“Most Americans are unaware that women ever die from cesarean operations, particularly when those surgeries are scheduled, rather than emergencies. Only rarely is a tragedy like this covered by news media. Most maternal deaths in the United States are kept secret from the general public. Few people have any way of knowing that maternal deaths take place in hospitals or that unnecessary surgery can actually cause a death. The twenty-first century began with the revelation from the Institute of Medicine of the National Academies of Science that roughly 100,000 people die from medical mistakes in the U.S. every year. Some of them -too many- are pregnant women.
Women can hardly make truly informed decisions when some of the most relevant information is not available to them. How many know, for example, that cesarean section (including the scheduled kind) involves the following risks to women?
- increase in hemorrhage requiring transfusion
- hysterectomy for uncontrollable hemorrhage
- accidental cutting of the bowel, leading to peritonitis, possible colostomy, or death.
- accidental cutting of the uterine artery
- surgical trauma to bladder and ureters
- increased postpartum infection, scar breakdown
- scar pain, numbness
- long-term severe back pain following epidural block
- increased pulmonary embolism
- anesthesia mishaps, including paralysis and death
- decreased fertility
- abdominal adhesions leading to bowel obstruction. This risk can happen irrespective of future pregnancy and can be fatal.
- increased tubal pregnancy
- increased placenta previa (the placenta lies over the cervical opening)
- increased placenta accrete (the placenta attaches too deeply into the uterine wall to separate normally, profuse and often fatal hemorrhage is the result)
- increased placenta abrupt (the placenta is prematurely separated from the uterus, cutting off the baby’s only source of oxygen)
- increased uterine rupture
- accidental fetal laceration, which occurs in nearly 2% of all cesareans; in breech presentations the incidence rises to 6%
- respiratory distress, a major cause of neonatal mortality; it is greatly reduced if the woman is allowed to go into labor prior to the C-section. Most women who choose cesarean however do not labor at all, since scheduling the surgery is often a high priority for them and their obstetricians
- accidental prematurity because the cesarean was performed too early. Even repeated ultrasound scans do not rule out this possibility.
“In no way can we improve a normal pregnancy and labor in a healthy woman; we can only change it, but not for the better” ~G.J. Kloosterman, Dutch OB and Professor in 1984
I am in no way suggesting that mothers who have a cesarean are of course going to suffer one of these consequences, or that it was even unnecessary. Remember to ask all the questions you can and do your research so you can really make an informed decision. There are of course, true emergencies that require surgery, and thank God we have surgeons to perform them! But unfortunately the way our maternal health system is set up in the US, we have a cesarean rate approaching 40% when the World Health Organization has called for a rate no more than 15%, and midwives like Ina May are delivery babies with a cesarean rate of 2% . Something isn’t lining up with those numbers. My heart breaks for the mothers and families that have become a statistic because of too many interventions, impatient and/or overworked physicians or midwives, misinformation, and fear of lawsuits.