Requesting a Cesarean


Around the world many women are seeking out cesarean section birth, not because it is necessary, but because it sounds better in some way. Many mothers-to-be are afraid of labor: It sounds uncontrollable, potentially long, and painful. Elective surgery may seem preferable: you schedule a date, get your anesthesia, and your baby is born. No watching the baby's heartbeat on the monitor, no anxiety about episiotomy or vaginal lacerations, no stretched-out private parts, and in the long run, maybe a lower chance of incontinence and uterine prolapse.

But:


  • Recovery from cesarean is typically more painful and prolonged than recovery from vaginal birth. Most new moms are in the hospital for three nights and require pain medications for weeks. Successful breastfeeding is certainly possible, but may be more difficult after cesarean; many moms feel unable to provide full care for their newborns for a week or two after surgery.



  • Serious complications are more likely. These include: surgical injury to the bladder, excess bleeding, blood transfusion, post-op fever, uterine infection and incision complications. These complications are all rare but more common from cesarean than after a vaginal birth.



  • After a cesarean, future pregnancies have about a one percent risk of uterine rupture, a potentially catastrophic event in which the uterine incision breaks open during pregnancy or labor.



  • Surgical complications become more likely after multiple prior abdominal surgeries (including cesarean); if you are planning on having a lot of children, you may be buying yourself a difficult third, fourth or fifth birth.



  • Most women (my guess is over 90 percent) who have had both a vaginal birth and a cesarean would choose vaginal birth if given the choice. Reasons include a feeling of participating in the birth, easier recovery, and fewer risks.

Medical journals are full of articles on the ethics of offering cesarean just for "patient request." While some physicians are willing to provide this service as long as the woman understands the risks, benefits and alternatives, others feel it is not good practice to offer a riskier procedure based just on patient preference. If you think that you want an "elective" cesarean, talk to your practitioner early on.