Elective C-sections have 3 times as many complications, infant deaths

Reuters is reporting (via MSNBC) that a new study by Canadian doctors indicates elective Caesarean Sections (C-Sections) show a significant increase in risk compared to normal vaginal births.

Dr. Shiliang Liu from the Public Health Agency of Canada, Ottawa, and colleagues have evidence that the rate of severe complications, such as major bleeding, infection and blood clots, is three-fold higher overall in women having a planned Caesarean section compared with women who planned a natural birth....

Liu’s team found that the rate of severe complications in the planned Caesarean group was 27.3 cases per 1,000 deliveries, compared with 9.0 per 1,000 deliveries in the planned vaginal delivery group.

These findings follow another study released in September 2006 that noted a three fold increase in infant mortality for infants delivered via C-section compared to normal births.

MacDorman and her colleagues had previously identified a 49-percent increase in C-section rates between 1996 and 2001 among women in this "no risk" category.

The risk of death in the first 28 days of life was 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. Even after analyzing the various causes of infant death, the researchers could find no clear explanation for the difference.

"Understanding the causes of these differentials is important, given the rapid growth in the number of primary Caesareans without a reported medical indication," they conclude.

Both studies note the growing popularity of elective C-sections for otherwise normal pregnancies. Caesarean rates have risen from 14.6% of all first-time births in 1996 to 20.6% of all first-time births in 2004--a 41% increase in C-sections in a 9 year period. And for women in the no-risk category C-sections (i.e. elective C-sections) rose a staggering 49% between 1996 and 2001.

To put this into perspective only 5.5% of births in 1970 were C-section. From 1970 to 2005 there has been a 549% increase in C-sections per-birth in the United States.

These increases are surprising considering the efforts to bring down the C-section rate in the US. The rate of C-sections rose from 21% in 1996 to 29% in 2004 , and was a record 30.2% of births in 2005. "Many experts believe a large number of C-sections are medically unnecessary and done only for the convenience of the mother or her doctor."

One of the reasons for the increased Caesarean deliveries is that Vaginal Births After Caesarean (VBAC) are being discouraged with 90% of Caeserean births in 2004 being repeat procedures. Compared with 2003, VBACs dropped by 13% in 2004 to a total of 9.2% births. VBACs are being discouraged due to malpractice issues as well as the discouraged use of prostaglandins for cervical ripening.

These are all very interesting statistics that Tammy and I have been tracking for a while. C-Sections are such a common procedure these days that we forget that it is a major surgery. As of statistics collected in 1990, the risk of a woman dieing after a cesarean birth is less than 1 in 2,500, while the risk of death after vaginal birth is less than 1 in 10,000 (although individual risks may alter these odds). Women who have C-sections have a significant increase in difficulties with a second delivery and it is not infrequent to have issues with later pregnancies, to the point it is recommended that women who want large familes should not seek a Caesarian section as an elective.

(Ed. - I never noticed the number of spellings for Caesarean Section before; in general I tried to keep the spelling consistent with the source I was quoting or summarizing.)

Doom and gloom aside, it is important to note that Caesarean sections are an important tool when used correctly and that, "C-sections have saved the lives of "countless" women and babies, and the risk of infant death is still very low" . C-sections can--and do!--save lives. Yet the medical community has realized the need to reduce the number of C-sections, notably the number of elective C-sections with no medical indication. The federal government in 2000 set a goal of no more than 15% of births be C-sections by 2010. While C-section rates are on a steady rise, it should be noted that between 1989 and 1996 the rate dropped from 24.7% to 20.7% which has been attributed to the increased frequency of VBACs.

To conclude, a doctor summerized our feelings on this issue well when he said, "It's unethical to recommend a practice [elective C-sections] that leads to more patient deaths."

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C-sections

Submitted by Tammy on Wed, 2007-02-21 23:59.

Thanks for posting all this info and links, Joshua. The rate of c-sections here in the US is really high -- and it's not just because of electives by the patient. I personally can't imagine electing to have a c-section for no medical reason. Birth is an awesome experience! :)

They're not fun, why would people choose one over natural birth?

Submitted by Anonymous on Mon, 2007-02-26 14:46.

