On Women: The Downside of C-Sections on Demand

Elective surgery is in, vaginal delivery is out, and the trend may be hurting women and their babies.

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My three pregnancies all ended well past their due dates—cosmic payback, perhaps, for my own perpetual lateness. Now, though, it's becoming trendy to schedule childbirth by appointment, not just for medical reasons but also for the convenience of women who wish to give birth without the muss and fuss of labor. There's a certain appeal to choosing baby's birthday in advance, say, in time to get that yearly tax deduction or use those upcoming Super Bowl tickets (yes, some wives really are that understanding). And certain celebrity moms-to-be have reportedly scheduled their cesareans three or four weeks before their due date to prevent the stretch marks and saggy loose skin that come from having an overstretched abdomen.

A growing body of research, however, suggests that this practice elevates health risks for both mom and baby. For mom, C-sections (regardless of whether they're emergencies or planned) mean a longer hospital stay; longer recuperation; higher risk of infection, blood clots, and complications from anesthesia; and an increased possibility of having a hemorrhage that results in a hysterectomy. Her baby also might not fare as well, especially if doctors perform the C-section more than a week before the due date, which they do routinely to avoid having a woman go through the pains of labor. Such babies have a higher likelihood of lung problems like pulmonary hypertension and respiratory distress syndrome, according to a study published last month in the British Medical Journal. Those delivered by elective C-section three weeks before the due date, the study found, had four times the risk of breathing complications and five times the risk of serious lung problems compared with babies delivered vaginally or by emergency C-section. And although only 2 percent of babies born by elective C-section experienced a respiratory problem in the study, many needed to be placed in an incubator and spent extra days in the hospital; they might also face an increased possibility of developing asthma later in childhood. The closer a baby was to the full 40-week term, the lower the lung risks, probably because the lungs had more time to mature, says lead study author Anne Kirkeby Hansen, a research fellow at Aarhus University Hospital in Denmark. The process of labor, too, might have benefits: "Certain stress hormones are released right before and during labor that are very important for lung maturity," Hansen says. For both these reasons, women who need C-sections for medical reasons may want to discuss with their doctor whether they can go into labor naturally before the surgery begins.

How often pregnant women order C-sections on demand isn't known, but the National Center for Health Statistics recently reported that the total C-section rate in the United States reached an all time high of 31 percent in 2006. Some of the rise is due to a swing away from vaginal births in women who've previously had C-sections; researchers have found that vaginal births in those cases increase the risk of uterine rupture. But beyond this, doctors may be pushing scheduled surgery more often these days. As the C-section rate rises, "obstetricians aren't as good at managing vaginal births as they used to be," says Gene Declercq, a professor of maternal and child health at the Boston University School of Public Health who has researched the utilization of C-sections. It's a lot easier for them to do a C-section, he says, than maneuver a large baby through the pelvic opening. "And," he adds, "it organizes their day infinitely better to do scheduled C-sections and not have to wait around the hospital for a woman to fully dilate."

But given all the care that a woman puts into eating well and taking care of herself when she's pregnant, convenience of the childbirth experience should be low down on her priority list. So, too, should worries about how her body's going to look afterward. With all the evidence pointing to the benefits of going into labor naturally, I'd say my stretch marks and tummy jiggle are worth it.