Cesarean Deliveries: Are Mother and Child at Risk?
By Pat Lendt

"In my opinion, no woman whether intelligent or unintelligent, modern or old-fashioned, wants the birth of a baby a blank in her memory. Certainly, none will wish to be relieved of pain at the risk of harm to the baby" (Edwards and Waldorf 1). This timeless quotation came from Gertrude Nielsen, an Oklahoma City physician and mother of three, in 1936. Dr. Nielsen’s opinions regarding childbirth were dismissed by many of her fellow male peers, who believed drugged births were more beneficial to mother and child. Even today a great majority of physicians still favor drugged childbirths and have begun to accept cesarean deliveries as the norm.

According to Diana Korte and Roberta Scaer, authors of A Good Birth, A Safe Birth, "[c]esarean births are now more common (20 percent of all births) than are totally drug-free hospital births (less than 10 percent)" (1). This number indicates that at least one in every five births will be a cesarean. If cesareans were safe and conducive, there would be no concern over the number of cesareans being performed daily. However, according to Dr. Kathryn Cox and Judith D. Schwartz, authors of The Well-Informed Patient’s Guide to Caesarean Births, the reality of the situation is that "[t]here is one maternal death for every 2,500 to 5,000 caesarean deliveries. This rate is two to four times the mortality rate for vaginal births" (109).

A great deal of the problem is that women trust their doctor to make the right decision concerning the delivery of their child. Many of these women do not realize that doctors are on a rush-rush schedule and do not want to wait the hours necessary for a baby to arrive naturally. And as stated by Nancy Wainer Cohen and Lois J. Estner, authors of Silent Knife, many women "welcome surgical delivery as the end to a poorly managed labor. Many cesarean mothers describe an initial feeling of relief when the ‘need’ for a cesarean is discovered; surgery provides an escape from the tortures of the hospital labor room" (7). Yet, if many of these women knew beforehand the dangers of a cesarean, they would more than likely feel fear rather than relief when the "need" for a cesarean is discovered. It is, therefore, important for women to educate themselves and to learn not to accept a doctor’s word or action as gospel.

A BRIEF HISTORY OF THE CESAREAN

"Legend has it that Julius Caesar was born by cesarean section and that the procedure was named after him" (Cohen and Estner 10). Whether or not this is true, it is evident that this type of surgical delivery has been in practice for many centuries. Originally this procedure was used to separate the infant from its dead mother so that a separate burial could take place. Later it was used to save the life of an infant when his or her mother had died. Eventually, in the sixteenth century, the cesarean was performed to save both the life of the mother and the child.

As technology advanced and women began to have their babies in hospitals, rather than at home, the cesarean gained in popularity. Some of this popularity was due to the opinion of many women who believed they should be free from the pains of labor and childbirth. According to Margot Edwards and Mary Waldorf, authors of Reclaiming Birth: History and Heroines of American Childbirth Reform,

[i]n the thirties and forties, most of the women who were aware of the controversy [natural childbirth versus drugged childbirth] . . . were not anxious to return to what their grandmothers had suffered.... Furthermore, they felt that undrugged childbirth was crude and unscientific, and as modern women they wanted no part of it. Nor would they accept the dictum that their greatest ecstasy and triumph in life would come from being awake to hear their infant’s first cry (17). This feeling was reinforced by Dr. Joseph B. DeLee, founder of the Chicago Maternity Center, who illustrated his theory with harsh images. Birth for the infant, he said, was equivalent to having one’s head squeezed in a slowly closing door, . . . . DeLee believed the repeated thrusts down the birth canal, head pounding against the rigid perineum, were in some cases responsible for brain damage, epilepsy, and cerebral palsy.

His remedy was to sedate the women during the first stages of labor, use ether during the second, make a cut of several inches to enlarge the vaginal opening and then lift the fetus out with forceps. Afterward, ergot would be administered to contract the uterus, followed by mechanical removal of the placenta and suturing of the incision. Women would thereby be restored to what he called "virginal conditions" and the infant saved from the worst of the torture. (Edwards 4-5)

 It is important to note that Dr. DeLee’s procedure was not meant to be cruel. He believed he was doing the most humane thing possible for both mother and child. It is also understandable how some women of this time permitted this procedure to be performed. After hearing what torture they may be putting their child through, many of them probably felt they were doing the best thing possible for their child and for themselves.

