Diseases

A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems. But is it safe and ethical for doctors to allow women to choose c-section? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits. Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, increased need for blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture in subsequent pregnancies. If the uterus ruptures, the life of the baby and mother is in danger. Supporters of elective c-sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery. The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need.

Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery. Today, VBAC is a reasonable and safe choice for most women with prior cesarean delivery, including some women who have had more than one cesarean delivery. Moreover, emerging evidence suggests that multiple c-sections can cause serious harm. If you are interested in trying VBAC, ask your doctor if you are a good candidate. A key factor in this decision is the type of incision made to your uterus with previous c-sections. Your doctor can explain the risks of both repeat cesarean delivery and VBAC. With VBAC, the most serious danger is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. Although very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. But doctors cannot always predict if uterine rupture is likely to occur in a woman. This risk, albeit very small, is unacceptable to some women. The percent of VBACs is dropping in the United States for many reasons. Some doctors, hospitals, and patients have concerns about the safety of VBAC. Some hospitals and doctors are unwilling to do VBACs because of fear of lawsuits and insurance or staffing expenses. Many doctors, however, question if this trend is in the best interest of women's health. Choosing to try a VBAC is complex. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice. If your doctor or hospital does not support VBAC, it may be necessary to find providers who will accommodate your wishes.

Your doctor might recommend a c-section if she or he thinks it is safer for you or your baby than vaginal birth. Some c-sections are planned, but most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:

• The mother is carrying more than one baby (twins, triplets, etc.)
• The mother has health problems including HIV infection, herpes infection, and heart disease
• The mother has dangerously high blood pressure
• The mother has problems with the shape of her pelvis
• There are problems with the placenta
• There are problems with the umbilical cord
• There are problems with the position of the baby, such as breech
• The baby shows signs of distress, such as a slowed heart rate
• The mother has had a previous c-section

You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually two to four days, to rest and bond with your baby. C-section is major surgery, and recovery takes about six weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed. Questions to ask:

• Can my baby be brought to me in the recovery room?
• What are the best positions for me to breastfeed?

The doctor will make an incision that is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Once inside the abdominal cavity, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask:

• Can my partner cut the umbilical cord?
• What happens to my baby right after delivery?
• Can I hold and touch my baby during the surgery repair?
• When is it okay for me to try to breastfeed?
• When can my partner take pictures or video?