C-sections:
weighing the risks
by Connie Schneider
The stars
have started yet another trend. Along with being tucked
and lifted and augmented, more and more of them, in a movement
dubbed by some “too
posh to push,” are choosing to schedule Caesarean deliveries
for reasons that have nothing to do with medical necessity.
Wanting to avoid the unexpected and unknown, the pain and
unpredictability of birth, and possibly even stretch marks,
and believing Caesareans to be as safe as natural birth,
they exercise their right to choose.
While some women are busy fighting
for the right to vaginal birth after Caesarean, others are
fighting for the right to choose Caesarean delivery. And
according to a recent report in the Canadian Medical Association
Journal, Canadian women may soon have access to elective
Caesarean sections.
So what are the risks, and how
do they stack up against those of vaginal birth?
For starters, the risk of maternal
and infant mortality is higher with Caesarean than with vaginal
birth. According to the International Caesarean Awareness
Network (ICAN), the maternal mortality rate for Caesareans
is 4 in 10,000, compared to 1 in 10,000 for vaginal births.
And the infant mortality rate for Caesareans is 4 in 1,000,
compared to 3 in 1,000 for vaginal births.
The leading cause of maternal
death from Caesarean surgery is pulmonary embolism. Pulmonary
embolism is a highly lethal condition caused by blood clots
formed in the veins traveling through the bloodstream to
the lungs. Its deadliness is in part because it typically
causes vague and nonspecific symptoms -- feeling faint, shortness
of breath, chest pain, and rapid pulse -- which increases
the risk of missed diagnosis, severe lung and heart damage,
or death.
The biggest risk to infants delivered
by scheduled elective Caesarean surgery, done prior to the
onset of labour, is respiratory distress syndrome, a condition
resulting from the infant's lungs not being fully developed.
Symptoms include tachypnea, which is abnormally fast and
laboured breathing, episodes of apnea (stopped breathing),
and bluish coloration of the skin and mucus membranes due
to low blood oxygen levels.
Another big risk for mothers
is the risk of infection -- uterine, kidney, bladder, and
pneumonia -- which can generally be successfully treated
with antibiotics, but which are also a very unpleasant way
to begin motherhood. While antibiotics can be life-saving,
their presence in breastmilk can upset baby's immature digestive
system, and the resulting discomfort to both mom and baby
are not conducive to comfortable and happy mother-infant
bonding in the early weeks.
Blood loss with Caesarean is
about double that of vaginal birth. That means that mom will
feel worse -- weakness and dizziness if it's relatively minor,
to confusion or shock, and possibly the necessity of a transfusion,
if it's major.
Potential reactions to epidural
medications range from mild to very serious. Itching from
the narcotics used in the epidural medications is common,
as is medication affecting chest muscles making breathing
difficult. Persistent post-op back pain lasting weeks to
months is also not uncommon and not fun at a time when nursing
moms may want to minimize taking pain medication. More rare
but more serious is anesthetic medication injected into a
swollen vein in the epidural space, causing dizziness and
rapid heartbeat. Also, leakage of spinal fluid into the epidural
space can result in post-op headache and nausea. Extremely
rare, but obviously very serious, is the possibility of permanent
nerve damage or paralysis. And remember: drugs in mom's bloodstream
also make their way into baby's.
Other drawbacks of Caesareans
include the longer hospital stays and recovery time required,
the increased danger of disorders with the placenta for subsequent
pregnancies, and the increased risk of additional reparative
surgeries such as hysterectomy or bladder repair. As well,
decreased bowel function is a common post-surgical difficulty
-- not usually serious, but uncomfortable at a time when
moms want to recover energy and well-being quickly so they
can enjoy their new baby.
While it is true that no birth
is without risk, and that the risks involved with Caesareans
are lower than they once were, vaginal birth is still the
lower risk. So maybe we ought not to fix what ain't broke.
And the birth experience, despite the exhaustion and pain
that accompany it, is still for many women a euphoric one,
one they look back on with pride and wonder for many years
to come.
Article from
Summer 2004 Birth Issues magazine, published by
ASAC in Edmonton.
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