Women's Health

With the number of babies delivered by Caesarean section at record highs, the debate among physicians over elective Caesarean vs. vaginal delivery indicates a need for more research. In the meantime, what are expectant mothers supposed to think? Is elective C-section an option only for celebrity moms, or is it something the average, first-time pregnant woman could sericonsider? Two UC Irvine OB/GYNs weigh in.

Q: What are the benefits of vaginal delivery vs. elective Caesarean?
>> Dr. Judith Chung: For the mother, the benefits of vaginal delivery are fewer anesthetic complications, less risk of infection and a shorter recovery time. Benefits for the baby include a lower risk of respiratory problems. Both mother and baby often have shorter hospital stays after vaginal delivery.

>> Dr. Karen Noblett: The primary benefit of elective Caesarean for the mother is preservation of pelvic-floor function. A 2006 study published in OB/GYN Magazine showed that compared to Caesarean sections, vaginal delivery was associated with a significantly higher risk of urinary and fecal incontinence, as well as pelvic-organ prolapse later in life. These conditions can have devastating, long-term effects on the quality of life. There is also evidence that elective Caesarean reduces the risk of neonatal death and brain disorders.

Q: Are incontinence and pelvic-floor issues a result of labor and the birth process, or a consequence of carrying a baby through pregnancy, plus hormonal changes in midlife?
>> Dr. Noblett: All women share some long-term risks for developing pelvic-floor disorders. But based on current evidence, vaginal delivery is the most important risk factor for a woman’s developing pelvic-floor problems.
>> Dr. Chung: The literature on this issue is not clear-cut. Long-term reduction in urinary incontinence after planned Caesarean delivery has not been definitely shown.

Q: What considerations should a woman discuss with her doctor when planning her strategy for delivery?
>> Dr. Chung: A Caesarean is a major surgery. Women who have a Caesarean may experience more pain and a longer recovery. Heavy lifting and exercise may be limited in the short term, so women with active lifestyles or small children may have more difficulty with their usual routine. Women should also consider how many children they want. A scar from a prior Caesarean can weaken the uterus in subsequent pregnancies. This could lead to the reopening of the uterine scar, causing problems for both mother and baby. A uterine scar can also create placental implantation problems in future pregnancies. The placenta becomes difficult to remove at delivery, resulting in heavy bleeding, a possible blood transfusion and, in a worst-case scenario, removal of the uterus (hysterectomy). Due to these risks, I would not recommend a Caesarean on request for women who desire several children.

>> Dr. Noblett: Women planning on 2 kids who have concerns about future pelvic-floor function should be given the choice of elective Caesarean. The data supports it as safe, with no increased operative or anesthetic risk, and reduction of pelvic-floor trauma. Women wanting more than 2 children should carefully consider the risks and benefits of each.

    Dr. Judith Chung is an OB/GYN specializing in high-risk pregnancies. Dr. Karen Noblett is an OB/GYN specializing in uro-gynecology, both with UC Irvine Healthcare. For more information: 714.456.2911 or ucihealth.com.