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Monday
Jul252011

What ARE the Risks of Cesareans?

This was a recent question in my Navelgazing Midwife Facebook Page. You’d think anyone reading anything on a more natural-oriented site would already know the answer to that, but I was really glad to see someone ask. It gave the readers a change to answer in a way no textbook can describe. 

A: Having the incision tear further when they pull the baby out - causing hemorrhage and complicated repair and possibly eliminating the possibility of a VBAC - this happened to me. Two hours to repair the extension. (I was able to VBAC though, but have talked to other women who were not able to.)

J: Risk of cutting the baby, nicking nerves, increased likelihood of adhesions in the abdominal cavity, increased risk for uterine rupture with future pregnancies, increased risk of placenta accreta with future pregnancies.

N: Nicking the bladder or intestines causing infection and all the complications that come along with that.

R: Post operative infection.

J: Increased likelihood of prematurity and associated morbidities, increased likelihood of blood loss and clotting problems.

M: Hematoma and uterine wall infection which are currently being experienced by a client of mine-landing her back in the hospital.

J: Increased risk of complications from anesthesia, and the risk of surgical complications is higher in obese moms.

C: Hemorrhage, infection, as you noted compartment syndrome, increased maternal mortality with each c-section, decreased fertility, increased pregnancy complications such as placenta accreta, nerve loss, bladder damage (accidents happen even with a catheter in place and an empty bladder), sleepy babies that nurse poorly if at all, late milk coming in, pain (a lot) and pain that stays for many months after delivery, poor incision healing, blood clots... It sort of becomes endless.

S: Significantly increased risk of death for mother.

S: So scary to read these in list form like this.

J:  Your eyes opened to shit you never ever wanted to know or feel, for months and years. Also, disfigurement.

A: In addition to the overall risks of major surgery (infection, reaction to anesthesia, etc), there are the risks to future pregnancies, particularly placental abnormalities like previa and accreta/increta/percreta. And then there are the potential problems (not insurmountable, but notable) of separating mom and babe in the early hours and the impact that can have on establishing breastfeeding. Plus due to not passing through the vagina, babe is not colonized with normal flora, increased respiratory difficulties . . . Where to stop?

L:  Death.

D: Excess fluid in lungs for newborn.

C: My son and I both carry scars from that operation. He was sunny side up, and they wheeled me in pushing. He now has a small scar on his cheek that, as he is getting older and bigger, is becoming more prominent. BTW, informed consent is a joke when your doc has a dinner party to get to on New Year’s Eve. Further risk? Maternal or fetal death. Increased placental placement risks. Fertility risks. Bowel, internal organ healing risks. If I knew then, what I know now....

M: Disgusting, oozing, adhesive burn from the dressing over my incision.

NgM: It's imperative to remember the Risk/Benefit Ratio. One of the things about cesareans is they are proof positive that a mother will lay down her life for her child; she forever has the scar(s) to prove it.

A: I read a lot of medical issues here, but not so much on the emotional issues. I remember feeling "broken" for a while.

R: Emotionally, issues bonding with baby, increased risk of postpartum depression/post traumatic stress disorder/postpartum psychosis.

L: Actual complications in my case, cut hip to hip, hemorrhage, cervical laceration, massive surgical infection that took 8 painful (not to mention shockingly expensive) months to heal. Additional surgery and medical advice to carry no additional children. Between the risk of another preemie, the scar tissue and the extent of tearing of my uterus including the cervical laceration, several docs have strongly advised against further pregnancy.

L: Repeat sections with increasing probability of placenta accreta is the one that scares me most. Freaks me out when this starts with a teen primip (first time mom). High-risk category forever. Bad news if you hoped for more than 2 kids ever.

W: Can we have this same thread with vaginal births, as that isn't a risk-free walk in the park either. Just because this needs to be said, just because it is a risk, doesn't mean it will happen to you. There is a risk of most offbeat things every time you get into the car (even the emotional things) but 99% of us still ride in cars.

NgM: No, it isn’t a “risk-free walk in the park,” but it is true that cesareans carry far more risks for mom and baby than a vaginal birth does. Acknowledging them is fine, but seeing them as equal is flat out wrong.

Reader Comments (14)

"Acknowledging them is fine, but seeing them as equal is flat out wrong."

Exactly. Thank you. Choice and respect and tolerance, yes please...but also KNOWLEDGE. We can't treat all things as inherently equal, because they're not. And I refuse to use that fallacious "fair play" (equal is not always fair, folks!) idea as a standard for debate. Glad to see you have a similar perspective.

