C-Sections: Too Quick to Cut?
By Jane Schneider

More pregnant women are having Cesarean deliveries than ever before. Here’s a look at what’s behind the trend – and what you need to know before you give birth.

When I had my first child at age 37, I was so sure I’d have a natural delivery, I never even read the Cesarean section portion in my pregnancy book. I assumed it didn’t apply to me. I had an easy pregnancy, got plenty of exercise and looked forward to having my baby.

After laboring 13 hours without drugs, however, my doctor determined my labor had stalled. “You need a C-section,” he told me gently. Moments later, the room exploded into controlled chaos. My husband was abruptly ushered out and my labor took a precipitous turn for the worse. As I received the epidural, I began to cry. I had worked so hard, only to have my plans dissolve before me. Less than an hour later, my beautiful, healthy son was delivered, but his unorthodox arrival was something I was completely unprepared for.

Perhaps I shouldn’t have been. A legion of women have experienced C-sections, a fact that would have been unusual in my mother’s day. What I didn’t learn until later was how this simple twist of fate would impact my future childbearing choices. My obstetrician never told me having a baby naturally after a C-section would be difficult at best, or that it might not even be my choice to make. I, like many women, was uninformed.

If you’re planning to give birth, you owe it to yourself to learn more about this increasingly common surgery.

Cesareans on the Rise

Of the 4 million births in the United States each year, nearly one in four babies are delivered by Cesarean section. C-section rates have steadily climbed from a low of 20 percent in the mid-1990s to an all-time high of more than 27 percent today, according to the National Center for Health Statistics. Some hospitals exceed 40 percent. In fact, C-sections have become the most common major surgical procedure among U.S. women of reproductive age.

Did You Know?

C-sections have become the most common major surgical procedure among U.S. women of reproductive age.

Why a Cesarean?

C-sections are typically performed because of:
• repeat Cesarean

• failure to progress

• twins and triplets

• high-risk pregnancy from diabetes or hypertension

• breech presentation

• fetal distress

• placenta previa
While once done only in an emergency, nearly half of the C-sections performed today are routinely scheduled – usually by a doctor for a pregnant woman who has already delivered once via Cesarean. Though a surgical birth can be lifesaving for women and their babies, the American College of Obstetricians and Gynecologists (ACOG) asserts that vaginal birth is still the safest way to deliver.

So Why are Cesareans on the Rise?

The reasons are numerous and complex. Repeat C-sections, like the one 32-year-old Sonia Hill experienced, lead the way. Hill had her first baby by emergency C-section, due to what her doctor termed “stalled labor,” the baby’s failure to progress through the birth canal. This is the most common reason first C-sections are performed. Hill had considered delivering her second daughter vaginally. But when her doctor learned of her previous delivery method, “There was no discussion,” she says. “My doctor said I’d have a C-section.”

Of course, if you believe articles like the one that appeared recently in Newsweek, more women who aren’t at medical risk are demanding the procedure. Though one study chronicled this small increase (and drew much media attention), many physicians say it’s still rare among first-time mothers.

“Elective C-sections contribute to the rise, but those numbers are still quite low,” concurs Dr. Jeff Ecker, an obstetrician specializing in high-risk births at Massachusetts General Hospital in Boston.

However, the growing discussion around elective C-sections did prompt ACOG to deem the procedure to be ethical, even if no medical reason exists. Many physicians believe it’s a woman’s right to choose her method of birth.

“If someone wants an elective C-section, I would say it’s a reasonable request, given the risks involved,” says Dr. Khalil Tabsh, chief of obstetrics at UCLA Medical Center. “But,” he adds, “the patient should be educated about those risks.”

More common factors behind the increase in C-sections are physicians’ concerns over malpractice suits, the prohibitive cost of malpractice insurance, and convenience – on the part of some doctors and mothers – who say they like being able to schedule their baby’s due date around their busy lives, as well as skip the pain of labor.

And then there’s the issue of women wanting to avoid the risk of pelvic floor damage that could lead to incontinence or sexual dysfunction later in life. Many doctors say there is scant medical evidence to support this claim.

“The great majority of women who give birth vaginally don’t have pelvic floor damage,” Dr. Joel Evans notes in The Whole Pregnancy Handbook.

Finally, there are many more medical reasons for doing C-sections today, including the baby’s position, the size of the head, the baby’s heart tones, as well as the mother’s health and age.

