With increasing rates of Caesarean section in Ireland and a trend towards some women opting for a surgical delivery never has there been more of a need for balanced information to counsel pregnant women. Research carried out in 2011 put the rate of caesarean section in Ireland at 26% of the total number of live births. This is above the European average. This increase in Caesarean delivery was attributed in part to an increase in the number of first time mothers and an increase in the maternal age of the mother at delivery. First time mums over 35 years are statistically more likely to need a Caesarean delivery.
Other reasons for Caesarean include breech presentation, failure of the labour to progress, multiple births and maternal choice. Maternal choice without medical reason is estimated to be a low percentage of the total number of Caesarean sections in Ireland. However, in China it is thought to be 11.6% of the total number of Caesareans carried out! Recently the NICE (National Institute for clinical Excellence in the UK) guidelines advised that best practice should be that if a women has a genuine fear of childbirth she should be offered counselling to overcome this. If following this she still feels she wants a Caesarean delivery then ideally this request should be facilitated.
A fear of childbirth is quoted often in the literature as a reason for women to opt for a surgical delivery. So what are the risks to mum and baby from a Caesarean delivery? There seems to be two schools of thought when looking for information. The first school says a Caesarean is much better and less complicated than a natural delivery. Knowing when and how the baby will be born may be appealing for a woman who is terrified about what might go wrong with a vaginal delivery. Then there is the second school that advocates natural delivery and will tell you that without a vaginal delivery you will not bond to your baby and your relationship will be affected forever more.
So listed below is an unbiased list of the pros and cons of Caesarean to help women make an informed decision.
If you have a Caesarean you will have a longer stay in hospital to recover. You will stay up to 3-5 days after Caesarean as opposed to 1-2 days after a normal delivery. The recovery time is also lengthier and as a Physiotherapist I always say 6 weeks for initial healing and 6 months for complete healing.
You have an increased risk of hysterectomy from post-partum haemorrhage but a lower risk of early postpartum haemorrhage on your first Caesarean.
The good news is that you are less likely to suffer trauma to the pelvic floor with a Caesarean. You have the same chance of being able to breastfeed although you may need a bit more help getting started. There is also no increased likelihood of developing post natal depression because of how you have delivered.
However, your baby is more likely to need neonatal intensive care. This is due to the fact that babies delivered by Caesarean have an increased risk of respiratory problems due to a lack of surfactant (a substance that lines the lung). This risk is greater the earlier the baby is delivered and a baby delivered after 39 weeks is less likely to have problems compared to a baby delivered after 38 weeks.
The other bad news is many of the complications associated with Caesarean seem to occur with multiple Caesareans. With each Caesarean the risk of developing problems with the placenta increases, as does the risk of both abdominal and pelvic pain caused by adhesions. Adhesions are deposits of fibrous tissue that develop as an inflammatory response to surgery. Some research links adhesions not only to pain but also to disruption to the bowel and to having a negative effect of fertility.
With more women now undergoing Caesareans, the cumulative effects of this surgery on the body is currently an area of much interest.
Miriam Rowlands
Chartered Physiotherapist & Clinical Pilates Instructor at Physio South East
