It’s a staple of movies and television sitcoms. Think Charlotte in Sex and the City. A hugely pregnant woman is going about her life—say enjoying a meal in a fancy restaurant, or taking a Yoga for Mommies class, or strolling the produce aisle looking for mangoes—when suddenly she clutches her belly, looks down at her feet, and announces, “My water just broke.”
Those four words demand action. The pre-packed hospital suitcase is grabbed, the sitter is called, and the car engine is revved. Next comes the wheelchair ride to the labor room, some rhythmic Lamaze breathing, and then—unless the baby is born unusually fast— the creeping realization that what lies ahead are hours of waiting as the contractions slowly build.
Increasingly, this familiar scene is changing. Some women are trying to take some of the surprise and unpredictability of out of giving birth, deciding instead to plan the event. They are opting for an elective Cesarean.
A Cesarean delivery (or C-section) is a surgical way of getting the baby out of the womb, through an incision in the abdomen. Based on 2007 Centers for Disease Control and Prevention statistics, the odds are now about 1 in 3.14 that a baby in the US will be delivered by C-section. This rate has climbed dramatically in the past decade: in 1995, the odds of a C-section were only 1 in 4.83.
High profile celebrities like Victoria Beckham (formerly Posh Spice) and Madonna have attracted attention to this trend of scheduled birth—the phenomenon has been dubbed “too Posh to push.” But a 2006 national survey found that just one woman out of 1,315 mothers surveyed had initiated the request for a primary (first-birth) C-section. The operations, precisely because they can be penciled in and planned for, are often easier for doctors as well. A morning C-section will be over much more quickly than a full night of labor, allowing physicians a glimmer of the 9-to-5 lifestyle. Performing a C-section rather than presiding over a natural birth even appears to decrease the chances a doctor will be sued over malpractice.
While C-sections may fit more easily into the calendar, they also carry higher costs, lengthier and more repeated hospital stays, and more risk of neonatal death. They put mothers at a higher risk of infection and blood clots, as well as other risks associated with any sort of major surgery. Some experts believe that the actual process of labor and the stress hormones released during it contribute directly to a baby’s wellbeing. Thus by surgically removing a child, certain developmental benefits may be lost.
Once a woman has had a C-section delivery, she is often advised not to have a vaginal birth for subsequent children. This treatment protocol of “once a Cesarean, always a Cesarean” contributes significantly to the overall spike in C-section rates. The recommendation guidelines for vaginal births after Cesarean delivery (called VBACs) continue to change: some studies show that women who have C-sections run a low but significant risk of uterine rupture if they attempt a VBAC, while other studies encourage more VBACS because the risks of optional C-sections outweigh the chance of uterine rupture.
Where a person lives geographically plays a major role in the likelihood of a C-section. The rates vary even within the US: the odds a baby in New Jersey will be delivered by C-section, for instance, are 1 in 2.61, while the odds for a baby in Utah are only 1 in 4.5.
As the trend toward optional C-sections continues, it raises new questions within the old and complicated story of human childbirth.