By Vance Voetberg
Cesarean sections, or C-sections, one of modern medicine’s most remarkable accomplishments, are increasingly being scrutinized. With over 30 percent of American babies delivered this way, many medical experts are raising alarms about the normalization of the procedure, which, according to research, may increase the risk of postpartum infection and maternal death.
Additionally, a 2021 investigative report published in JAMA Network Open found that financial incentives may influence C-section use.
Are Unnecessary C-Sections Putting Mothers at Risk?
Very few births are emergent in nature and actually require C-sections, Dr. Nathan Riley, a board-certified obstetrician and gynecologist, told The Epoch Times. Since many doctors are uncomfortable handling complex vaginal deliveries like breech births, C-sections are often recommended to avoid potential risks, he added.
However, C-sections have higher maternal mortality and severe complication rates compared to vaginal delivery, according to the American College of Obstetricians and Gynecologists.
Planned C-sections had more issues like infection, hemorrhage, hysterectomy, longer hospital stay, and even cardiac arrest versus planned vaginal births, a Canadian study that analyzed over 2.3 million births from April 1991 through March 2005 found.
The American College of Obstetricians and Gynecologists advises providers to carefully weigh cesarean risks and prevent overuse. Primary C-sections, a woman’s first C-section, are especially not recommended, as each one raises the chance of problems with the placenta in future pregnancies.
“Placental abnormalities like placenta previa and placenta accreta occur when the placenta grows in the wrong place of the uterus,” Dr. Riley said. “Each time a doctor makes a C-section incision, the greater the chances are of the placenta attaching itself to the incision scar.” This poses significant risks to both the mother and the baby, he noted.
Between 1999 and 2019, C-section rates have risen from 22 percent to over 32 percent nationwide. Maternal mortality has doubled in that same period. This parallel trend highlights the need for nuanced discussions of C-section risks and benefits.
Beyond the Scars
While a C-section can be a lifesaving procedure for both mother and baby when complications arise, this surgical delivery method also comes with its own set of potential side effects—beyond the likelihood of permanent scarring on the skin and uterus from the incisions made during the procedure.
Research has shown that C-sections can delay the onset of mature milk production, or when a mother’s breast milk comes in.
Breastfeeding complications aren’t typically long-term. In rare cases, however, permanent neurological impairment can stop milk production altogether.
Dr. Michele Sayball, a licensed naturopathic physician and midwife, shared one woman’s story.
The patient elected a C-section for her first birth at 38 weeks gestation, seeing it as low-risk. “The operation was successful in the sense that both the baby and the mother were healthy,” Dr. Sayball told The Epoch Times. However, anesthesia side effects prevented the mother from producing breast milk for her newborn.
Upset over the downplayed risks, the woman later chose natural vaginal births and successfully breastfed those babies, Dr. Sayball said.
C-section patients often struggle with post-op pain, Dr. Courtney Kahla, a chiropractor specializing in postpartum care, told The Epoch Times. “One patient said that she sat in excruciating nerve pain for days after her C-section, that the pain was worse than labor contractions, and recovering from a C-section was the hardest thing she’s ever done.”
Doctors administer epidurals or spinal anesthesia to numb the mother’s body to perform C-sections. Anesthesia can cause ongoing pain from the surgery or injection site, Dr. Kahla added. Severe spinal headaches may also occur due to fluid leaks.
Other Health Issues
If the needle is inserted too deeply or at the wrong angle, it can potentially damage the spinal cord.
In some cases, a hematoma, a collection of blood, can form around the spinal cord if a blood vessel is accidentally punctured during the procedure. This can put pressure on the nerves and potentially cause damage.
An allergic reaction to the anesthesia medications can cause symptoms that mimic nerve injury, such as numbness, tingling, or weakness.
Infection can occur if the skin at the site where the needle is inserted is not properly cleaned and disinfected before the procedure. Introducing bacteria from the skin’s surface into the subarachnoid space, where the cerebrospinal fluid circulates, can lead to an infection. Patients with compromised immune systems, such as those with certain medical conditions or taking immunosuppressive medications, may be more susceptible to infections.
Why Are C-Section Rates Going Up?
Multiple factors drive the increase in C-sections.
First, the decline in America’s overall metabolic health has led to more high-risk pregnancies and births requiring C-sections, according to Dr. Riley. Women with conditions like gestational diabetes and high blood pressure have much higher rates of C-section delivery.
Inadequate medical training on handling complex vaginal deliveries is another reason, Dr. Riley said. When babies are not optimally positioned, many doctors default to C-sections as a more familiar procedure. “Whenever we humans attempt to combat nature, it typically doesn’t end well,” he added.
C-Sections Generate More Profits
The United States is one of the most expensive countries to give birth, with C-sections costing up to five times more than vaginal births.
The 2021 report found a “shockingly sizeable” association between hospital C-section profits and rates. The report authors also found higher costs at hospitals with more C-sections.
The study revealed that in health care systems where physicians’ earnings are linked to the volume of procedures they perform (for instance, when physicians bill directly to payers based on fees or when an individual physician’s salary is influenced by the revenue generated from these fees via bonuses), there’s a likelihood that financial incentives can influence physician behavior.
As the study notes, “More cesarean procedures would produce a bigger paycheck.”
The findings highlight financial incentives as a potential driver of the country’s high C-section rates. Researchers recommend examining for-profit hospital incentives to encourage appropriate use.
Research from 2017 also shows for-profit hospitals perform more C-sections than nonprofits. As financial motivations appear to play a role, a closer look at hospital incentive structures is warranted to ensure women receive optimal, personalized care, the authors concluded.