Babies born by Caesarean often have some initial trouble breathing. In addition, because the baby will be drowsy from the pain medication administered to the mother, and because the mother’s mobility is reduced, breast-feeding may be difficult.

A Caesarean section is a major operation, with all that it entails. Pain at the incision can be intense, and full recovery of mobility can take several weeks or more.

A prior Caesarean section increases the risk of uterine rupture during subsequent labour.

Prevalence

The World Health Organisation estimates that the rate of caesarian sections at between 10% and 15% of all births in developed countries compared to about 20% in the United Kingdom and 23% in the United States. In 2003, the Canadian caesarian section rate was 21%, with regional variations. [citation needed]

Concerns have been raised in recent years that the procedure is frequently performed for reasons other than medical necessity. While many obstetricians report cesarean rates over 30%, traditional midwives regularly report a cesarean rate lower than 10%, with a decreased risk of maternal and infant morbidity and no increase in mortality (Gaskin 2003).

Critics worry that caesareans are performed because they are profitable for the hospital, or because a quick caesarian is more convenient for an obstetrician than a lengthy vaginal birth. Another contribution factor may be fear of medical malpractice lawsuits. For example, the failure to perform a c-section became the core of numerous lawsuits against obstetricians over incidents of cerebral palsy.

Organizations have been formed to make the public aware of caesarean operations and their dramatically increased incidence. Attendance by a midwife and out-of-hospital labor are associated with much lower rates of caesarean section, when controlled for all relevant maternal and fetal indicators.

Anaesthesia

The mother usually receives regional anaesthesia (spinal or epidural), allowing her to remain awake for the delivery and avoiding sedation of the infant.

In modern practice, general anesthesia for caesarean section is becoming increasingly rare as scientific research has now clearly established the benefits of regional aneasthesia for both the mother and baby.

Vaginal births after caesarean

Vaginal births after caesarean (VBAC) are not uncommon today. In the past, caesarean sections used a vertical incision which cut the uterine muscle fibers. Modern caesareans typically involve a horizontal incision along the muscle fibers. The uterus then better maintains its integrity and can tolerate the strong contractions of future childbirth. Cosmetically the scar for modern caesareans is below the “bikini line”.

Obstetricians differ on the relative merits of vaginal and caesarean birth following a caesarean birth. Some still recommend a caesarean routinely, others do not; still others respect the wishes of the expectant mother.

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