High-Tech Birth: Do You Need a C-Section?

Childbirth may be perfectly natural, but it's not harmless. Around the world, some 500,000 women die from pregnancy complications each year. Though maternal death is rare in developed countries, vaginal delivery has its complications, such as hemorrhoids, months of back pain and higher risk of incontinence down the road. Natural birth holds risks for babies, too--especially those born to older women.

These are just some of the reasons for the steep increase in cesarean sections. Fifty years ago, fewer than one American baby in 50 was delivered surgically. The proportion now exceeds one in four, and cesarean rates have risen in most other developed countries. Critics say the trend toward high-tech delivery wastes money and makes childbirth less safe. Yet some women now demand C-sections, and doctors are ever quicker to perform them. Is all this surgery warranted? What's a prospective mother to do?

It's not a simple question. Surgical delivery does spare a woman from labor and its after-effects, and it gives her some flexibility in scheduling delivery at her convenience instead of the baby's. But it also slows recovery. Women who have C-sections can't drive or lift anything heavier than a baby for a few weeks afterward. They require more rest than those who deliver vaginally, and most receive pain medications that can compound their tiredness. The safety issues are even murkier. Surgery can improve birth outcomes in complicated pregnancies, but no one has fully evaluated the impact of elective C-sections. Does surgery raise or lower the risk of complications in women who could safely de-liver vaginally? Because elective C-section is such a recent phenomenon, we still don't know.

The vast majority of cesareans are still ordered by physicians, and the increase stems mainly from changing medical needs. As women give birth at later ages--and as fertility treatments yield more twins and triplets--babies are more likely to arrive early, when they're too small to risk vaginal delivery. Some studies suggest that women receiving epidural anesthesia or labor-inducing drugs are more likely to require a C-section. And improved fetal monitoring has made it easier to tell when a fetus is not reacting well to labor. Even in women with similar risk factors, the rate of C-section varies widely depending on the doctor and the setting. A woman attending a small community hospital is usually seen by one physician who knows her well. This personal care has an obvious upside, but women in these settings often end up having their labor induced, just to guarantee that the familiar physician performs the delivery.

Wherever you live, the first step to a good birth is to speak up about your preferences. Many physicians are willing to perform an elective C-section once the mother understands the risks and benefits. But if you've had one cesarean, don't assume you're destined for another. For women without other risk factors (obesity, advanced age, an extended pregnancy, a very large baby, more than one previous C-section), vaginal birth is only slightly riskier than a second surgery--as long as it's done in a hospital where emergency services are always available. In the end, what happens during labor is also up to your baby. If the child foils your plans, take heart. It won't be the last time.