More than one-quarter of American women today deliver via Cesarean section. Will you be one of them?
It took Holly Zboyan-Lee, 31, a split second to decide whether she wanted a Cesarean section. “I saw the look of concern on the doctors’ and nurses’ faces, and it was the worst feeling in the world,” she says. “I wanted my daughter out.” Fetal monitoring showed her baby’s heart rate was unusually slow to return to normal after each contraction, and there was meconium (waste from the baby’s intestines) in the amniotic fluid, another sign of possible distress. Zboyan-Lee was wheeled across the hall to an operating room, and less than half an hour later, she had a healthy baby girl. “I would definitely make the same choice again,” says the Bellaire, Texas, mother.
But many situations aren’t so clear-cut, and a lot of women are far less certain whether a C-section or a vaginal delivery would be best for them, their babies and future pregnancies. Understanding the risks and benefits before you go into labor is the surest way to feel confident about your decision.
Some background: The nation’s C-section rate rose from 5 percent in 1970 to an all-time high of 26.7 percent in 2003, according to the Centers for Disease Control and Prevention. (The World Health Organization maintains that 15 percent should be the maximum rate.) The boom can be traced to a steady decline in the number of women attempting a vaginal birth after a previous C-section, known as VBAC (just 10.6 percent of babies were delivered this way in 2003); an increase in C-sections due to “failure to progress”; greater attention to risks of vaginal deliveries; and safer surgical techniques. But that’s not all: “The popularity of televised cosmetic surgery may lead some people to have fewer fears about surgery,” says Howard Minkoff, M.D., chairman of the obstetrics and gynecology department at Maimonides Medical Center in Brooklyn, N.Y.
C-section pros and cons
Many experts find the burgeoning C-section rate troubling. The surgery poses serious potential risks, including blood clots, organ damage and, very rarely, maternal death. More commonly, studies show that women feel pain at the incision site, remain in the hospital longer and may develop a post-surgical infection. “Think of it as pay me now or pay me later,” says Gene Declercq, Ph.D., professor of maternal and child health at Boston University School of Public Health. “A woman who delivers vaginally will experience more discomfort during labor, while a woman with a Cesarean will experience much greater postpartum pain.”
As for the babies, in general, there’s less opportunity for complications when an infant is delivered surgically, says Charles J. Lockwood, M.D., chairman of the obstetrics, gynecology and reproductive sciences department at Yale University School of Medicine in New Haven, Conn. But such babies are less likely to be breastfed and more likely to have asthma later in life, according to the New York City-based Maternity Center Association (MCA), a nonprofit group that reviewed more than 300 studies on vaginal- and C-section-birth outcomes. Plus, there is a small but heightened chance of placental problems and stillbirths in future pregnancies; risk increases with each previous C-section.