by Danelle Frisbie ©2003
statistics updated for 2009
"When doctors and mothers assess the risks of cesareans, they generally only think about what the risks are at that time and ignore the impact they might have five years down the line," says Dr. James Walker, who recently led a study on the long term implications of cesarean section. "Neither the medical profession nor women themselves realize the extent of the long-term problems cesarean sections can cause."
In the study, published in the British Journal of Obstetrics and Gynaecology (1), it was found that 43% of women (almost half!) who have a c-section for their first birth do not have any additional children. Of these women, 20% have chosen not to birth more babies because they report being too traumatized by the first cesarean surgery they had to endure. Women who experienced c-section surgery were six times more likely to have post-traumatic stress disorder as a result of their surgical birth than women who had birthed their babies vaginally. 30% were found unable to become pregnant again due to cesarean-caused infertility complications.
Walker led this study at Leeds University's Department of Pediatric Obstetrics and Gynocology (UK) which followed 500 women throughout their pregnancies and births.
Of the group, 165 mothers who had c-section births (43%) chose not to have any additional children in the years to follow their first cesarean birth. 20% of the women who had a c-section with their first baby reported that they could not handle going through the pain (emotional and physical) of cesarean surgery again. 30% of mothers in the study who had cesarean births were impacted by secondary infertility which prevented them from having any more children without additional means of conception assistance.
In a literature review on cesarean birth research, Walker reports that it is common to find this 1 in 3 infertility rate among women after having a "routine" c-section.
C-section surgery may result in infertility as a result of several things including:
* scarring of the uterus (preventing a hospitable environment in which an embryo can implant)
* hemorrhaging (blood loss) sometimes requiring a hysterectomy
* pelvic infections as a result of the invasive abdominal surgery - which can lead to blocked fallopian tubes (preventing conception)
* scar tissue on and around the ovaries or in the fallopian tubes (preventing ovulation or conception if/when ovulation does occur)
* anesthetic shock or other complications (resulting in additional surgical damage or need for hysterectomy)
* miscarriages due to the placenta being unable to embed securely and grow in the wall of a scarred uterus
* uterine rupture during pregnancy (rupture during pregnancy or birth is very rare, but can occur)
* mothers who are out of shape, stressed, or physically or emotionally weakened at the time of a first c-section can experience infertility due to the physical pain and stress of having major surgery
Walker's findings were validated by another study conducted in Norway between 1967-2003. The Norwegian Institute of Public Health (NIPH) followed 600,000 women after they had their first child during the initial 30 years of this large-scale study. NIPH found that 12% more women did not have a second child if they had experienced c-section with their first baby than women who birthed vaginally.
Walker reminds us, "With other health issues people think about the future, but when they have cesarean sections, which carry an even greater risk of losing a second baby than taking hormone replacement therapy or having cancer, they make the decision without knowing or thinking about the risks involved."
Current (2009) cesarean rates in the UK (where Walker's study was conducted) sit at 25% while c-section rates in the United States have skyrocketed to 37% (up from 32% in 2007). Canada's cesarean rate is at 28%.
35 years ago the U.S. and Canada shared a 5% c-section rate and just 20 years ago the UK still had a low 5% c-section rate. Professional midwives attending homebirths today continue to demonstrate a typical 3-5% cesarean rate for their clients world-wide. Birth research suggests that cesarean surgery is only truly needed in about 3% of all cases of human birth, and should never surpass 10%, or we find that women's and babies' health suffers across the board as a result. Approximately 97% of the time, birth happens perfectly fine on its own when left alone. When babies come gently into this world, the complications (for both mom and baby) do not exist that we currently find due to the major abdominal surgery of unnecessary cesarean section.
(1) BJOG: An International Journal of Obstetrics & Gynaecology. Vol 106:3. pp. 227-232
For more information on the statistics and implications of c-section also see:
International Cesarean Awareness Network
Born in the USA by Dr. Marsden Wagner
Pushed by Jennifer Block
The Caesarean by Dr. Michel Odent
Gentle Birth, Gentle Mothering by Dr. Sarah Buckley
Birth & Breastfeeding by Dr. Michel Odent
Ina May's Guide to Childbirth by Ina May Gaskin
The Thinking Woman's Guide to Better Birth by Henci Goer