Cesareans have taken a strong position in our society as a way to birth a child.

And we can be thankful for them, as they have saved many lifes in emergency situations. But we also need to recognize that there has been a massive transition from an emergency procedure to a “elective cesarean” as a birth choice.

In South Africa the private sector has a c-section rate of almost 80%. The World Health Organisation recommends a cesarean rate between 10-15%.

So lets have a look at the reality of cesareans.

Many reasons given for a cesarean should be questioned. They include

  • macrosomia ( large baby )

  • maternal age

  • assisted reproductive technology

  • CPD ( CephaloPelvicDisproportion )

  • Dystocia ( obstructed labour )

  • failure to progress, breech presentation

  • fetal distress and even prolonged second stage.

There are a few true indications for a cesarean in which the risks of surgery outweigh the risks of vaginal birth.

Psychological outcomes such as negative feelings, fear, guilt, anger and postpartum depression are common consquences of both emergent and elective cesarean. A cesarean is indicated in the following situations

  • complete placenta previa at term

  • transverse lie at complete dilation

  • prolapsed cord

  • abrupted placenta

  • eclampsia or HELLP with failed induction of labour

  • large uterine tumor that blocks the cervix at complete dilation ( most fibroids will move upwards as the cervix opens, moving it out of the babys path )

  • true fetal distress, confirmed with a fetal scalp sampling or biophysical profile

  • true absolute cephalopelvicdisproportion or CPD ( baby too large for pelvis ) This is extremely rare and only associated with a pelvic deformity. Fetal positiong during labour and maternal positioning during second stage, most notably when women are in semi- sitting position, cause most CPD diagnosed in current obstetrics

  • initial outbreak of active herpes at the onset of labour

  • uterine rapture

These are the risks of a cesarean section

  • infection, blood loss, haemorrhaege, hysterectomy, transfusions, ballder and bowel injury, incisional endometriosis, heart and lung complications, blood clots in the leg, anesthesia complications and rehospitalisation due to surgical complications

  • The establishment and ongoing breastfeeing is reduced, psychological well-being is compromised and there is an increased rate of emotional trauma

  • Potential chronic complications from scar tissue adhesions, include pelvic pain, bowel problems and pain during sexual intercourse

  • One half of women who have undergone a cesarean suffer from complications and the mortality rate is at least two to four times that of women with vaginal births

  • Each successive cesarean greatly increases the risk of developing placenta previa, placenta accreta and placental abruption in subsequent pregnancies. Cesareans also increase the odds of secondary infertility, miscarriage and ectopic pregnancies in subsequent pregnancies.

These are the risks for the baby

  • respiratory stress syndrome ( RDS )

  • iatrogenic prematurity ( when surgery is performed because of an error in determining due date )

  • persistent pulmonary hypertension ( PPH )

  • and surgery related injuries such as lacerations

With a cesarean the baby is not exposed to the vital microbes, bacteria and organisms that build the immune system compared to when they move through the birth canal and the vagina, where they are seeded with the mothers microbes.

The lack of microbes can facilitate later problems with auto immune disorders ( For more information watch Microbirth )