Cesarean Birth and Informed Consent
By Alicia Farmer
Two recent studies document the elevated risks to mother and baby of birth by Caesarean section. At the same time, surgical delivery rates continue to rise in the United States. Currently, the national average is at 30 percent. Clearly our culture’s approach to birth does not reflect “evidence-based practice.” There is a gap between knowledge and acquisition of that knowledge by those who need it the most – the expectant couple.
The September 2006 issue of Birth includes an article by Marian F. MacDorman, who works in the Center for Vital Statistics at the Centers for Disease Control. Her research found that newborn babies were more likely to die when born by Caesarean section than by vaginal delivery. Nearly three times more likely. The elevated risk to babies was present even when the study population was controlled for pre-existing medical and socio-economic factors. MacDorman concludes that the hormonal and mechanical process of labor and delivery may better prepare the baby for life outside the womb. She refers to earlier studies that show improved outcomes for babies born vaginally, particularly in the area of respiration:
Labor induces the release of fetal catecholamines and prostaglandins that promote lung surfactant secretion. In addition, epinephrine release during labor, as well as the physical compression of the infant, helps to remove fetal lung fluid and facilitates postnatal lung adaptation. Other risks of cesarean delivery include delayed neurologic adaptation, possible laceration of the infant during the performance of the cesarean surgery, and delayed establishment of breastfeeding.
Babies are not the only ones at increased risk from surgical delivery. In the September 2006 issue of Obstetrics and Gynecology, Dr. Catherine Deneux-Tharaux reports mothers are three and a half times more likely to die if their babies are born by Caesarean section rather than vaginally. Caesarean delivery brings with it a host of associated complications. Dr. Deneux-Tharaux found that the risk of death was primarily caused by “complications of anesthesia, puerperal infection, and venous thromboembolism.” Deneux-Tharaux concludes,
Although cesarean delivery is increasingly perceived as a low-risk procedure, the present study suggests that it is still associated with an increased risk of postpartum maternal death as compared with vaginal delivery, even when performed before labor. This needs to be taken into account by clinicians and women when balancing the risks against the benefits of the different methods of delivery.
Similarly, MacDorman says [emphasis added],
Timely cesareans in response to medical conditions have proved to be life-saving interventions for countless mothers and babies. At present we are witnessing a different phenomenon – a growing number of primary cesareans without a reported medical indication. Although the neonatal mortality rate for this group of low-risk women remains low regardless of the method of delivery, the resulting increase in the cesarean section rate may inadvertently be putting a larger population of neonates at risk for neonatal mortality for reasons that remain uncertain.
It is precisely this kind of information that must be made available to pregnant women. At the Center for the Childbearing Year we will present the risks as well as the benefits of Caesarean delivery and other medical interventions in the birth process. Only when you are aware of your full range of choices, can you make the informed choice that is right for you.
Please share this information with someone you know. The health of women, babies, and families is our highest priority.