I most certainly agree with this information. All three of my babies were born via c-section. The first was a true medical emergency on the baby's part. The second was a fear induced repeat, the third I planned and prepared for a natural vaginal birth. Right before the due date, my doctor put me in a difficult place, where I had almost no chance to deliver naturally, and as I was miserable I opted for the surgery. I always wanted many children, but the thoughts of going through the surgery again make me sick. I was in so much pain with all of them that breastfeeding was horrible. I couldn't deal with pain in so many places, thus all of my daughters have been formula fed. After my second surgery my incision reopened twice. I had lots of pain for months afterward. This could be because I had two babies in the same year!!! (Jan. 2003 and Dec. 2003)

If we decided to have more children I will either have to have a c-section or go to the woods somewhere :)

C-sections

Submitted by Tammy on Fri, 2007-03-16 16:01.

Anonymous, thanks for sharing! Recovering from a c-section doesn't sound fun! :| Sorry you had such a rough time!

I'm so thankful...

Submitted by Court on Sat, 2007-03-17 10:15.

The Lord has blessed me with the ability to have healthy, natural deliveries so far. My mom on the other hand, had to deliver all 7 of her babies via c-section. So, I know and understand the gift that 1) a supportive and natural-delivery-minded midwife is, 2) a body build that can easily lend itself to natural deliveries and 3) the education I have on c-sections.

I really believe though that a lot of c-sections are soley based on the doctor's convenience and/or lack of being able to educate their patients (and even themselves) on the importance of avoiding c-sections except for emergency situations. A long labor does not alway mean it's time to cut the baby out, unless all other measures have been taken in order to encourage natural delivery.

This was a great post and one I think many of us can relate to in some way or another. Thanks for the information!

C section

Submitted by Anonymous on Sat, 2008-03-29 02:06.

Umm.. i dont agree at all.

Though i have had some serious issues with pregnancy i think all woman should have C-sections if they want them. I would never have had another child had i been forced to have it vaginally. I am now pregnant with my 4th child i have 3 boys.

All of mine where emergency. The first for sever fetal distress, the second for pre-eclmapsia, placenta abruptia, Placenta preiva, Pulmonary edema.(he was born at 6 months 3 weeks and is now 4) The third because he was so big he crushed my chest cavity. He was 10'11 23 (and born 3 weeks early) inch.

I had no complications with the first one (other than extreme pain from now anesthesia, i was put to sleep) The second i had the wound reopen (i was traveling over 100 miles to see my baby AND moving alot) The third i was fine no issues at all! i loved it great everything!

I am going to the same doc who did my last one and i am confidant he will be just as good as the first time... there is no reason in my opinion that people should have to go through the trauma of vaginal birth when C-sections are a great alternative.

there is no reason in my

Submitted by Tammy on Sun, 2008-03-30 00:09.

there is no reason in my opinion that people should have to go through the trauma of vaginal birth when C-sections are a great alternative

Did you even read our post and links? :) We didn't make this stuff up ourselves. ;)

"Elective C-sections have 3 times as many complications, infant deaths"

As far as natural childbirth being "trauma" and c-sections being "great" -- I just don't think those are fair generalizations based on the evidence. :)

c sections

Submitted by Cryssie_bou on Fri, 2008-05-23 09:53.

I personally have never had to have a c section but my aunt who is close in age to me had to have both her son and daughter by c section. Her son was an emergency fetal/mother distress and severe bleeding.. Her second was because of her glucose levels and the baby was rather large.

I almost had to have a section with my second child as I was induced and in labrour for a very long time and near the end of it they were having problems getting his heart beat and they were fearing that they might lose him.. but I managed to deliver before they were going to do the section. but My ob gyn I have alot of faith in he is a great doctor and I have no fear that If i do ever need a section.. That I will be fine..

C sections

Submitted by Anonymous on Fri, 2008-05-23 11:16.

Tammy thanks for addressing this serious problem we have in our country.
I enjoy your blog and read it almost daily (or when you post).

I have had 2 c sections, and the more I learn about them, I don't know if they were completely necessary. C sections are given way too many times in this country. There are some very sad statistics out there. It is a lot of the time for the doctors convenience or fear of malpractice or just the medicalization of the birth process. But of course there are true emergencies that warrant them and I am grateful we have the medical care that we do.

May I recommend to those women who had csections and are looking for answers to their pain or to the possibility of have it vaginally next time, check out the International Cesarean Awareness Network.

I just had my 3rd child and was able to deliver vaginally, praise be to God. Many people assume once a csection always a csection, this is just not true, you just need a good doctor who is willing to support you, they are out there :) The ican network of women (there are local branches) was a great encouragement to me that I could birth without the knife! I can, you can too!

-mommamoody