Vaginal Delivery or C-Section?
Innovations in anesthesia, antiseptic practices and antibiotics established cesarean sections as safe birth procedures by the middle of the 20th century. Still, c-sections were uncommon until the 1980s when this surgical procedure grew to represent nearly one quarter of all deliveries. When the c-section rate reached its peak in 1988, it came under closer scrutiny. Critics expressed alarm at the frequency of a procedure that places the mother at risk for infections, hemorrhage and other complications. Moreover, the cost of the operation is nearly double that of a vaginal birth.
Currently, more than 20 percent of births in this country are delivered through c-section. The U.S. Department of Health and Human Services and the World Health Organization believe this high percentage is not justified and have set a target of 15 percent or less. Of course, in a certain percentage of cases, a cesarean is unavoidable—such as when labor is halted, the baby is in breech position or when there are signs of serious fetal distress.
Cesarean delivery may also prevent the transmission of HIV infection and genital herpes. Interestingly, cesarean rates are also influenced by non-medical factors. Rates are higher for women with insurance, for private versus public clinic patients, for older women, married women, women with higher education and those in a higher socioeconomic bracket.
More than one third of all cesareans are repeat c-sections. Ten years ago, over 80 percent of all American women with a previous c-section had a cesarean later in life. But the concept of “once a cesarean, always a cesarean” is changing. The American College of Obstetricians and Gynecologists (ACOG) recommends that routine repeat cesareans be replaced by a specific indication for surgery, and that most women can be encouraged to labor and have a vaginal birth after cesarean (VBAC). Some 60 to 80 percent of women now attempt VBAC and deliver babies successfully this way, without resorting to surgery.
This change in attitude is largely due to the fact that most uterine incisions used in c-sections are now “low transverse incisions” rather than vertical incisions. That is, they are low and horizontal across the abdomen, lowering the risk of rupturing the uterine scar. ACOG further states that a woman with two previous cesarean deliveries with low transverse incisions should not be discouraged from VBAC if she has no other risk factors
“I am a proponent of VBAC; however, the trend is turning again towards repeat cesarean sections,” commented C. S., M.D., obstetrician/gynecologist for The Fort Hamilton Hospital. “In mothers who have already had a cesarean delivery, there is a 1 percent chance of a catastrophic occurrence with VBAC. This 1 percent chance is enough to persuade most mothers to have a second cesarean.”
The best way to decide if a cesarean section is the best option for you is to consult with your physician. Most physicians are willing to openly discuss how much intervention is necessary and try to abide by a woman’s wishes when possible.
If you have any questions about VBAC or cesarean section, or to see which method is right for you, consult your obstetrician or nurse midwife.
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