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I was always taught by my mom (who studied nursing and midwifery 30 years ago) that a vaginal birth is vastly preferable over a c-section in low-risk pregnancies.

I'm not a medical professional, but my understanding from what she's said is that the baby benefits by moving through the birth canal and the recovery time for the mother is much lower than a c-section. I have done some googling on the subject and have found this to be the case. For example: Vaginal Birth vs. C-Section: Pros & Cons

As a result, I have been very surprised at the prevalence of elective c-sections amongst my friends and in my community. I know no one my age in my acquaintance who has had a vaginal birth. Everyone I have spoken to about this has chosen to voluntarily have a c-section for reasons of convenience ("my husband had work") or fear ("I'm squeamish and scared of labour").

I asked my obgyn about this and he seemed relatively nonchalant, that the recovery time wasn't that bad compared to an episiotomy and that no matter what there are risks.

It is very clear that the mindset now has shifted significantly compared to what it was 30 years ago when my mom did her studies. Due to the conflicting information available, I'm really not sure which is preferable anymore.

I understand c-sections are more convenient, but are they considered medically preferable, or even on-par with a vaginal birth? Perhaps my understanding of the medical side of things (or what my mom taught me) is out of date or old fashioned.


I'm only referring to low-risk pregnancies where the mother chooses an elective c-section beforehand even though she could give birth vaginally. Of course, emergency c-sections or scheduled c-sections (due to medical issues during pregnancy/birth) are a completely different case here.

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    The underlying question is very interesting. Alas, this Q has quite some personalised stuff in it. This background info makes the Q more relatable but it also moves a bit too far into the off-topic area. If you remove these bits with an edit it will be nice. – LаngLаngС May 8 '18 at 17:35
  • @LangLangC i included the personal detail to show what lead me to the question. I removed the part about questioning my own decision, which is the only part I could see makes it borderline into "asking for advice" territory. Is that better? Or should I remove all the personal stuff completely? – user12041 May 8 '18 at 17:59
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    It's a quest for perfection. It was a quite good Q from the start, now it's very good ;) Thx. – LаngLаngС May 8 '18 at 18:08
  • I found this: ncbi.nlm.nih.gov/pubmed/21833896 pdf: researchgate.net/profile/Moshe_Fridman/publication/… great paper but I don't know if I have the medical know how to make the most use of it. It's up for grabs if someone else wants to make a nice answer out of it. – user12041 May 8 '18 at 21:16
  • The answer is different for mother and child, as far as I know. A c section also reduces the chances of death to almost zero (if performed on healthy mother in a good hospital) but increases the chances of injury to the mother to 100%. So it depends on which risks you prefer. – Anush Dec 30 '18 at 18:43
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If we are assuming that there is no valid reason1 for a c-section, a c-section is obsolete per definition. Any operation has risks and strains the body: The anesthesia, the cutting of the body to name the two obvious points. If an operation is not indicated, it shouldn’t be performed. So, if c-section are not medically indicated, they shouldn’t be performed.

If there was a valid reason for the c-section, the answer is obvious: Do get a c-section.


Some references:

Based on the available data, and using internationally accepted methods to assess the evidence with the most appropriate analytical techniques, WHO concludes: Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons.

Emphasis Mine, Taken from WHO Statement on Caesarean Section Rates

A more elaborate source:

Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger. [...]

The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need.

If you are even more interested, this is a great source as well.


1: These include psychological factors. If a to-be mother is as an example afraid of natural delivery, this can be considered a valid reason after evaluation.

  • My apologies if I misunderstand you, but surely the state of pregnancy means that a procedure is indicated. I understand, for example, if I don't have tonsillitis then I don't need my tonsils removed. But in this case a pregnancy requires some procedure to safely deliver the baby. The decision of what procedure that is is my question. The vaginal birth has always been the default option. If a c-section has been found to be more medically preferable, then it would (expectedly) become the default option. If a woman is pregnant, there is no option to do nothing. – user12041 May 8 '18 at 20:50
  • When is a c-section medically indicated (as opposed to a vaginal birth, of course; one is chosen over the other)? I suppose that's a better rephrase of my question. If they are only performed when medically indicated, then why are there so many of them? Is every time medically indicated, or are they being performed due to other reasons too? I am observing c-sections more often, and trying to consolidate why they are seemingly preferred now. – user12041 May 8 '18 at 21:04
  • Well the default option is in fact to do nothing and have a normal delivery. It's worked that way forever. C-Sections are nowadays performed "on maternal request", although there's no ICD code for that. They are most certainly not preferred by most doctors, as WHO and the other sources conclude. I don't know why the rate of c-section increased, but at least in Germany, I know them on the decline. – Narusan May 8 '18 at 21:26
  • Hospitals as profit centres and statistics that indicate that there are many more c-sections than medically valid reasons indicate a certain popularity of elective c-sections. Alas, my impression is that your sound reasoning with "valid" does not reflect some parts of reality. E.g. How much is the re-imbursement for the hospitals from the c-section vs "normal" births. If there is an incentive, financially, even in Germany, for the providers, then this will make a certain trend, invariably. A campaign to make births more natural again is successful in Germany, other "markets" differ? – LаngLаngС May 8 '18 at 21:31
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    Absence of action is implying that vaginal birth is preferred. It is one choice over the other, but a choice has to be made, even if the choice is to not intervene and have a vaginal birth. Nonetheless, your edit has clarified. Especially "They are most certainly not preferred by most doctors, as WHO and the other sources conclude. " is the information I was looking for. – user12041 May 8 '18 at 21:38
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Society is pulling us in directions that degenerates us on so many levels. That something is becoming popular and normal is not any indication whatsoever that it's a better choice, or even a comparable choice. It simply means this is the "new normal". Just look at all the health problems directly correlated to modern western society which is not found in more primitive populations. Normal has nothing to do with what is best, or what is healthy.

