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Home :: Intervention :: Caesarean
Caesarean

An increase in surgical birth rates was not associated with any clear benefit for mothers or babies, “but is linked to increased morbidity for both. Elective caesarean delivery could increase neonatal morbidity and mortality.. and is known to be associated with respiratory distress syndrome” — Professor Villar, leader for maternal and perinatal health research in the department of reproductive health and research at the World Health Organisation

Baby being born by caesarean

Baby being born by caesarean

A Caesarean section is major abdominal surgery that can only be performed by a surgeon or obstetrician and can be a life saving procedure for some women and their babies.

A Caesarean section, also known as C-section or Caesar, is a surgical procedure in which incisions are made through a mother’s abdomen and uterus to deliver one or more babies and the placenta.

In Australia in 2006, more than 30% of women who gave birth had a caesarean.

The World Health Organisation states that caesarean rates should not be over 10 – 15%.

Women being seen by a private obstetrician are more likely to have a caesarean than those in public care, even though Australian research shows them to be the healthiest in our society. Women under the care of a Midwife in a Group Practice model or an Independent Midwife are the least likely.

More than half of all caesareans in Australia are due to the effects of intervention or for reasons other than medically indicated.

statsStatistics

23.7% Private Hospital Caesarean rates (NSW)

31.25% Public Hospital Caesarean rates (NSW)

(Source: NSW Mothers & Babies Report 2009)

Check your local hospital c-section rates here in our Birth Services Revealed.

Medical reasons for performing a Caesarean operation can include:

  • Placenta Previa
  • Transverse position of the baby
  • Herpes infection as the baby may face life-threatening situation if it contacts the infection.
  • Very low birth weight
  • Placenta abruption
  • Cord prolapse
  • Unsuccessful induction
  • The big baby

Unfortunately, history shows that advances in the practice of medicine and surgery are rarely attained in a thoroughly rational manner, but that a period of undue enthusiasm, or even of almost reckless abuse, usually precedes the establishment of the actual value of a given procedure.
— John Whitridge Williams, pioneer of academic obstetrics

Reasons suggested that might not be essential:

  • Breech births (often because the obstetrician is more skilled in caesareans than in delivering breech babies.)
  • Twins
  • Foetal distress shown on Continual Foetal Monitor
  • Previous caesarean
  • Slow procession of labour
  • Large baby
  • Unnecessary augmentation and inductions
  • Precious (high risk) baby
  • Previous operation on or injury to the uterus
  • Caregiver’s preference

thupPositives

  • Caesareans eliminate the pain of labour; but the pain after lasts longer than with vaginal birth and recovery usually takes longer.
  • Can save a life

thdownNegatives

A team of obstetricians perform a caesarean section in a modern hospital. The image shows the very first moment the mother glimpses her new-born child.

A team of obstetricians perform a caesarean section. The image shows the very first moment the mother glimpses her new-born child.

  • Risk the baby may be cut in the procedure. There is a 1.9% chance the surgeon’s knife will accidentally lacerate the foetus (6.0% when there is a non-vertex foetal position)
  • Babies born by caesarean have higher rates of admission to neonatal intensive care with breathing difficulties. This risk increases dramatically if caesarean is done before 39 weeks gestation.
  • Bladder infections from the catheter
  • The higher risk of maternal death due to complications is much higher than with a vaginal delivery (less than one in 2,500 after a caesarean and less than one in 10,000 after a vaginal birth).
  • Risks are low, but caesareans carry a higher rate of injury to abdominal organs, infection, blood clotting and other complications.
  • A caesarean can impact on how you deliver subsequent babies.
  • Anaesthesia problems
  • Thrombophlebitis
  • Haemorrhaging is six times more likely if you have a caesarean
  • Pain
  • Bonding between mother and baby, and consequently breastfeeding, may be harder
  • You are not the first person to hold your baby, often many people handle your baby before you will get to.
  • You may not be able to have skin to skin contact straight away and may be separated from your baby for some time after the birth.

Factors such as the socio-economic status of the women, the influence of malpractice litigation, a woman’s expectations, financial considerations and convenience may be more important than medical reasons in the decision to perform a caesarean.

If you are advised to have a caesarean by your caregiver and you are not sure or happy with the reasons given, you are totally within your rights to seek a second opinion and/or change your care provider

What has been trivialised to date is the value of the vaginal birth. Labour is a very finely orchestrated event that allows the baby to say, ‘I’m ready’, which triggers a series of hormonal changes in the mother ultimately geared to benefit the bonding between mother and baby. I can tell you that the difference between the high of a mother who’s had a vaginal birth and the response of a mother who’s had a caesarean … well, they are worlds apart. — Dr Andrew Bisits, the head of obstetrics at John Hunter Hospital in Newcastle (Good Weekend, 05/09/09)

The doctors and nurses were gossiping amongst themselves in the most casual manner. It felt like my body was a lump of meat and they had done this so often that no one realised I was a person with another person in my tummy. — Janelle

Having a caesarean birth also affects the future reproductive possibilities of the woman, because having a cesarean section means she has a decreased chance of ever getting pregnant again. And if she does get pregnant again, she is at higher risk that her pregnancy will occur outside her womb, a condition that will never result in a live baby and is life threatening for the woman. If in her subsequent pregnancies she succeeds in making it to the end of pregnancy and goes into labour, she is also at higher risk of two serious complications during the birth, both of which can threaten her own life and the life of the baby: a placenta that blocks the outlet for the baby or a placenta that detaches itself before the baby is born. — Marsden Wagner, M.D., M.S., for 15 years a Director of Women’s and Children’s Health, World Health Organization.

