Cesarean section — advantages and disadvantages
Cesarean section, especially if planned, is a quite common and safe procedure. Sometimes it is required in order to save the mother or the child. In such cases, it is the only and safest way to avoid complications.
World statistics in the recent years suggests that the number of births performed by cesarean section has increased several times. For example, in China, India, Brazil and other Latin American countries, cesarean sections exceed 40%. Average data are given for the United States, Canada, Europe, Australia and New Zealand. A number of cesarean sections that does not exceed 15% is performed in Netherlands, Sweden, Japan, and Russia.
In some situations, choosing the type of birth is not so easy. Sometimes the woman in labor and the doctor need to weigh all the advantages and disadvantages of the cesarean section in order to make the best decision.
The state of the woman’s health and her lifestyle play an important role. The risks of complications after cesarean section are higher:
- in women who are overweight or obese;
- in women with previous cesarean sections;
- in women with chronic health problems.
If stimulation has been done, but labor still does not start, a cesarean section might be needed. The induction of labor (using the vacuum extractor and forceps) increases the probability of a medical intervention. The patient and her doctor need to weigh these risks and to compare them with those of the cesarean section.
Cesarean delivery may be both scheduled (planned) and performed under emergency. A C-section is planned when its indications are set during pregnancy. The need for surgery is decided in the antenatal clinic or health center, where the course of the pregnancy and the condition of the patient are under supervision. The examination is conducted not only by the obstetrician-gynecologist, but also by other doctors. The final decision of a cesarean section and the timing of its implementation are taken by doctors when the delivery starts.
Determining the indications for cesarean section is highly difficult. They are divided into absolute – when there is a threat to mother’s life in case of a vaginal delivery, and relative – when the issue cannot be solved in one time). Sometimes in the course of labor, the decision can change.
Absolute indications for cesarean section are:
- the presence of a small pelvis, when the presenting part of the fetus cannot pass through the mother’s pelvic ring;
- tumors, which do not allow the fetus to move through the natural birth canal, such as uterine fibroids, located in the cervical region;
- scarring of the vagina;
- placenta previa – when the placenta is located next to or covering the cervix, overlapping the way out for the child. This situation is seen in the course of routine ultrasound during pregnancy, but becomes an absolute indication only in the last week;
- premature detachment of the placenta, which makes fetal breathing impossible and requires emergency caesarean section because of the risk of bleeding;
- threatening uterine rupture due to numerous previous births, which lead to the thinning of the uterine wall and to failure of the uterine scar left from previous cesarean sections;
- complications during pregnancy, endangering the lives of both mother and child in a natural birth (severe preeclampsia);
- shortage of oxygen to the fetus.
Relative indications for cesarean section are:
- - persistent weakness in labor;
- - in diseases not related to pregnancy, but when the load of the delivery threatens the life or health of the mother (diseases of the cardiovascular system or of the kidneys, severe hypertension, asthma, untreatable late toxicosis);
- - defective scar on the uterus after the first cesarean or other operations;
- - ages over 40 years are dangerous, because of being associated with loss of tissue elasticity and with accumulation of chronic diseases;
- - breech presentation of the fetus;
- - shoulder presentation of the fetus;
There are three conditions that must be fulfilled before the cesarean section:
- The mother should not be at risk of infection (inflammation of the placenta)
- The fetus must be viable
- The mother’s permission for surgery
Cesarian section implies a lot of risks that could endanger the mother’s or the child’s life and, before this surgery is made, the doctor should thoroughly analyze all possible consequences.
DISADVANTAGES OF CESAREAN SECTION
One of disadvantages is the pain in the incision site, which will be felt some time after the surgery; thus, the woman’s recovery takes longer than in case of vaginal birth. The chances of feeling pain in the incision area and general discomfort in the abdomen for a few weeks after the surgery are very high, because the body needs time to recover.
Although analgesics could certainly be administered, the performed operation will affect everyday life.
Before operation, a dose of antibiotics is usually prescribed to reduce the risk of infection. However, many women develop infections after C-section. The symptoms of the infection may be: unusual bleeding, discharge with an unpleasant odor or fever.
