Feb 5, 2010 7:09 PM
Ellen Spencer, 40, of Hanson, Mass., is recovering from a cesarean section. With a 1-month old to take care of, and her older toddler underfoot, bouncing back from major surgery isn't easy.
"I knew I was going to have a C-section," Spencer tells WebMD. "I had abdominal surgery a couple of years ago to remove some fibroids in my uterus, and as a result, my doctor thought it was the better option over going natural. But the recovery has been tougher and longer than I thought it would be."
Despite the slow-going recovery, the convenience of knowing exactly when she was going to have the baby made planning easy, especially with a busy job. And for out-of-town family, making the trip to Massachusetts to welcome the newborn was scheduled and coordinated well in advance.
Spencer's situation is increasingly common: Today, C-sections represent 31.8% of all births in the U.S. annually -- that's more than 1.3 million births. And that number continues to rise. In fact, in the last decade, the rate of C-sections in the U.S. has grown by more than 50%.
With the numbers inching upward, it's important for expectant moms to understand what a C-section means for their bodies, and their health. Here, experts explain the pros and cons of C-sections, why the C-section rate is rising, and what recovery from a C-section is really like.
Simply put, a C-section is a surgical procedure in which a baby is delivered through a mother's abdomen.
Nearly one in three women in the U.S. deliver their babies by C-section, either for elective reasons, or because of a risk to mother or child.
As with any surgical procedure, there are benefits and disadvantages to C-sections that need to be carefully considered.
"There are benefits to a C-section, especially practically speaking," says Iffath Hoskins, MD, chair of the department of OB/GYN at Lutheran Medical Center in Brooklyn, N.Y. "A mom will know in advance, if it's a planned C-section, when she will have the baby."
Another advantage, Hoskins says, is knowing that you may have important resources available, like neonatologists who can help if there are issues with the baby.
Although C-sections can offer conveniences, they also carry risk.
"Women really need to understand that a C-section is major abdominal surgery," says Jan Kriebs, a certified nurse mid-wife in the University of Maryland Medical Center's obstetrics, gynecology, and reproductive sciences department. "While a team of health care professionals, including an OB, your mid-wife, and nurses work together for a successful outcome, C-sections are very serious."
The procedure involves an incision through the skin, abdomen, muscle, and then into the uterus. From start to finish, including pre- and post-op, a typical C-section lasts 3-4 hours.
"Because we do so many so often, people are lulled into a false sense of security," Hoskins says. "While the process usually works very well, we are cutting into abdomen, adjusting the organs, and making incisions near the bladder and bowel."
As a result, there could be damage to the surrounding organs, excessive bleeding, or an infection, Hoskins says.
For women who have three or more C-sections, the risk rises even further.
"The placenta could be deeply attached to the uterus because of scarring from previous C-sections, and it could be difficult to get out, which means heavy bleeding, therefore a higher chance of needing a blood transfusion, or needing hysterectomy just to save the mother's life," Hoskins says.
He says that 40% or more of women having three or more C-sections will experience these complications, so keeping the procedure limited to those that are medically necessary could be life-saving.
Despite the risks, the number of C-sections being performed in the U.S. continues to climb, for several reasons.
"Physician training and willingness to use instruments like forceps and vacuum has decreased," says Katherine Economy, MD, MPH, a maternal fetal medicine specialist in the department of OB/GYN at Brigham and Women's Hospital/Harvard Medical School. "And if you haven't been trained on how to properly use these tools when the situation warrants it, then you're more likely to turn to a C-section."
Also, as the number of primary C-sections rises, so does the number of subsequent C-sections.
"Women are not being educated on vaginal birth after C-section, or VBAC," Kriebs says. "And in fact, many institutions will simply not even allow this procedure after a woman as already had a C-section."
As a result, births that could have occurred "naturally" are being performed as C-sections, pushing the number even higher. In March 2010, an NIH advisory panel recommended that hospitals end bans on VBAC.
Risk also comes into play -- medical and legal, Kriebs says. More health care providers are turning to C-sections at the slightest hint of a complication during childbirth. "When a situation turns complicated during a delivery, today there is a greater tendency to perform a C-section to minimize the risk to the child," Kriebs says.
The number is also creeping upward because women are tapping into C-sections as a childbirth "option" more frequently.
"Women are worried that something will happen to their baby during labor, so maybe they opt for a C-section upfront," Economy says. "Or, they don't want to go through labor pain, because it is painful, and think they can handle the pain of surgery better because it's a controlled setting."
Age also plays into the expanding number of U.S. C-sections. Hoskins says that more women are delaying childbirth until they're older, and, as a result, are more likely to need a C-section; especially if they're over 40, because of the increased risk of complications in older moms.
Waiting until later in life to have children may also mean more need for fertility treatment, which could increase the chance of having twins. And that, in turn, makes a C-section more likely.
"Recovery from a C-section isn't easy," Economy says.
The typical hospital stay for a C-section is four days, compared to the two that new moms need after a vaginal birth, Economy says.
Immediately after the procedure is over, you'll still have a catheter in, the effects from the regional anesthesia will linger for a few hours -- which means you'll be numb from the waist down -- and you'll need narcotics for the pain.
The good news is by the next day, the catheter will come out and you'll have feeling again in your feet and legs. But you'll still need the narcotics, especially because the nurses will want you to get out of bed and move -- which will hurt -- to minimize the risk of blood clots.
C-section recovery isn't over when you go home. "Once you're out of the hospital, you can't lift anything heavier than baby for the first couple of weeks," Economy says.
And, no driving for about two weeks, no exercise for 4-6 weeks, and no sex for six weeks, Economy says.
"You are really going to feel worn down and tired after a C-section, and on top of that you have a newborn baby to take care of, so the load and the demand on your body is very high," Hoskins says. "Don't expect any great miracles before 3-4 weeks, and many women will go up to three months to be 100%."
A C-section may sound intimidating, but thousands are successfully performed in the U.S. every day, resulting in happy and healthy moms and babies.
"The important message is that both [vaginal and C-section births] are safe," Economy says. "But it's also important to keep in mind that if you compare a vaginal [birth] that goes well and a C-section that goes well, a vaginal [birth] is still far safer."