Vaginal birth creates "needless" pelvic floor disorders?

For whatever reasons women choose CS, very few are clearly informed about fetal risks. In an emergency CS where the baby has developed a problem during the labor, the risks to the baby of doing the CS will likely be outweighed by the risks to the baby of not doing it. In an elective CS where the baby is not in trouble, the risks to the baby from doing a CS still exist, meaning the woman who chooses CS puts her baby in unnecessary danger. That some women are choosing CS strongly suggests women are not told this scientific fact.

The first danger to the baby during CS is the 1.9% chance the surgeon's knife will accidentally lacerate the fetus (6.0% when there is a non-vertex fetal position). (5) Obstetricians may be less aware of this risk--in one study only one of the 17 documented fetal lacerations was recorded by the obstetrician doing the surgery. (5)

A much more serious risk to babies born by CS is respiratory distress. Many reports in the scientific literature document the CS procedure per se is a potent risk factor for respiratory distress syndrome (RDS) in preterm infants and for other forms of respiratory distress in mature infants. (1) RDS is a major cause of neonatal mortality. The risk of newborn RDS is greatly reduced if the woman is allowed to go into labor prior to the CS.

Another serious risk to the baby born by CS is iatrogenic prematurity (the baby is premature because the CS was performed too early). Even with repeated ultrasound scans, the standard deviation for estimating gestational age is large, creating errors in judging when to do an elective CS. Doing the elective CS after the woman goes into spontaneous labor would markedly reduce this risk as well. A vast literature documents the increased mortality and morbidity, including neurological disability, associated with premature birth.

Pregnant women beware. Surgeons try to sell surgery. Never forget that obstetricians are, after all, surgeons. Women must be extremely cautious in the face of this hard sell and get the facts from those who do not have a vested interest in surgery.

Bibliography

1. Wagner M, 1994. Pursuing the Birth Machine: The Search for Appropriate Birth Technology, Sydney, Australia: ACE Graphics.

2. Enkin M, Keirse M, Renfrew M, Neilson J, 1995. A Guide to Effective Care in Pregnancy

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