HOW A CESAREAN IS PERFORMED

Basically, "[a] caesarean birth is a delivery of a baby in which the mother’s abdominal and uterine walls are surgically cut through, or ‘sectioned.’ It is also called a caesarean section or a c-section." (Cox and Schwartz 18). As simple and uncomplicated as this sounds, in reality this is major surgery. It is not simply a matter of being snipped here and there, having the baby removed, and then stitched up. The reality is that

[a] caesarean operation generally lasts between 30 minutes and an hour. The actual birth is accomplished within the first ten minutes or so, or sooner if general anesthesia is used. A doctor must cut through several layers to reach the baby: the abdomen, the uterus, and finally the amniotic sac, ....  As soon as the head emerges, it is suctioned free of amniotic fluid, mucus, and blood.

The remaining time is devoted to sewing up the incision. The ovaries and fallopian tubes can be visualized. Then layer by layer, the surgical incisions are repaired . . . . (Cox and Schwartz 29)

 While all of this is happening, the mother may or may not be conscious. Whether she is conscious or not, she is not an active participant of the birth of her child. And while this may seem a small price to pay, in reality some of "the physiologic costs of cesarean section to the mother . . . . are pain and depression, gas, infection, hemorrhage, adhesions, injury to adjacent structures, blood transfusion complications, aspiration pneumonia, anesthesia accidents, cardiac arrest, and death" (Cohen and Estner 29). In addition to this, "having lost control over her childbirth experience, she is likely to feel cheated, disappointed, angry, frustrated, guilty, regretful, helpless, and depressed . . . . she may [also] experience a sense of failure . . . and envy of those who have given birth vaginally" (Cohen and Estner 33).

It is important not to forget that the infant is also often greatly affected by the cesarean. For example, the newborn may experience "jaundice, fewer quiet and alert periods after birth, iatrogenic respiratory distress, neonatal acidosis due to maternal hypotension, inadvertent infant-to-placenta transfusion and neonatal death" (Cohen and Estner 35). It is, therefore, amazing how many doctors continue to use this procedure so casually—especially when they are aware of all the complications involved.

FACTORS FOR THE RISING CESAREAN RATE

If a cesarean is performed under the correct circumstances, it can be a life-saving procedure. For example, if the infant "stubbornly refuses to budge from a transverse presentation [it] must be delivered by cesarean" (Cohen and Estner 16). Unfortunately, cesareans are often performed when a vaginal delivery is possible. If cesareans are to ever decrease in number, the public and the medical profession need to examine the reasons why cesareans are often performed. The following five factors are derived from Cohen and Estner’s (11-12, 14) list of twelve factors for the causes for the rising cesarean rate in the United States:

    1. Threat of malpractice suits is the most frequent reason given for the increase. Doctors are concerned about the threat of malpractice suits if a cesarean is not performed and the outcome is a "less than perfect baby" . . . .
    2. The policy of "Once a cesarean, always a cesarean" has become standard obstetrical practice in the United States . . . .
    3. Lack of training makes physicians ill prepared to manage labor. . . . Many physicians stated that they are not familiar with normal labor but have received extensive training in the use of highly technical equipment. . . .
    4. Most physicians believe that a cesarean section results in a superior outcome. . . . In fact, fetal mortality and morbidity rates have shown little change in the decade since the cesarean rate took wings and flew. . . .
    5. Economic incentives are involved: increased earnings for obstetricians—more money for less time, a predictable expenditure of physician time, added length of hospital stay with increased hospital earnings, and greater reimbursement by third party payment for a cesarean—provide little incentive to support vaginal birth or to adopt a "wait and see" attitude that could culminate in a vaginal delivery. . . .
What a shame it is that human life is being put at such high stakes because of fear, lack of knowledge, and money. The purpose of a cesarean is to save lives not to exploit human suffering. It is time for expectant parents to take an active role in the birth of their child. This means learning what options are available, what their doctor’s opinions are regarding childbirth, and what their hospital’s policies are. Many expectant parents do not realize that they have the right to choose where and how they want to have their baby delivered.

Cohen and Estner (40) best sum up the feeling of cesarean births when they write,

[i]n the meantime, the silent knife continues to slash its way across the stomach of America, maiming our confidence in out bodies and murdering our hopes and dreams for our children’s births. Its quick stealthy flash cuts through to the core of our being, stripping us of our illusions of control and leaving us wounded and vulnerable.

Works Cited

 Cohen, Nancy Wainer, and Lois J. Estner. Silent Knife. Massachusetts: Bergin and Garvey Publishers, Inc., 1983.

Cox, Kathryn, M.D., and Judith D. Schwartz. The Well-Informed Patient’s Guide to Caesarean Births. New York: Dell Publishing, 1990.

Edwards, Margot, and Mary Waldorf. Reclaiming Birth: History and Heroines of American Childbirth Reform. New York: The Crossing Press, 1984.

Korte, Diana, and Roberta Scaer. A Good Birth, A Safe Birth. Toronto: Bantam Book, 1984.