Posted November 22, 2012 in BIRTHING

Elective Cesarean section – why are women making this choice?

Elective Cesarean section
Elective Cesarean section

Elective cesarean section refers to making an intentional choice of cesarean delivery instead of spontaneous vaginal delivery.  A remarkably high rate of cesarean births has been observed over the past few decades that are attributed to the choices made by physicians as well as pregnant mothers. According to latest data, almost 30% of all child-births are taking place via cesarean section that greatly affects maternal health in long term period. Out of this 30% a lot of cases are not even recommended or medically necessary. According to national data of elected cesarean delivery (also called cesarean delivery on maternal demand) almost 2.5% cases of cesarean sections are chosen by mothers.

According to another published study in renowned New England Journal of Medicine, majority of cesarean sections are being performed on the preference of mother and at a fairly early stage (i.e. before 40th week of gestation, as oppose to 42nd week of gestation after which baby is referred to as post-term) that increases the risk of a number of heath issues (like respiratory and gastrointestinal infection in babies due to anesthesia exposure), because of which it is important that spontaneous vaginal deliveries must be encouraged in mothers, except if there is a clear medical indication.

The primary causes of maternal preference of cesarean section over vaginal delivery are:

Stress of labor:

The process of labor can be fairly distressing which leads to stress and anxiety in mothers. Most cases are reported in mothers who had gone through a prior bad episode of vaginal delivery. The option of epidural anesthesia during delivery or childbirth relaxes the mother so that she does not have to go through agonizing and potentially embarrassing period of labor pains and vaginal birth.

More convenient:

Cesarean section may appear fairly convenient for women as they know the exact date of childbirth and so it helps them to plan various events and other important things like leave from work, making prior arrangements for nanny to take care of other kids at home and other home chores so that once the mommy is away, kids and other family member don’t have to go through any hassle or issue.

Psychological relief:

Mothers may feel more relaxed and calm as they don’t have to do much for the delivery of baby and it also saves them from the worry of birth trauma to the child as a result of impacted labor, fetal distress (seen with prolong labor), trauma while passage through birth canal as a result of possible instrumental delivery like forceps or vacuum. Moreover, there is always a slight risk that even a normal spontaneous vaginal delivery may end up in emergency cesarean section due to mismanagement of labor.

Certain medical issues:

Some women have issues that make them a much better candidate for cesarean section than vaginal delivery. The role of healthcare providers in this regard is also very important as positive counseling in the favor of cesarean section encourages mommies to plan elective sections without considering the option of the trial of labor. Mothers who are obese or who became pregnant after the age of 35 years often consider cesarean section as a preferred mode of childbirth.

Trauma or harm to mother:

The rate of cesarean section on maternal demand is fairly getting high in past few decades. This is also attributed to maternal wish to avoid any potential harm or damage to her perineum or perineal structures. It has been suggested that woman who undergo multiple vaginal births are at an elevated risk of developing urinary incontinence in later life. Moreover, due to difficult delivery or labor process, delicate tissues and muscles of pelvic floor may also get damaged leading to an increased risk of prolapse. A lot of women are opting cesarean section to prevent long term sequelae.

Moreover, post procedure risk of urinary incontinence is highest in spontaneous vaginal deliveries (23%) and instrumental delivery (35%) than elected cesarean section, in which the risk of incontinence is only 4%.

Effect on sexual stimulation and intercourse quality:

As a result of vaginal delivery, the pelvic ligaments stretch greatly to allow the fetal head to pass; moreover an episiotomy can greatly impair sexual stimulation if performed in inexperienced hands. A lot of women complain of dyspareunia after episiotomy that can greatly affect the quality of personal life.

All these factors come into play when mothers plan elective cesarean section on demand-but the role of healthcare providers is pivotal in this regard as they do not always explain the potential issues that a woman can face after cesarean section.

Dr Rabia Sikandar(MD-OBGYN) and Guest health writer.