Unnecessary Surgery in Childbirth

Complications of Caesarean Delivery During the Surgery

• Blood loss may be greater, or less than, at a vaginal delivery compared with a planned elective Caesarean section for a first pregnancy. Women who have an uncomplicated vaginal delivery have the lowest risk of blood transfusion. Women who have a primary (first pregnancy) planned Caesarean delivery have an intermediate risk, while women who either have a vaginal delivery after prolonged labour, a forceps delivery, failed forceps or vacuum delivery leading to an emergency Caesarean section, any type of Caesarean section during labour, or a planned repeat Caesarean section, have higher rates of blood loss requiring a blood transfusion. Overall, the risk of blood transfusion at a planned term Caesarean delivery in a first pregnancy is 1/200.

• Women may also experience negative reactions to anaesthesia for Caesarean section. They may:

          o Feel more pain during surgery if the anaesthetic is not working properly

          o Experience more nausea and/or vomiting from internal manipulation to perform a Caesarean section

• Bladder injury is an infrequent complication of Caesarean Deliveries and is rare in a first Caesarean section. However the risk increases with repeat Caesarean Deliveries. Bladder injury is extremely rare with vaginal deliveries.

• Bowel injuries occur in less than 0.1% of all Caesarean Deliveries, but cannot occur at a vaginal delivery, as the abdomen is not opened.

 

After the Surgery

• The recovery time for women after Caesarean delivery is longer than after a vaginal delivery, and can range from weeks to months due to pain at the site of incision. The length of hospital stay after a Caesarean delivery is currently 2-3 days, while the average hospital stay after a vaginal delivery is 1-2 days. While it is rare for women to need intensive care following delivery, it is more commonly required after a repeat Caesarean delivery, compared to a vaginal delivery.

• The risk of all types of infections, including wound infection after Caesarean delivery is approximately 17% (source CAESAR trial, UK). Amongst women delivering by Caesarean section, this risk is lowest for planned primary Caesarean delivery.

• Urinary tract infections (UTI) are more common in women delivering by Caesarean section than with a vaginal delivery. Women delivering by Caesarean section require a bladder catheter during surgery. This remains in place to drain the bladder for 12-24 hours post-operatively, and can be a source of infection. 

• Caesarean Deliveries also increase the risk of developing deep vein thrombi, which are blood clots in the legs that could lead to blood clots in the lungs, known as pulmonary emboli, by 3-5-fold compared to vaginal delivery.

Mount Sinai Hospital 

Canada sees hospitalization childbirth deliveries of over 350,000 births annually. One-third of those deliveries take place by  caesarean section (C-section), a high rate that continues to climb. More women are choosing to have caesarean sections than normal, vaginal births and for a variety of reasons. Some of those reasons are not linked to medical necessity but rather to convenience, a new social convention that many women have adopted for timing that is more aligned with their schedule, knowing when the birth will take place, and eschewing long periods of labour.

Caesarean Delivery

The surgical process involves having an incision made in the mother's abdomen and uterine wall to enable extraction of the foetus. C-sections are normally recommended in situations where the mother's or the baby's life may be at risk with a vaginal delivery and that could be for a variety of reasons, such as mothers bearing children later in life. The rising C-section rates also may reflect higher rates of obesity and the complicating presence of chronic diseases such as diabetes.

Almost 105,000 C-sections are performed annually in Canada, marking it as the most common hospital-based surgery in the country's hospitals.

When C-sections are medically indicated the benefits are seen to exceed by far the risks for the pregnant and newborn. On the other hand, C-sections are major surgical operations, a surgery that comes with significantly greater risks than does a vaginal birth, including higher rates of infection, hemorrhage and death for the mother. In some instances, immediate and long-term risks for the newborn can also surface.

Following a C-section, the uterus is left scarred, a condition harbouring implications for future pregnancies and labour. Moreover, C-section recovery can be painful, along with the fact that a longer hospitalization and recovery period ensue. An organization, Choosing Wisely Canada campaign whose purpose is to reduce unnecessary tests and health care treatments recently released recommendations for the attention of clinicians involved in birth which includes obstetricians gynecologists, family doctors and midwives, urging reconsidering when C-sections may be required.

According to research, driving issues in support of the overuse of C-sections are linked to mothers whose early labour fails to progress as anticipated. Labour has a number of stages, the initial stage is called the latent or beginning phase followed by an active phase. Transition from latent to active labour can stretch out over many hours, particularly for first-time mothers. A latent phase taking up to 20 hours is viewed as normal for a women in her first pregnancy.

Optimal management for healthy women awaiting a single pregnancy during the latent phase is to wait out the period until it progresses, while supportive care is given which would include pain relief and rest. Following which most women enter active labour which proceeds to normal vaginal delivery. Research indicates a major driver of variations in C-section rates among hospitals, within cities and provinces and even obstetricians is, simply put, impatience.

Caesarean Section Incisions

These are issues where obstetricians' singular practise styles come into play, and where impatience, scheduling and/or system pressures play a role in prompting an unnecessary C-section which increases risks for mother and newborn, and for future pregnancies associated with that decision for a particular pregnancy. The overuse of C-section surgeries and the continued increase they represent burden the hospital system, increase costs, and gamble with the health and safety of mothers and infants.

Dr.Margaret Morris, professor in the department of obstetrics, gynecology and reproductive sciences, University of Manitoba, president-designate of the Society of Obstetricians and Gynecologists of Canada, and Dr.George Carson, clinical professor of obstetrics and gynecology, University of Saskatchewan, past president of the Society of Obstetricians and Gynecologists of Canada recommend physicians rethink their practise, in an effort to curb rising C-section rates in Canada.