There are three main types of infection:
- Infection of the incision site with the following signs: redness and discharge from the wound, increasing pain and dehiscence of the incision wound. This complication occurs in one of ten women, even if they were given antibiotics preoperatively. The risk is higher if the patient suffers from diabetes or is overweight.
- Inflammation of the inner tissues of the uterus (endometritis). The risk is increased if the amniotic liquid “breaks” before the onset of the labor, or if a vaginal examination was performed several times before the cesarean section.
- Urinary tract infection. During the operation, the mother’s bladder is being drained through a catheter, that may cause inflammation. In this case, urination becomes painful, difficult and is accompanied by a burning sensation.
Any surgery is associated with an increased risk of blood clots and it all depends on the organ the blood clot gets in. If it causes blockage in the pulmonary arteries, it can be life-threatening. Common symptoms of arterial embolism are: cough, shortness of breath or pain and swelling of the ankles. Blood thinners and elastic support stockings that improve blood circulation in the legs are recommended for the prevention of blood clots. Also, it is recommended to get up as soon as possible and to walk around the room in order to restore blood circulation and, thus, to reduce the risk of blood clots formation.
Recovering from a cesarean section may be further complicated by adhesions. Adhesions represent a scar tissue, which holds together the organs of the abdominal cavity or brings them closer to the abdominal wall. They can cause pain and discomfort, as they restrict the mobility of the internal organs. Sometimes this can lead to problems related to intestinal obstruction and infertility – especially if they apply pressure on nearby organs or block them. Adhesions appear in about a half of the women who have had a cesarean section. The number of previous cesarean operations is also highly important. After the second operation the risk of adhesions increases to 75%, and after the third – up to 83%.
In most cases, the C-section is performed using local anesthesia, whether epidural or spinal, which is safer than general anesthesia. However, any type of anesthesia is associated with certain risks. After epidural anesthesia, the following complications may appear:
- Severe headache, observed in 1% of cases and more likely to occur if several different local anesthetics have been used during labor;
- Nerve lesions, which fortunately occur very rarely and, in most cases, last for several days or weeks;
- Chronic complications are of an extremely rare occurrence.
In the majority of cases, during and after the cesarean section, the child is all right. However, some babies have troubles in breathing. Usually this is not a serious problem, but sometimes the child needs special care.
Breathing problems are most likely to occur if the baby is born preterm, or if the cesarean section was performed before the onset of labor.
In about one of 50 cases, the surgeon touches the child with the scalpel, but such injuries usually heal without any consequences.
Once a woman has suffered a cesarean section, the probability of a repeated cesarean during the next pregnancy is quite high. Anyhow, vaginal birth after cesarean delivery is still possible. Cesarean section also slightly increases the risk of placenta previa.
An early post-natal depression is more common in women undergoing cesarean section than in those who give birth in the usual way. However, within two months, the chances are equalized.
Despite all the negative sides of the C-section, it also has many advantages that a vaginal birth cannot offer.
ADVANTAGES OF CESAREAN SECTION
First of all, the women who decide to have a C-section do not have to worry about the tension of the delivery or endured pain in the perineum. Another advantage is that they can program the exact day and hour when the child will be born.
With a planned caesarean section, women do not have to deal with unpleasant sensations, as those met in natural childbirth, such as:
- pain in the abdominal muscles and in the wounds of the perineum;
- severe bleeding after childbirth;
- weakening of the pelvic floor muscles, that brings to involuntary urination when coughing or laughing (urinary incontinence);
- uterine prolapse;
Serious complications occurring during the first 60 days after natural birth and after cesarean section (per 1,000 women):
Medical complications requiring repeated hospitalization
After natural birth
|Hemorrhage, massive blood loss||2.4||2.9|
|Genital or urinary complications||1.3||1.7|
|Cardiac and pulmonary complications||0.6||1.3|
There are some opinions according to which cesarean sections disrupt the natural process of birth and destroy the special bond between the mother and her child. Once the child is placed to the mother’s breast, however, the moments of affection and tenderness reinforce this link; thus, the moment of birth is the culmination of a new and beautiful experience that began nine months before. In addition, it is the mother’s choice whether to give birth by natural means or by C-section, as long as she is conscientious about the possible consequences.