Cesarean birth is on the rise in the United States, according to the Centers for Disease Control (increasing from 22 percent in 1989 to 26 percent in 2002). Part of the reason is that there is growing confusion and disagreement about the safety of vaginal or cesarean birth and the role each plays in preventing future problems such as incontinence. In many cases a cesarean can help preserve the life and health of mother and infant.

When a cesarean appears medically necessary, your physician will explain to you and your family the benefits and risks of a cesarean and other options available. Some reasons a cesarean may be suggested include:

• Bleeding from the placenta
• Umbilical cord that has slipped into the vagina and is compressed
• Maternal health problems
• Problems with the baby’s heart rate
• Baby in a position other than head down
• More than one baby and first baby is not head down
• Labor is not progressing
• Arrest of descent– baby is not coming into the pelvic outlet because it is too small
• Previous difficult vaginal birth
• Previous cesarean birth and not being a candidate for vaginal birth after cesarean

The cesarean birth rate is approaching 3 in 10 women in the United States. While a cesarean is a relatively safe procedure, short-term complications include an increased—though low—risk of infection, bleeding and blood clots. Long-term complications include an increased risk of abnormal placental implantation (placenta is too low in the uteurs) in subsequent pregnancies and development of pelvic pain.

Most obstetrical providers feel that a cesarean birth should be performed when it will clearly benefit the health of the baby and/or mother. However, a new trend—elective cesarean birth—has been reported and debated in both the popular press and medical journals. Why would a mother request to have a major surgical procedure? Some women are concerned about going through labor. Many more women are worried about developing pelvic prolapse (weakening of the muscles at the base of the pelvis), bowel, bladder and/or sexual problems later in life. Some studies do show that women who have had a prior traumatic vaginal birth may have an increased risk for developing some of these conditions. Other studies also show that even women who have never had a baby can also develop these problems.

John Eichenlaub, MD, Chair of the OB-GYN Department, cautions against thinking of an elective cesarean as the easy answer to delivery concerns.

“While relatively safe and straightforward, a cesarean is still a major surgery and carries significant risks,”

Dr. Eichenlaub says. “However, many times the risks associated with a cesarean are far less than the risks of allowing the mother to attempt a vaginal delivery.”

Also, just because a woman may have had a cesarean with a prior delivery, she does not necessarily need a cesarean with future deliveries. The American College of Obstetricians and Gynecologists estimates that up to 60 percent of women who have had a cesarean may be able to have a vaginal birth the next time. If a woman is in this situation, she should discuss her options with her doctor.