date calculation is inaccurate. One study found an increased complication risk if a repeat elective Caesarean section is performed even a few days before the recommended 39 weeks.[34] Higher infant mortality risk: In C-sections performed with no indicated risk (singleton at full term in a head-down position), the risk of death in the first 28 days of life has been cited as 1.77 per 1,000 live births among women who had C-sections, compared to 0.62 per 1,000 for women who delivered vaginally.[35]

/r/Parenting Thread