If the caesarean section rate keeps rising then we may well reach a tipping point where once we reach 40% to 45% we’re almost halfway there and it may rapidly accelerate to the point, as has happened in some countries in the world where caesarean section rates can be 70% or 80%. Now if that were to happen then you know we really are becoming a species that no longer gives birth vaginally in the way that we were designed to give birth and I would make the point that probably once we get to that position there’s no turning back. Now all the skills that have been developed over the years to make childbirth safe we would not be able to turn the clocks back and go back to a situation where vaginal birth was the norm. Essentially birth would be something that was surgically managed. — Obstetrician Dr David Ellwood

The primary objective should not be to reduce the rates of caesareans: it would be dangerous, if not preceded by a first step. This first step should be an attempt to promote a better understanding of birth physiology and particularly a better understanding of the basic needs of women in labour. In hospitals where the watchword is to reduce the rates of caesareans, the first effect is usually an increased number of difficult births by the vaginal route and of dangerous last-minute emergency caesareans. This is exactly what we should avoid in the age of the safe caesarean. I have had many recent reports of deliveries during which the obstetrical team tried “everything” in order to avoid a caesarean: drip of synthetic oxytocin, epidural anesthesia, and, finally, either a forceps delivery with episiotomy or even a caesarean after trying the use of forceps. Forceps have their place in museums. The last time I used forceps was in February 1965. Obstetrician Dr Michel Odent

videosFeature Video

c-section_avoid

More than 130,000 pregnant women could avoid cesarean deliveries each year in the US if they and their doctors simply wait a few hours more during labor, according to a study by researchers in the UCSF Center of Excellence in Womens Health. Watch Video.

storiesBirth Stories

At 6am the obstetrician who started his shift came into my room with great urgency yelling at the midwives. He asked for an update on my status and without any explanation he proceeded to try to break my waters. A glimpse of a long sterile object I managed to see before it was thrust upon me. After a few minutes of excruciating pain I said “what the hell are you doing”. His reply was a grunt and he then got up and yelled something at the midwife. Read more.

resourcesResources

Admission of Term Infants to Neonatal Intensive Care: A Population-Based Study
This study from the university of New South Wales shows a greatly  increased risk, for babies born by elective caesarean section to ‘low-risk’ mothers, of admission to neonatal intensive care units.

Maternal and neonatal individual risks and benefits associated with caesarean delivery:
Writing in the British Medical Journal on his study of more than 97,000 deliveries, Jose Villar noted that an increase in surgical birth rates was not associated with any clear benefit for mothers or babies, “but is linked to increased morbidity for both. Elective caesarean delivery could increase neonatal morbidity and mortality … and is known to be associated with respiratory distress syndrome,” wrote Professor Villar, leader for maternal and perinatal health research in the department of reproductive health and research at the World Health Organisation.

Technology in Birth: First Do No Harm – by Marsden Wagner
Caesarean section can save the life of the mother or her baby. Cesarean section can also kill a mother or her baby. How can this be?

The Health Report Part 1 – ABC Radio

The Health Report Part 2 – ABC Radio
Listen to their features on caesarean sections – issues and concerns about the rising caesarean rates in Australia and how with a caesarean “you could be making decisions that could affect potentially the next baby, the one after, family life, how you are physically, mentally, for the rest of your own life and what you’re capable of doing.” (November 2009)

If you have to have Caesarean for medical reasons such as placenta previa, read this to learn how to negotiate with your care providers to make it a better experience for you and your baby.

http://www.birthrites.org/ – a website offering information and support following a caesarean and for women wanting a VBAC (Vaginal Birth After Casarean). Download their 52 page Birthrites booklet, crammed full of information detailing the physical and emotional aspects of caesarean birth, and the challenges of planning future births – exploring the VBAC option in some detail, but also outlining ways to plan a positive caesarean. The booklet considers issues in a before/during/after format to enable women to make informed choices and provides relevant information in relation to caesarean section birth.

statsStatistics

Check your local hospital caesarean rates here in our Birth Services Revealed.

awardsAwards

HIGHEST EMERGENCY CAESAREAN RATE IN NSW (2009)

Broken Hill Base 20.2%

HIGHEST ELECTIVE CAESAREAN RATE IN NSW (2006)

Kareena Private 35.3%

(Source: NSW Mothers & Babies Report 2009)

Check your local hospital c-section rates here in our Birth Services Revealed.

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