C-sections for Convenience?
By Lykke E. Andersen*, La Paz, 12 March 2007.

Giving birth the natural way (vaginally) is extremely painful and often inconvenient, which is why some women decide on a planned Cesarean section instead. According to the latest national health survey in Bolivia (2003), 47.1% of mothers in the richest quintile have C-sections, while this only happens to 4.0% of mothers in the poorest quintile. Such a large difference is obviously not due to more pregnancy complications among the rich. C-section rates vary greatly from doctor to doctor, but the rate medically justified is usually around 10-15%.

In the United States the C-section rate has reached an all time high of 29%, which is considerably higher than in most other developed countries, but not nearly as high as among the relatively rich mothers in Bolivia. The high and increasing C-section rate has started to worry people as recent scientific evidence indicates that C-sections increase the risks to both mothers and babies. A Canadian study, for example, shows that the risk of severe complications is about three times higher for planned Cesareans than for planned vaginal birth (1). And an Australian study suggests that a first Cesarean delivery increases the risk of complications during subsequent deliveries (2).

Obviously C-sections are necessary and life-saving in some circumstances and can be recommended in other cases after a careful weighing of risks and benefits, but the 47.1% rate mentioned above is so high that I suspect obstetricians in Bolivia are taking advantage of relatively rich and uninformed Bolivian women to schedule births at convenient hours and extract extra money, without telling them about the risk.

I know an obstetrician in La Paz who recommends planned C-sections for all first births, so that the babies don’t have to suffer the squeeze through the narrow birth canal. This is obviously absurd, and it actually deprives the baby of the natural stimulation that will help it breathe once born and of certain hormones that will help it deal with the trauma of being born. First-time mothers are extremely vulnerable and tend to trust their doctors much more than their own bodies, since they have never previously experienced anything even remotely like child birth. So they are easy to take advantage of. And once you have had one C-section, you will most likely need them during following deliveries also, due to the increased risk of uterine rupture.    

If your or your baby's life depends on a Cesarean, of course you will agree to have it, but why you would voluntarily choose to have unnecessary major surgery and expose yourself and your baby to a host of additional risks and a much longer recovery period is beyond me (but I am admittedly more than normally scared about needles, scalpels and doctors).

There is one big advantage of having a C-section, though, which is that it is easy to make a female sterilization while your gut is wide open, so you can with no further inconvenience eliminate the risk of ever having to give birth again.

(*) Director, Institute for Advanced Development Studies, La Paz, Bolivia. The author happily receives comments at the following e-mail: landersen@inesad.edu.bo.
(1) Shiliang Liu, Robert M. Liston, K.S. Joseph, Maureen Heaman, Reg Sauve, Michael S. Kramer (2007) “Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.” Canadian Medical Association Journal, February 13, 2007, 176(4): 455-460.
(2) Robyn Kennare, Graeme Tucker, Adrian Heard and Annabelle Chan (2007) “Risks of Adverse Outcomes in the Next Birth After a First Cesarean Delivery.” Obstetrics & Gynecology;109:270-276. 

Ó Institute for Advanced Development Studies 2006. The opinions expressed in this newsletter are those of the author and do not necessarily coincide with those of the Institute.

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