* Why do some women labor for more than 24 hours only to find out that they need a C-section?

 

* Is C-section better or worse for mother? For baby?

 

* Which risks of vaginal birth are rarely or never discussed with expectant moms?

 

* Which advantages of C-section do doctors avoid telling their patients about?

 

* Who decides what kind of treatment you will receive, you and your doctor? Or will it be the insurance company?

 

If you have a breech baby or have previously had a c-section you will be given a choice. Otherwise you will be expected to try for a vaginal birth and will only deliver by c-section after failing a prolonged labor (sometimes 24 hours with a couple of hours of pushing) or when your baby gets into "distress". As I mentioned earlier, a section done for emergency reasons or after a long labor is more than twice as dangerous for the mother.

Every year close to one million women have c-sections in the U.S. Often the operation is performed for the safety of the mom or baby when a complication occurs during childbirth. (more than one in five births in the U.S. are cesarean) But women are made to feel like "failures" is they did not have a vaginal childbirth -- they are treated as if they are not "real women". When done electively, it appears that c-section is as safe as vaginal delivery for the mother and is definitely safer for her baby. (Actually I suspect that we will find, in the near future, that vaginal birth is more dangerous for moms too.)

Although it is not clear that cesarean birth costs more than vaginal birth, most hospitals charge much more for this mode of delivery. (Doctors' fees are typically almost the same for the two types of delivery). Consequently insurance companies strongly oppose cesarean delivery (unless it is the "last resort") and have applied economic pressures against doctors to prevent them from offering c-sections to their patients.

As a result it is highly unlikely that you will be told about the advantages of elective repeat c-section. These include some long term advantages you, the mom, such as a decreased risk of urinary incontinence later in life. Elective c-section is also much safer than the emergency c-section you will need if your VBAC attempt fails.

If you had a c-section before and do not wish to try for a vaginal birth, you should not be pressured by your OB. The American College of Obstetrics and Gynecology (ACOG) states that you should be given a choice and that your preference should be honored. If your OB tells you that you must try to VBAC, you should get a second opinion.

A new book by OB/GYN doctor, D. Campbell Walters M.D., challenges the inferiority of cesarean birth, showing why it is the preferred choice of many women OB doctors in England and the U.S. and why many OB/GYN doctors here in the U.S. believe that we should routinely offer c-section as an option.

Fourth Degree Laceration:

A fourth degree laceration occurs during childbirth. It is a severe tear that involves the entire area between the vagina and the rectum, connecting the two. Risk factors include instrument delivery, episiotomy and large babies, but anyone can get a fourth degree laceration. It can lead to negative long term consequences such as fecal incontinence.

Birth Injuries:

Birth injuries such as brachial plexus traction caused by shoulder dystocia occur during vaginal birth. After the delivery of the baby's head, a shoulder may become trapped behind the mother's pubic bone. If the shoulder cannot be released, brain damage to the infant may occur because the baby is not receiving adequate oxygenation. If the shoulder is dislodged using excessive force, however, a brachial plexus traction injury may result in permanent neurologic damage to the arm and hand. This condition is known as Erb's Palsy.

Cerebral Palsy:

Cerebral palsy is a condition where prenatal brain injury to the baby results in long term developmental difficulties which are often severe. While the causes of cerebral palsy are not well understood, some cases are thought to be caused during childbirth by insufficient oxygen being supplied to the baby. This issue is the subject of ongoing debate in obstetrics, but most estimates place vaginal birth as the culprit in 10% to 30% of cases. Your OB doctor is likely to tell you that C-section is not any safer for your baby. But can this be true. The most common reason OB doctors are sued is for not doing a c-section soon enough to avoid injury to a baby.

Uterine Rupture:

This rare complication is more likely to occur in attempted VBAC and has caused the American College of Obstetrics and Gynecology (ACOG) to temper its enthusiasm for VBAC as a means of lowering the c-section rate. If your uterus ruptures at the site of the previous c-section scar, there is a significant risk of injury or death to your baby.

Better Sex after Cesarean?

In a survey last year, 31% of women OB doctors in England said that they would prefer a c-section over vaginal birth if given the choice. (More than half said they would rather have a c-section for a baby that weighed more than 9 pounds) One of the top reasons these well-informed women gave for their preference was that they believed sexual function would be better preserved if they avoided vaginal birth. Meanwhile a recent 20/20 show featured a Beverly Hills gynecologist who has gained significant attention with a procedure to improve sex for women who have had vaginal births -- the procedure is known as "laser vaginal rejuvenation".

Urinary Incontinence:

By the time they reach 50 years of age, approximately one half of women in the US experience some stress urinary incontinence (they lose urine when they cough, sneeze, laugh, run, etc.). Most experts agree that vaginal birth is the main cause of these problems. The more babies and the bigger babies a woman has, the more likely she is to suffer with this often debilitating problem. Women who deliver by cesarean, especially if they do no go through labor first, are at a much lower risk for urinary incontinence later in life. If you don't believe me, find a woman uro-gynecology specialist and ask her what she thinks.

Stillbirth:

Stillbirth at term is a rare tragic complication at term, right? Well that depends what you consider rare. If you are pregnant at 39 weeks and are between 25 and 35 years old, there is a one in 450 chance that you will have a stillbirth. If you are older than 35, this chance goes up to one in 225. Doctors do not have a way of predicting who will have this awful experience. As a consequence most avoid discussing the possibility because their patients will put them under pressure to deliver the baby sooner. The doctors know that this will result in an increased c-section rate which they are desperately trying to avoid because of third party pressures.