Some See Troubling Trend
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While C-sections are safer today than ever before, the fact that the surgery is becoming such a common method of giving birth is troubling to some in the medical community.

“We should be very concerned,” says nurse-midwife Katherine Camacho Carr. “Women are capable of giving birth. This is not a procedure without risk for women and babies. It impacts a woman’s health in the present and future.”

But it appears many women are becoming more comfortable with those risks, which include blood clots, hemorrhaging, postpartum infection, and damage to the bladder, bowel and other internal organs. Recovery time is also longer than when delivering vaginally.

As president of the American College of Nurse-Midwives (ACNM), Carr says her organization’s concern over the escalating use of C-sections prompted her to send a letter to several members of Congress calling for a public hearing on the issue, in hopes of creating national guidelines around the use of C-sections.

“We’re on a technological spiral, trying to control our environment and avoid stress,” says Carr. “We must make the decision to not use technology routinely.”

Once a Cesarean, Always a Cesarean?

What many women fail to realize is that once they deliver a baby via Cesarean, it will likely become their method of birth. Vaginal births after Cesarean, or VBACs, have fallen from a high of 28 percent 10 years ago to about 13 percent today. With appropriate care, 70 percent to 80 percent of women successfully deliver vaginally after a C-section.

Thirty-two-year-old Shelley Shamp gave birth to her first child via an emergency C-section because her son was breech, but desperately wanted to have a natural birth. Living in a tiny community, she found the local hospital unwilling to perform a VBAC, and her family practitioner, though supportive, couldn’t counsel her on birthing options. Shamp eventually found a hospital and midwife who would deliver her baby naturally. But she endured a two-hour drive – along with labor aboard a ferry – in order to give birth the way she desired.

“For me, a C-section wasn’t a natural way to have a baby,” Shamp says. “I knew my body could do it. I felt like it was a right of passage. I wanted to experience the emotional sensation of natural birth.” But fewer women will have the opportunity to choose that option as VBAC restrictions tighten.

Again, malpractice issues have made many obstetricians unwilling to do the procedure, and requirements by ACOG that hospitals have anesthesiologists and obstetricians “immediately” available during a VBAC has made it too costly for some facilities to comply. Additionally, a report released several years ago in the New England Journal of Medicine outlining the increased risk of uterine rupture (a 1 percent risk), has scared women away from the procedure.

Even at teaching hospitals, where VBACs are routinely performed, “fewer patients are making that choice,” according to Ecker. He believes part of what’s affecting the rise in C-sections is a societal downshift in how much risk people are willing to assume.

“When women are told that there is a low risk of uterine rupture (with VBACs),” Ecker says, “many aren’t willing to take that risk.”

Dr. Thomas Greenwell, president of the medical staff at Baptist Memorial Hospital for Women in Memphis, where 30 percent of the deliveries are by C-section, agrees. “I think our society has evolved to where we expect a perfect outcome when it comes to giving birth,” he says. “Doctors are being held to a level that’s not attainable and more will err on the side of performing a C-section if a child appears to be in distress than would have 10 or 15 years ago because they want a good outcome for the baby.”

So what should you do during pregnancy to ensure you and your baby’s best outcome?

Educate yourself. Ask questions of your physician, decide the method of birth you’d like to work toward, and weigh both the benefits and risks of a natural versus surgical birth. Realize too that since multiple C-sections are still a relatively new phenomenon, the long-term risks to women’s health are still unclear.

“What I learned through this experience is that you must take charge of your own health and question your doctor’s advice; do your own research,” says Shamp. “I wanted to do what’s best for me. I knew a natural birth was possible and I wanted that opportunity.”

How can you avoid a Cesarean section? Click here for guidelines.  



The Essential C-Section Guide, by Maureen Connolly and Dana Sullivan, Broadway, 2004. A somewhat pro-C-section book, but comprehensive and practical, with good chapters on body wellness and workouts.

What If I Have a C-Section?, by Rita Rubin, Rodale, 2004. Solid, accurate analysis of what’s behind the rising Cesarean trend, and what to expect during surgery.

The Whole Pregnancy Handbook, by Joel M. Evans, M.D., Gotham Books, 2005. A balanced if brief reporting of the main issues around Cesareans; as well as measures women can take to adjust to this delivery.

Online  – Offers downloadable booklets on “Tips for Avoiding an Unnecessary Cesarean Section” and “Having a Safer, More Satisfying C-Section.”

Jane Schneider is a freelance writer and veteran parenting editor.

From United Parenting Publications, June 2005