by Amy Spangler
September 30, 2010

Since 1965, the cesarean birth rate in the U.S. has increased seven-fold from 4.5 percent to 32 percent in 2007. According to a recent review of 228,668 births at 19 U.S. hospitals, nearly 1 out of 3 women gave birth surgically from 2002-2008.

When medically indicated, cesarean section (c-section) can prevent maternal and infant mortality and morbidity. But just the opposite is true when too many c-sections are performed. Data show that the best outcomes for mothers and babies occur when c-section rates are 5-10 percent; and that rates of less than 1 percent or greater than 15 percent may actually do more harm than good.

Studies have warned against potential adverse outcomes from cesarean section for mothers and babies, including longer hospital stays, higher rates of readmission to the hospital, and higher rates of maternal mortality due to complications from anesthesia, infection, and blood clots. Longer-term effects of c-sections include increased risk of placenta previa, placenta accreta, and abruption in subsequent pregnancies and possible association with stillbirth in future pregnancies.

Cesarean birth increases risk for infant mortality
Concerns have also been raised about links between cesarean section and infant morbidity and mortality. In 2004, the infant mortality rate for babies born by c-section was nearly three times that of babies born vaginally (1.77 deaths per 1,000 live births compared to 0.62 deaths). Even after controlling for those variables (demographic and medical) that might explain the difference in infant mortality rates between babies born vaginally and those born by c-section, the difference did not change significantly.

Research shows that labor and type of birth do affect a newborn’s health. The incidence of respiratory distress (breathing difficulties) is three times greater (35.5 per 1,000 live births compared to 12.2) in infants born by c-section without labor, compared to those born by c-section with labor, and nearly seven times greater than those born vaginally (5.3). Data also show that the risk for circulation problems such as persistent pulmonary hypertension is five times greater in babies born by elective c-section compared to those born vaginally.

It’s known that labor triggers the release of hormones and chemicals in unborn babies that in turn stimulate the release of proteins that enhance lung function making it easier for babies to breathe after birth. In addition, the release of epinephrine and the compression of the baby during labor help to remove fluid from the baby’s lungs so that newborns can easily breathe on their own after they’re born.

Breastfeeding after a cesarean birth
Mothers who have had a cesarean birth will still be able to breastfeed, but post-surgery pain and weakness may make it necessary for them to depend on others for help with positioning, burping, and diapering. Cesarean birth increases the likelihood that a mom or a baby will require special care. When mothers and babies are separated and breastfeeding is delayed for more than 12-24 hours, mothers will need to begin expressing their milk to ensure adequate milk production. Early milk expression (a minimum of eight times in 24 hours) lets a woman’s body know that milk is needed.

C-sections are performed for many reasons—medical conditions, family and social pressures, malpractice concerns. Reducing the rate of c-sections will require a collective effort on the part of all those concerned—parents, doctors, lawyers. Each 1 percent increase in the rate of cesarean births costs roughly $9.5 million—money that many public health experts feel could be better spent on doulas trained to help women achieve a vaginal birth. If you want to be part of the solution, be informed, and talk with your doctor or midwife about the birthing option that is best for you and your baby.