5 facts about C-sections: Repay to Cesarean What Belongs to Cesarean
I want to expand on 5 facts posed by the International Cesarean Awareness Network. The International Cesarean Awareness Network is “a non-profit organization whose mission is to improve maternal-child health by reducing preventable cesareans through education, supporting cesarean recovery, and advocating for vaginal birth after cesarean (VBAC).”
To start with, I want to make it known that when a cesarean is necessary, it can be a life-saving technique for both the mother and infant. My goal in going through these facts is not to depreciate the women and children of C-section births. Life is precious and any procedure that aims to keep that in mind is beneficial for society. With any birth method: natural, unassisted, assisted, C-Section, education is paramount.
1. One in four births is a cesarean, with some hospitals reporting as high as one in two. This represents a 400% increase in less than 15 years. This cesarean rate increase has not led to an improvement in the infant mortality and morbidity rates but instead has put mothers and babies at greater risk. Rates began to fall in the mid-1990s, but are rising again in the new millennium.
Currently, the national C-Section rate is 32.8%. It is hard to believe that 1/3 of all pregnancies are high risk to the point where a C-section procedure is a better option than a natural childbirth. And the available data backs up this suspicion. There are three reasons for the uptick in C-section rates.
First off, the modern medical birthing process itself often requires a C-section to step in when adverse events arise. The second and third reasons are interconnected. Overall, the informed choice of having a vaginal birth is being stifled. Our culture is un-educating women in their own ability to give birth.
Too many people are giving up their rights to the doctor. The OBGYN often prefers a C-section because of liability or personal choice reasons. As soon as the cord is cut, the liability falls more on the hospital than on the doctor. A C-section can be a well-scheduled and doctor-controlled event that only accelerates this transfer of liability.
Childbirth, once a natural phenomenon of life, is now considered a “condition” that requires medical procedure 100% of the time. And since surgery is a type of medical procedure, a C-section can become a “natural” option for childbirth. But it is a false presumption to believe that a C-section is benign. A cesarean is an invasive surgery that has risks.
2. Vaginal Birth After Cesarean (VBAC) is safer for both mother and infant, in most cases, than is routine repeat cesarean, which is major surgery.
The biggest concern for VBAC women is the risk of uterine rupture. Depending on the location of the C-Section incision and severity of the previous procedure, the risk of uterine rupture in a vaginal delivery is between 0.2 to 1.5%.
Potential harm to the mother from the C-section surgery include: accidental surgical cuts to internal organs, major infection, emergency hysterectomy, complications from anesthesia and deep vein thrombosis.
Potential harm to the baby from a C-section include skull hematomas, clavicle and long bone fractures, brachial plexus and cranial nerve stretch injuries as well as spinal cord injuries. The majority of the infant injuries are a result of the hyperextension, traction and rotation performed to the head and upper cervical spine with the procedure.
According to The American College of Obstetricians and Gynecologists, a VBAC is safer than a repeat cesarean. Even if there is a history of more than one cesarean, a VBAC does not pose an increased risk. 90% of women who had a previous C-section delivery are candidates for VBAC.
The VBAC rate is highest in 3rd pregnancy women who had a vaginal birth first and then a cesarean. If given the choice, these women will choose a vaginal birth for their next delivery. Other studies have shown that between 60-80% of women who have had a previous C-section can successfully give birth vaginally.
3. The risk to your infant from the very low incidence of uterine rupture (less than 1%) is much less than the risk to your infant from respiratory distress as a result of a scheduled cesarean.
Only 2% of women deliver on their due date. The due date is often an arbitrary date that can change frequently with ultrasound analysis or other criteria. This statistic increases the potential for the baby to be born late-preterm via a scheduled cesarean. A baby can be considered late preterm between 37 to 39 weeks of pregnancy.
Respiratory distress is a major concern of premature babies. It can be severe enough that the baby requires admission to a special care nursery. Besides respiratory distress, other complications from a late-preterm scheduled cesarean for the baby are: digestion issues, liver dysfunction, jaundice, dehydration, infection, feeding problems, and trouble regulating blood sugar and body temperature. Late-preterm babies also have more immature brains. This can increase the risk of learning and behavior problems later in life.
4. One-half of all cesarean women suffer complications, and the maternal mortality rate is at least two to four times that of women with vaginal births. Approximately 180 women die annually in the Uniter States from elective repeat cesareans.
From 2000 to 2014, there was a 26.6% increase in the estimated maternal mortality rate. In 2000, 18.8% of women died during pregnancy, during birth or in the first week after giving birth. In 2014, that number jumped up to 23.8%.
Less severe complications after a C-section include: breastfeeding problems, pain that may last six months or longer, adhesions and thick internal scar tissue that may cause future chronic pain, endometriosis, appendicitis, stroke, gallstones and negative psychological consequences.
5. Many indications for cesarean can and should be questioned, including cephalopelvic disproportion (CPD or baby too big, pelvis too small), dystocia, failure to progress, breech, etc.
Cephalopelvic Disproportion, or CPD for short, has weak diagnostic parameters. Over 2/3rd of women who were diagnosed with CPD and had a C-section, there next child who was born vaginally was larger than the one delivered by C-section. CPD is often due to a malposition of the fetal head and ineffective uterine contractions NOT due to a small pelvis.
Failure to progress and dystocia accounts for 50-60% of all C-sections. The biggest contributor to this number is an incorrect diagnosis. 25% of all failure to progress and dystocia cases are diagnosed at 3 centimeters of cervical dilation.
Cervical dilation stalling of 4 centimeters is needed for a precise diagnosis of failure to progress or dystocia. False presumptions are made at 3 centimeters of dilation. It is debatable whether a period of slow progression in labor, which often happens at 3 centimeters, is pathological or a normal variation in the process leading up to delivery.
How the individual practitioner measures the descent of the fetal head and fetal head-to-cervix can also create variables that lead to misdiagnosis. Epidurals that numb/stall contractions and OBGYN convenience and/or their fear of litigation can also contribute to a hasty diagnosis of failure to progress or dystocia. What is most eye-opening, is that there is no major consensus on the length of a normal labor.
Conclusion
We all have the right to informed, conscious consent AND refusal when it comes to our health choices. This must be established on facts and awareness. If not, our health will stand for nothing and fall for everything.
Chiropractic care wants to help support the natural process that is pregnancy and birth. We help support it by promoting normal physiology. The more we can reduce neurological disruption and spine imbalance, the better health outcomes can be witnessed in the mother and child.
A natural, unassisted childbirth can not only be the ideal, but the norm if we wish to achieve such a bright and healthy future.
More information on these topics can be found on the International Cesarean Awareness Network’s website at www.ican-online.org.
Jarek Esarco, DC, CACCP is a pediatric, family wellness and upper cervical specific Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). Dr. Jarek has postgraduate certification in Pediatric Chiropractic through the ICPA. Dr. Jarek also has postgraduate certification in the HIO Specific Brain Stem technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.
