Does Cesarean Section Prevent Maternal Injury?
In any case, cesareans are not protective. The studies comparing pelvic floor strength between women having vaginal births and women having cesarean deliveries have all been done within a few months after birth. In point of fact, the pelvic floor recovers (7,11). Studies doing long-term followup fail to find differences in muscle strength or urinary incontinence between women birthing vaginally and women having cesareans (13,21,27,40). What's more, a program of pelvic floor exercises can strengthen the pelvic floor and relieve symptoms in many women (4,32). In other words, weakness can often be remedied without risk or expense.
Are Cesarean Sections Safer than Vaginal Birth?
As someone whose life work is evaluating and synthesizing the obstetric research, I can attest that NO data support the contention that cesareans are as safe as vaginal birth for mother or baby. A cesarean section is major abdominal surgery, with all that entails. Compared with vaginal birth, cesarean section causes pain and debility, sometimes for weeks (26). The surgery itself, as opposed to medical problems that might lead to a cesarean, increases the risk of maternal death, hysterectomy, hemorrhage, surgical injury to other organs, infection, blood clots, and rehospitalization for complications (16,24,33-34,39). Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs and the risk of chronic problems from adhesions. The surgery itself also increases the risk of the baby being born in poor condition or having trouble breathing after planned cesarean or cesareans done for reasons other than the baby's condition (2,8,18). Also, because of scar tissue, the incidence of placenta previa (the placenta overlays the cervix) and placenta accreta (the placenta grows into or through the uterine muscular wall), complications that kill babies and mothers, soars with each successive cesarean (1,3,10,17,28,36). Infertility and ectopic pregnancy (the embryo implants outside the uterus) associate with previous cesarean section as well (17). Finally, the uterine scar raises the specter of uterine rupture during a subsequent pregnancy or birth, a danger not removed by planned repeat cesarean (15,30).
The Newsweek article stated that vaginal birth caused cerebral palsy, implying that elective cesarean section was the solution. Studies show that few cases of CP arise from events in labor, which is one of the main reasons why electronic fetal monitoring has had no effect on the CP rate (5,25,29,31). Even the fact that some babies develop cerebral palsy after vaginal birth without an obvious explanation does not necessarily mean vaginal birth was the cause. As with pelvic floor weakness, obstetric management plays a role. For example, Pitocin, used to induce labor and stimulate stronger contractions, can cause overly strong contractions that deprive the baby of oxygen, and instrumental delivery can cause bleeding in the brain. Also, while a policy of routine cesarean might prevent a few cases of CP, the benefit would be vastly outweighed by the harm done to many thousands of other mothers and babies.