When my my twins were born in 2012 I had both a vaginal birth and an emergency C-section, after my son became distressed during delivery. I'm grateful to the skilled doctor who got him out quickly, but having experienced both types of deliveries at pretty much the exact same time, I really wouldn't want to have a C-section again if I could help it. How common are elective C-sections? Pretty common, actually: According to Consumer Reports, C-sections are the most commonly performed surgeries in the United States (approximately 32.2 percent of all births, according to the Centers for Disease Control). And what's even more surprising? Almost half of those surgeries aren't actually medically necessary.
That figure is pretty staggering, and there are lots of reasons why it's hugely problematic. But it's also not quite as straightforward an issue at it seems. Although the notion of elective C-sections often conjures the idea of "too posh to push" moms who choose the "easy" way out (clearly no one who believes this has ever actually had a C-section, because, yeah right), the reality is that any C-section that is not medically necessary (as in, the baby could have been delivered safely without surgery) is considered elective, regardless of whether the mother "chose it" or not.
To be sure, there are still many women out there who specifically ask for C-section deliveries (known as Cesarian delivery on maternal request), though the actual rate is unknown. But the American College of Obstetricians and Gynecologists (ACOG) estimates that those types of births are relatively much rarer, comprising somewhere around 2.5 percent of all births in the United States. Because of the potential risks involved of having a C-section (it is major abdominal surgery), ACOG recommends that pregnant women who don't have any specific medical need for C-sections plan for vaginal births.
After all, there are some really good reasons why a vaginal delivery would be preferable. According to the National Institute of Health, research has found that women who have C-sections tend to experience longer hospital stays than women with planned vaginal deliveries, are at a higher risk for infection, anesthetic complications, and are more likely to have more trouble initiating breastfeeding. Studies have also shown that C-sections carry an increased risk of serious complications for future deliveries, including uterine rupture, placenta previa, placenta accreta, bladder and bowel injuries, and hysterectomies — risks which only increase further the more C-section deliveries a woman has in her life.
That's not to say though, that vaginal delivery isn't also without risk (any form of delivery is inherently pretty risky), and there are indeed some specific benefits to requesting a C-section. According to ACOG, women with planned C-sections have a "decreased risk of postpartum hemorrhage and transfusion, fewer surgical complications, and a decrease in urinary incontinence during the first year after delivery," (though it's worth noting that after 2 years, the rates of stress urinary incontinence were about the same no matter how women delivered). There is also research showing that elective C-sections that don't involve any laboring beforehand can be safer than C-sections with labor, or vaginal delivery with labor that then ends up in an emergency C-section (but since most women labor safely, the risks of going into labor are still lower overall than the risks of an elective C-section).
Why would anyone request a C-section then, given the risk? Dr. Linda Szymanski, medical director of labour and delivery at Johns Hopkins Hospital, told the Huffington Post that often women ask for C-section deliveries for scheduling reasons, preferring to deliver on a certain day or to ensure they don't deliver spontaneously on a particular day. For others, previous trauma or sexual abuse means that labor and delivery could be triggering or unnecessarily difficult. Some women also request C-sections due to fears about pain or vaginal birth, but often those concerns can be dealt with in other ways as well, such as birthing classes, or counseling. Szymanski said,
Truly, the number or women who request elective cesareans is relatively low... When women request this, it is critical for them to sit down with their doctor and have a frank discussion about the potential risks involved in having a c-section.
If self-requested C-sections are so low though, then what's behind the high rate of medically unnecessary C-sections? According to Consumer Reports, the biggest factor affecting how likely a women is to have an elective C-section is actually what hospital she delivers in. Currently, it's recommended that the rate of C-sections for low-risk births should be below 24 percent — yet 60 percent of hospitals in the United States have C-section rates higher than that. While some states' hospitals have C-section rates below the target (South Dakota's C-section rate for low-risk deliveries is only 14 percent), others are much higher (D.C. has the highest low-risk C-section rate, at 35 percent).
According to Dr. Aaron B. Caughey, chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University School of Medicine, those figures are problematic. Caughey told Consumer Reports,
Once cesarean rates get well above the 20s and into the 30s, there’s probably a lot of non-medically indicated cesareans being done. That’s not good medicine.
The variation in hospital C-section rates is one reason why researching your hospital up front is a good way to decrease the likelihood that you might have a C-section. Of course, in many cases (like my son's), C-sections are necessary and save lives, but if the hospital you're planning to deliver at has a particularly high rate of low-risk C-sections, it might be worth considering going elsewhere. Other ways to minimize the chances of a C-section, according to Connecticut-based OB/GYN practice Riverside Obstetrics and Gynecology? Create a birth plan early on in your pregnancy, try to eat as healthily as possible and limit excess weight gain, stay active, and consider hiring a doula to assist during labor.
Ultimately, every pregnant woman should make the best choice she can for herself and her baby, with help from her doctor or medical team. But since elective C-sections are common and not without risk, it's important to have as much information as possible before going into labor.