Secondary Cesarean Sections Pose Risk Factors

Wednesday, March 18, 2009 by: Jen Patterson
Tags: C-section, health news, Natural News

(NewsTarget) Doctors warn most expectant mothers with a previous Cesarean section about the risks of vaginal birth following a Cesarean (VBAC) but not about the risks of multiple Cesarean sections both to mother or her baby. The primary cause for concern during VBAC is uterine rupture, which could lead to the deaths of mother and baby. When told of that possibility, and often under pressure from her doctor, many women opt for a scheduled repeat Cesarean section.

That a Cesarean section is major surgery is often downplayed. Yet, risks to the mother include increased risk of emergent hysterectomy, hemorrhage, organ damage, infection with increased risks of rehospitalization, and cardiopulmonary and thromboembolic conditions. Surgical wound complications such as adhesions can cause bowel obstruction and chronic pain; pain at the incision site often persists beyond six months. Risk of maternal death is 4 times higher with Cesarean section than with vaginal birth, although this risk is small in both cases.

Babies born by Cesarean section have an increased risk of respiratory distress syndrome and a five-fold increase in persistent pulmonary hypertension over those born vaginally. Problems with future reproduction associated with previous Cesarean sections include infertility and numerous placenta problems. Placental abruption, where the placental lining separates from the uterus, rises from a risk of 1 in 1500 to 1 in 300 after just one Cesarean section; 20-40% of placental abruptions result in neonatal death. Placenta previa occurs when the placenta adheres to the uterus dangerously close to or covering the cervix and has a 5 times higher frequency after a Cesarean section. This risk increases with number of previous Cesarean surgeries: after 4 or more, placenta previa is 9 times more likely. Risk of ectopic pregnancy (those that develop outside the uterus or within the Cesarean scar) is slightly increased as well, with the likelihood about 1.3 times higher.

The occurrences of negative outcomes listed above are likely to increase as the rate of Cesarean section increases. As measured in 2005, the rate of Cesarean sections in the US was 30.2%. This excessive rate is due in part to the low incidence of VBAC which is in part due to maternal 'choice' and in part due to lack of VBAC support by hospitals and doctors. In his recent Naturalnews article, 'Early Repeat C-Sections Linked to Health Complications in Newborns' Reuben Chow states "...It is also likely that many women are opting for C-sections with the hope that it would be the easier choice of delivery. And the thing about C-sections is that, once a woman has had it once, she is very likely to use the same method for subsequent pregnancies." This statement reflects a common theme portrayed by the media that women choose Cesarean sections over vaginal births. However, the 2005 'Listening to Mothers' survey found only 1 woman out of 1500 who requested a primary Cesarean section (for a first birth that is). Choice of primary C-section is virtually non-existent. As for the choice of subsequent Cesarean section, VBAC is often not an option; many US hospitals officially ban VBAC, while others have 'de facto' bans where no doctor on staff will support one.

This risk that women are advised of, that of uterine rupture while attempting a VBAC, is about 6 in 1000 or 0.6%. During a primary vaginal birth uterine rupture can still occur and does at a rate of about 2 in 1000 or 0.2%. Additionally, because an obstetrician is required to be present in any hospital were a VBAC is underway, the risk of death to mother and baby during an actual uterine rupture is very low. With a skewed assessment of this risk and little, if any, assessment of the risk of secondary Cesarean, the ability of women to make informed decisions is badly compromised.

Birth is a natural process that can be very empowering for a woman. A Cesarean section is often the antithesis of birth empowerment and can be emotionally traumatic for many women. The International Cesarean Awareness Network (ICAN) has more information including local support groups (http://www.ican-online.org).

Sources:
Hemminki, E. and J. Merilinen 1996. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. American journal of obstetrics and gynecology 174: 1569-1574
Zelop, C. and L.J. Heffner 2004. The downside of cesarean delivery: short- and long-term complications. Clinical Obstetrics and Gynecology 47: 386-93.
Fang, Y.M. and C.M. Zelop 2006. Vaginal birth after cesarean: assessing maternal and perinatal risks--contemporary management. Clinical Obstetrics and Gynecology 49: 147-153.
Lamaze International: http://www.medicalnewstoday.com/articles/407...
Block, J. 2007. Pushed The Painful Truth About Childbirth and Modern Maternity Care, Da Capo Press, Cambridge, MA.

About the author

Jen Patterson is a mom, doula, and evolutionary biologist. She is co-teaching nutrition classes for fertility enhancement.