The Risks of Cesarean Section

Historical Introduction

The first documented cesarean section took place around 327 BC, as mentioned in the writings of Hippocrates, although there may be earlier evidence in Roman texts. At that time, the procedure was extremely rudimentary and carried high risks. Since then, cesarean sections have evolved significantly, saving many lives for both mothers and newborns. Today, it has become a common practice in modern maternity wards, especially when complications make vaginal delivery dangerous.

The Rise of Cesarean Sections: A Contemporary Issue

Cesarean sections are increasingly common today. In some private practices, this procedure is sometimes preferred for practical and financial reasons. It is crucial to note that some reasons given for cesareans may not be based on solid medical evidence, and women may sometimes be informed of unjustified reasons for undergoing a cesarean.

Nature and Natural Birth

The female body is naturally designed to give birth vaginally, and natural birth is generally preferable due to its benefits for both mother and child. A cesarean is necessary in some cases but should not be the norm when a vaginal birth is possible. Nature has prepared the body for spontaneous birth, and this route is often better when conditions allow.

Clear Medical Indications for Cesarean Section

Here are the recognized medical indications for a cesarean section:

• Breech Presentation: When the baby is in a breech position, a cesarean may be recommended to avoid complications during vaginal delivery.

• Active Genital Herpes at Delivery: The risk of transmitting the virus to the baby is high, and a cesarean can reduce this risk.

• Previous Cesarean Section: Women who have had a previous cesarean may require another cesarean due to the risks associated with vaginal birth after cesarean (VBAC).

• Multiple Pregnancy: In some cases of twins or triplets, a cesarean may be necessary depending on the presentation and possible complications.

• Placenta Previa: When the placenta is implanted near or on the cervix, a cesarean is often indicated to avoid severe bleeding during vaginal delivery.

• Shoulder Dystocia: When the baby’s shoulders are stuck after the head has emerged, a cesarean may be considered if the disimpaction maneuver fails.

• Severe Preeclampsia or Eclampsia: These serious hypertensive conditions may require a cesarean to protect the health of both mother and baby.

• Severe Fetal Complications: Such as abnormal heart rate patterns, a cesarean may be performed to minimize risks to the baby.

  
  

Contested Medical Indications

Some indications for cesarean sections are more debatable:

• Suspected Small Pelvis Dimensions: It is crucial to assess these cases accurately, as actual dimensions can often differ from initial estimates.

• Condylomata (Genital Warts): Generally, genital warts do not justify a cesarean unless there are significant complications.

• Presentation in a Circular or Deviated Position: A circular or deviated presentation generally does not justify a cesarean unless it is associated with other complications that make vaginal delivery unsafe.

• Maternal Preference Without Clear Medical Indication: Personal preferences for a cesarean, without a medical justification, should not be the primary criterion for the decision.

  
  

Risks Associated with Cesarean Section

Immediate and long-term risks of cesarean sections include:

• Risks During the Procedure:

  • Infection: Postoperative infections can occur in about 5 to 10% of cases.

  • Hemorrhage: Significant blood loss occurs in about 2 to 5% of cesarean sections, sometimes requiring a transfusion.

  • Anesthetic Complications: Risks related to anesthesia, with a complication rate of 1 to 2%.

• Long-Term Risks:

  • Scar Issues: Complications can occur at the abdominal scar in about 5 to 10% of cases.

  • Adhesions: The formation of scar tissue can lead to chronic pain or fertility issues, affecting about 15 to 20% of women.

  • Increased Risks in Future Pregnancies: Risks of complications, such as uterine rupture, are higher. The risk of uterine rupture in a subsequent pregnancy is about 0.5 to 1%.

    
    

Risks for the Baby

Risks for the baby during a cesarean section include:

• Respiratory Problems: Babies born by cesarean may experience respiratory issues in about 1 to 2% of cases.

• Challenges with Adaptation to Birth: Babies may have difficulties adapting to extrauterine life, with increased risks of respiratory problems and other complications.

  
  

Conclusion

Cesarean section is an essential and potentially life-saving procedure in specific situations, but it also carries significant risks for both mother and baby. Careful assessment and clear indications are necessary to determine if a cesarean is the best option. Decisions should be based on rigorous medical criteria rather than practical or financial preferences. By understanding the indications and risks, women can make informed decisions about how to approach their delivery.

Take care and stay informed,

Dr. Sandra Yene Amougui

Photo de Amit Gaur sur Unsplash