When you put this discussion in the context of an individual person, it's certainly possible that the meaning of these risks changes. But she should have the real facts and then she can decide for herself, if in her situation, things look the same as they do in the abstract.

July 25, 2011 | Unregistered CommenterMelissa

If I may, one more potential complication is actually endometriosis. Bits of the uterine lining can escape into other portions of the abdomen, and continue to react normally to monthly hormone cycles. My mother experienced this, and it took her 12 years to get it diagnosed. It was only diagnosed and/or treated as a real thing because the symptoms of endometriosis continued after a hysterectomy.

July 25, 2011 | Unregistered CommenterStaudtCJ

“it is true that cesareans carry far more risks for mom and baby than a vaginal birth does.”

Really? I thought that cesarean birth was slightly more risky for women but much safer for babies.

July 26, 2011 | Unregistered CommenterAlison Cummins

Really? I thought that cesarean birth was slightly more risky for women but much safer for babies.

Very interested in hearing the rationale behind that statement...

July 26, 2011 | Unregistered CommenterDreamy

"Acknowledging them is fine, but seeing them as equal is flat out wrong."

Those are words I often find myself saying to people.

July 26, 2011 | Unregistered CommenterMaddy

There is a lot of evidence indicating that c-sections are safer for babies. And when you consider the possible consequences of vaginal birth, as few people seem to want to do, it turns out that the risks of c-section are not much higher, if at all.

Why don't you ever discuss the risks of vaginal birth? The assumption always seems to be that c-sections carry risks but vaginal births are considered risk-free, or their risks aren't worth being considered, and that really is not right.

July 27, 2011 | Unregistered Commenterflo

It's obvious you aren't on my Facebook Page, Flo. ;) The follow-up question *was* "What are the risks of vaginal birth?" and that post is being edited as we speak! I am well-aware that it is NOT All-Vaginal-Birth-All-the-Time.

A tiny bit of credit, please?

July 27, 2011 | Registered CommenterNavelgazing Midwife

So are those of us who only can birth by Cs less than because the way we birth isn't equal to a vaginal birth? What is gained by putting one form of birth over the other? Why is it so important to not just educate, which is very important, but to also put a value judgement on the method? Does it make mothers by vaginal birth feel better and allow them to pity those poor mothers by cs?

July 27, 2011 | Unregistered CommenterWendyLou

Hmmm, WendyLou... I don't see *anyone* making "value judgments on the topic at hand. Talking about risks... shouldn't that be a pretty b&w kind of topic? You are dragging in a LOT of baggage; might want to check it at the door.

July 27, 2011 | Registered CommenterNavelgazing Midwife

What evidence says C-sections are safer for babies? It just isn't true. Do you know anything about the benefits of vaginal births for babies? What are the benefits of a C-section birth for a baby? Wow.

July 27, 2011 | Unregistered CommenterRebecca

Trust me--you're not missing anything, WendyLou. Some women are very invested in the birth process and keeping it as natural as possible, to the extent that their perspective becomes kind of skewed. C/S are perfectly fine and there's absolutely nothing about natural birth that is essential to motherhood. I thought it was horrible, personally.

Looking forward to that VB risk post, NGM.

July 28, 2011 | Unregistered Commenterflo

Calling the different methods of as not equal clearly implies one method of birth is superior to another. Yes, imnsho that is a value judgement. Do you think it is possible to just state the facts and let people make up their own minds about the different method without the value judgement.

As for my baggage, I see plenty of others baggage showing on this and the vaginal birth thread.

Thankfully my baggage is a matched red set with Bright pink luggage tags so no one else can claim it. :) If I must have baggage, mine sure is the prettiest in the belly of the plane.

July 28, 2011 | Unregistered CommenterWendyLou

I see the same things you are seeing, WendyLou. The NGM is giving a nod toward fairness here, but for the most part people who frequent this blog and most other birth blogs are ridiculously whacked about C/S. Just letting you know, from my perspective, as a mom who had a natural VB that I didn't particularly want, those people are totally nuts. VB isn't better than C/S--that's totally ridic.

July 28, 2011 | Unregistered Commenterflo

I'm not up to date with all the jargon but one complication I haven't seen mentioned is vulvodynia. It can come from vaginal birth as well, but people aren't aware that it is also a (fairly common) complication of c-sections. Sure, it is not life threatening. But it is no walk in the park either.

That, and the risk of PTSD is also higher. (Which is not intrinsically caused by c-sections but rather by the way they tend to be carried.)

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