Obstetricians will be forever known by their decisions to make the Cut. This used to mean whether to have an episiotomy or not. But now Cut means, order the Cesarean Section. The mantra used to be mostly uttered under the breath from obstetrician to nurse when the fetal monitor tracing was suspect, ordering a Cesarean instead of allowing labor to proceed, and it could be heard echoing loudly once the anesthetist has the patient satisfactorily asleep telling the obstetrician to proceed with the operation. But now, it’s just Cut Cut Cut. Caesarean rates, a mere 3% in the 1950s have risen nationally to about 30% and in inner cites in various locations, Brazil seeming to be the leader, it’s risen to 90% of births. But have we left the safety zone for the expedient zone?

Complications of cesarean have loomed minuscule in light of the risks of vaginal births on continence, sexuality, and the schedule. The old reasons of failing to dilate, fetal distress on the heart rate monitor, maternal illness are statistically beginning to take a back seat to: because I want to, because I’ve had herpes, and because I had a prior C/S. This has translated into some big positives for the babies: the risk of dying right before term is almost eliminated, the risk of aspirating the bowel movement meconium is almost eliminated, and the risk of being born overdue or with what has been called post-maturity syndrome are all eliminated for the babies. But what might not be as evident is that these babies are less likely to breast feed, have poorer bonding because of the mother’s poor birth experience, the babies don’t get the normal fluid squeeze as they’re coming through the birth canal so they are a bit more likely to have transient breathing problems, and even increased asthma, and although being born overdue isn’t likely, some are inadvertently delivered prematurely! Rarely, in C-sections babies are inadvertently cut during delivery!

And for mom: the complications don’t stop with getting through this pregnancy. In this pregnancy she’s at greater risk for a blood clot, an infection, and pain after delivery. In the future she’s at greater risk for uterine rupture, tubal pregnancies, adhesions and infertility. In a future pregnancy if the placenta implants over the scar, a risk that is many times increased if she has 4 or more C/S, then her risk of hemorrhaging with the birth and needing a hysterectomy jumps up about 4 times. Simple decision, nope. You and your gyno have some gabbing to do.


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