There are risks to performing a C-section :

https://jennifermargulis.net/everyone-i-know-had-a-c-section-whats-the-big-deal/

Why is it getting more normal to do a C-section?

doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.

https://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections

However..
The most important factor for making this choice may be the impact on your baby's health.

You need to research how a c-section impacts the microbiome, strength of immune system, digestive system and correlation with chronic diseases. There has been a lot of focus on this over the last decade. It's not popular topics that you get stuffed in your face, but there are a lot of litterature and studies if you just google these search terms. The gut/immune/brain connection is where the true breakthrough in medical science is happening today. We need to pay attention to and educate ourselves in this field if we want to stay healthy and get healthy children.

C-section infants don’t get enough good microbes

Vaginal vs. Cesarean Birth: Effects on Baby's Microbiome

EDIT:

Adding some reliable references backing up the points mentioned. Most links above also have further links to medical journals.

3.7 times higher risk of maternal mortality with cesarean vs vaginal delivery:

https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the-Primary-Cesarean-Delivery

"finds an increase in the C-section rate in the Medicare population after C-sections became more highly reimbursed relative to vaginal deliveries. Specifically, they found a 0.7 ppt increase for a $100 increase in the fee differential."

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2295856

"Meta-analyses of cohort and case-control studies find a positive association [of caesarean delivery] with type 1 diabetes (based on 20 studies),2 asthma (23 studies),3 and obesity (nine studies).4 We did not find any meta-analyses that reported no association with these outcomes." https://www.bmj.com/content/350/bmj.h2410

"planned c-section is associated with early breastfeeding cessation."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847344/

"Maternal morbidity associated with multiple repeat cesarean deliveries"

https://www.ncbi.nlm.nih.gov/pubmed/16738145

"Cesarean delivery associated with childhood diseases" (allergy, asthma, celiac disease, diabetes, gastroenteritis)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

"primary gut flora in infants born by cesarean delivery may be disturbed for up to 6 months after the birth"

https://www.ncbi.nlm.nih.gov/pubmed/9890463/

"The mode of delivery was associated with differences in intestinal microbes 7 years after delivery." "There is accumulating evidence that intestinal bacteria play an important role in the postnatal development of the immune system. 30 Thus, if the intestinal flora develops differently depending on the mode of delivery, the postnatal development of the immune system might also be different."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

"Vaginal birth after cesarean was related to a 31% (95% CI: 17%, 47%) lower risk of offspring obesity compared to repeat cesarean section. In within-family analysis, individuals born by cesarean had a 64% (8%, 148%) higher odds of obesity than their siblings born vaginally."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854473/

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    Welcome to Health.SE, bretddog! I do not disagree with most parts of this answer. Although the health of infant and mother are equal in importance? But in principle, health is an important topic & the site has a strict policy that all answers should be backed up with reliable references so that this can be independently verified, regardless of the reader's background. See this list of reliable sources. – LаngLаngС May 8 '18 at 18:18
  • The sciencenordic link doesn't work for me. It's the apostrophe in the URL. Working one: sciencenordic.com/c-section-infants-don’t-get-enough-good-microbes – user12041 May 8 '18 at 18:59
  • @LangLangC Acknowledged. Edited with targeted references. – bretddog May 8 '18 at 19:28
  • Thanks for the references. Unfortunately I'm not knowledgable enough to interpret their results and assess the quality of the studies. In the "planned c-section is associated with early breastfeeding cessation." one, it also says that the mothers who chose to have c-sections were also more likely to be less interested in breastfeeding. So maybe they stopped because of inconvenience? Perhaps it wasn't the c-section itself, just that there's an overlap where the same mother who chooses a c-section for convenience is also going to make other choices for convenience. – user12041 May 8 '18 at 20:04
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    @Narusan-in-coma - "I highly doubt that doctors would have a personal gain from getting more c-sections done." Most Obstetricians are fine, upstanding folks, but your optimism is misplaced. A doc can get muuuuch more for a C-s than a vaginal delivery. Aaaand... they need an assistant surgeon, so two docs get more money! – anongoodnurse May 9 '18 at 20:41

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