As history has progressed, pregnancy, labor, and delivery have become increasingly safer, allowing pregnant people to become the parent they wish to be. This is due to not only advancements in medical technology, but also through surgical interventions such as cesarean sections, or c-sections. While c-sections allow for the safer delivery of babies, the rates of c-sections have been rising continuously at an alarming rate in the past 40 years [1] (Figure 1). There are many reasons why c-sections might be the choice of delivery for some women, but several studies show that some of these surgeries are not medically necessary. 

Before discussing the issues surrounding c-sections, it is important to first understand why it is done in the first place. Firstly, c-sections have been shown to reduce perinatal mortality and maternal mortality [2] (Figure 2). Perinatal mortality is defined as the death of a newborn within 7 days of its birth, while maternal mortality is the death of the mother. Additionally, mothers may also get c-sections due to halted labor, abnormal fetal heart rate, and unideal positioning of the fetus [3] (Figure 3). Many also believe that c-sections are safer for the baby although that fact is not necessarily true [4]. According to a statement released by the World Health Organization in 2015, no evidence shows the benefits of c-sections in cases where it was not required [5]. In other words, c-sections are not necessarily “better” for normal pregnancies. Parents are also concerned about possible genital modifications and pain during vaginal delivery and believe that c-sections would lessen their pain [4]. When it comes to the healthcare team, they are afraid of medical malpractice suits that can arise due to unexpected outcomes and complications during vaginal delivery [4]. If they were to conduct a c-section in the operating room, they would have all the staff and medical equipment necessary to have control of the situation. In this sense, physicians and parents alike are relying on c-sections as a safety net. 

Well, what’s the issue with c-sections in the first place? First, it is an invasive abdominal surgical procedure, which means that there are risks such as infection and death. Mothers have a higher risk of blood clots, extreme blood loss, and abnormal placenta placement in subsequent pregnancies [2]. In addition, should a mother choose to have a vaginal birth in her next pregnancy, it will prove to be more difficult for her physically, and perhaps psychologically [6]. Newborns have a higher risk of respiratory complications that can lead to death and an increased chance of obesity and diabetes later in life [2]. Furthermore, they can develop atopy, which is an increased sensitivity to common allergens[2].

Several alternatives to c-sections have been discussed in medical literature, such as the use of oxytocin for halted labor [3]. This hormone causes and promotes uterine contractions, allowing the labor to continue and perhaps make it easier for the mother to push. In cases where the fetus is in an abnormal position, such as head-first, there is an external cephalic procedure in which the fetus is externally rotated into the proper position. This procedure can be difficult for the mother to handle, but it is one of the better options as opposed to major abdominal surgery. 

Other alternatives to c-sections are not medical interventions, but instead, discuss how society or the medical field can help reduce the increasing c-section rates. As mentioned previously, many physicians are not trained in instrumental deliveries, therefore a diverse education should be applied in their training. Furthermore, a diverse education would mean physicians would be confident in their skills and would no longer be afraid of malpractice lawsuits. They would no longer be using c-sections as their safety net and instead use their medical knowledge to the best of their ability.

It is important to note that there are many factors regarding the increasing rates that are not well-understood. There have been changes in maternal characteristics and professional practice styles, increasing malpractice pressure, and economic, organizational, social, and cultural factors that influence the rise in c-sections. Because of all these factors, interventions to reduce c-section rates have only shown moderate success [4]. 

Despite all that has been said, c-sections are not unfavorable, as they are the best form of delivery for certain medical conditions such as abnormal placenta positioning. Should a mother attempt a vaginal delivery under these circumstances, they can risk losing a tremendous amount of blood and it may result in death for both mother and baby. Hence, it is up to the mother’s discretion if she wants to have a c-section. Physicians also have to weigh the risks and benefits of undergoing the surgery. Every patient is not the same, and the approach to their care should be catered to them. The increasing c-section rates are not an emergency, but it is concerning to see it rise when it is not medically necessary.

References

1. Althabe F, Sosa C, Belizán JM, et. al. (2006) Cesarean Section Rates and Maternal and Neonatal Mortality in Low-, Medium-, and High-Income Countries: An Ecological Study. Birth: Issues in Perinatal Care Volume 33: 270-277.
2. Ayres de Campos D, Cruz J, Medeiros-Borges C, et. al. (2015) Lowered national cesarean section rates after a concerted action. Acta Obstetricia et Gynecologica Scandinavia Volume 94: 391-398.
3. Caughey AB, Cahill AG, Guise JM, et. al. (2014) Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus.
4. Betrán AP, Ye J, Moller AP, et. al. (2016) The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS ONE Volume 11.
5. World Health Organization and Human Reproduction Programme. (2015) WHO Statement on Caesarean Section Rates. World Health Organization. 
6. Dietz HP and Campbell S. (2016) Toward normal birth—but at what cost? American Journal of Obstetrics & Gynecology Volume 215: 439-444.