Women's Bodies, Women's Wisdom (104 page)

Even women who’ve had a cesarean section can deliver subsequent babies normally. Approximately 50 to 85 percent of them are candidates for vaginal deliveries. Though obstetricians used to be taught the dictum “Once a cesarean, always a cesarean,” by the late 1970s there was a body of scientific literature documenting the safety of subsequent vaginal deliveries. During my medical training, we routinely offered vaginal birth after cesarean section (VBAC) as an option. Yet this option is now withheld from many women who are candidates for it because both doctors and patients are afraid of the rare possibility of a uterine rupture. In an article entitled “When Your Patient Demands a C-section” in one of the ob-gyn magazines, Bruce Flamm, M.D., was right on target when he said, “When someone is scared, it is not an indication for surgery. It is an indication for education.”
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C-section rates vary tremendously among individual doctors. Some physicians have personal C-section rates of only 6 percent. These tend to be the same doctors who are highly supportive of midwifery.

R
ISKS OF
C-S
ECTIONS

Although some women elect to have C-sections for convenience or because they fear the birthing process, having a cesarean when there is no medical indication is a controversial practice, and for good reason. A C-section is major surgery that entails some serious risks. The following risks, compiled by the Coalition for Improving Maternity Services, are greater in women with C-sections when compared with vaginal births:

Maternal death (five to seven times greater)
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Injury to the bladder, uterus, and blood vessels; hemorrhage; anesthesia accidents, blood clots in the legs, pulmonary embolism, paralyzed bowel; and infection (up to fifty times more common)
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Difficulties with normal activities two months after birth (one in ten);
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one in four women who have had C-sections report that pain at the incision site is a major problem, and one in four teen still report pain six months after delivery
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Rehospitalization (twice as likely)
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Internal scar tissue resulting in pelvic pain, pain during sex, and bowel problems

Reproductive consequences, such as subsequent infertility,
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miscarriage, and premature birth
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Increased risk of unexplained stillbirth in future pregnancies
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Increased risk of placental problems in subsequent pregnancies, such as placenta accreta, where the placenta grows through the uterine wall, resulting in massive blood loss and possible need for hysterectomy
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Risks to a baby born via C-section include:

Breathing and breast-feeding problems due to even slight prematurity
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Being cut accidentally by the surgeon (one to two per hundred)
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Lower Apgar scores (50 percent more likely) and admission to intermediate or intensive care (five times more likely)
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