Women considering a Caesarean section for non-medical reasons often assume the risks to themselves and their babies are no greater than if they delivered vaginally.
But this isn't true, according to a group of doctors and health professionals speaking this week at a conference in New York City.
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The panelists reported that women who have a Caesarean section are at a significantly higher risk of pain after surgery, infection, re-hospitalisation and problems with subsequent pregnancies.
And babies delivered by C-section are less likely to be breast-fed, appear to have a higher risk for asthma, and, if born before the 39th week of pregnancy, are more likely to have respiratory problems than babies delivered vaginally, according to the speakers.
The conference, held Wednesday at the New York Academy of Medicine, was sponsored by the Maternity Center Association. A non-profit group, the association promotes safe, effective, and satisfying maternity care for all women and their families, according to its website.
A lifesaving procedure
Choosing whether to have a vaginal delivery or an elective Caesarean section is based on the premise that these two choices are essentially equivalent, but this is simply not true, said Eugene Declercq, one of the panelists and a professor of maternal and child health at the Boston University School of Public Health.
The choice is between one that carries a greater risk than the other, he said.
A Caesarean is a lifesaving procedure, said panelist Dr Timothy Johnson, chairman of the Department of Obstetrics and Gynecology at the University of Michigan Health System. And for the great majority of women, the overall risks of the surgery outweigh its benefits.
"Many women don't know this," said panelist Dr Michael Klein, head of maternity and newborn care at The University of British Columbia.
Childbirth not on women's health agendas
Women are concerned about violence, osteoporosis and breast health, but childbirth is not on women's health agendas, he said.
"To some extent, it's a class issue," Klein added. "Childbirth used to be on women's health agendas. In the seventies, women demanded no episiotomies, for instance. But now women are going out in the world, becoming CEOs, and are no longer judged by their reproductive capability. I'm not saying it shouldn't be that way, but there needs to be a rebalance. If women are making decisions on incorrect information, then informed consent didn't happen."
US increase in C-sections
The rate of Caesarean sections has been increasing in the United States during the past 30 years, from 5,5 percent of births in 1970 to 26,1 percent in 2002, according to the Maternity Center Association.
The increase is attributed to a complex set of legal and financial factors, said the panelists. But the higher numbers are also partly due to some women's perception that the risks of a Caesarean section are no higher than those for vaginal deliveries. So they schedule a C-section for a convenient time or because they think the surgery will protect them from urinary incontinence later in life, speakers said.
So many factors are affecting the rise in elective Caesareans other than the well-being of mothers and babies, like fear of liability, convenience of organising your life, and hospitals viewing the procedure as a revenue source, said Carol Sakala, director of programs at the Maternity Center Association.
"Further," she said, "The practice has changed so fast without looking at the facts".
More important findings
Sakala and her colleagues at the Maternity Center Association reviewed more than 300 studies on different methods of giving birth and published the results in a pamphlet called What Every Woman Needs to Know About Caesarean Section. It outlines the risks and benefits of delivering vaginally compared to a Caesarean section.
Among the findings:
A woman who has a Caesarean section is more likely to have difficulty conceiving again than a woman who delivered a child vaginally.
A woman whose uterus has a Caesarean scar is more likely to experience problems with subsequent pregnancies. They include placenta previa, in which a placenta attaches near the opening of the cervix, increasing the risk of serious bleeding.
While women who give birth vaginally are more likely to experience problems with urinary incontinence, the problem lessens significantly one year after giving birth.
The incontinence problems may be due to interventions during labour, such as episiotomies, rather than the vaginal delivery itself.
By about age 50, there's no difference in incontinence problems between those who delivered vaginally and those who had C-sections. The later-life incontinence appears to be related to other factors, like excess weight and smoking.
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