“Choosy Mothers Choose Cesareans”

Sometimes, briefly, you feel like you’re making progress, that midwifery outreach is making a difference, that people are becoming more educated and informed, and then you read an article like this one, over at Time Magazine, and you realize that you exist in a small bubble where your philosophy on birth is far different than the majority of the country, and no matter how much you talk yourself hoarse educating people about the issues, they’re still going to buy into the myths of birth, hook, line and sinker.

Cesarean births are not “safer”. Numerous studies have demonstrated, again and again, that cesarean births carry more risks than vaginal delivery, and these risks multiply with each cesarean birth. Sure, the woman in this article had a “safe” and uncomplicated primary cesarean, but no attention is given to what happens when this same woman comes back for her second or third repeat cesarean—how difficult it is to perform surgery on the same site, to cut through scar tissue, how the risks for abnormal placentation such as placenta previa or placenta acreta increase exponentially with each cesarean, how the risk of hemorrhage increases dramatically. There’s also no discussion about how painful recovery from a cesarean is compared to recovery from a vaginal delivery, and how statistics have shown that this poorly affects bonding and breastfeeding rates in women who’ve given birth by cesarean. (Not to mention the fact that the motivation for elective cesareans for many women is a fear of pain, and in fact, the entire process is often much more painful, for a much longer period of time, post cesarean).

    Vaginal delivery can, for example, lead to future incontinence and pelvic damage, while babies born by C-section may suffer from respiratory problems because of not being exposed to certain hormones during the birthing process.

Where is the author, Alice Park, getting this information from? How come there are no articles or references cited? I thought we were well beyond the argument that cesareans prevent pelvic floor damage. While injury to the pelvic floor can and does occur during vaginal delivery, it’s often caused by practices such as episiotomy, vacuum-extraction, forceful pushing and lithotomy position during deliveyr, all of which can be (and are being) minimized during vaginal birth. Routine episiotomy, for example, is now by and large a thing of the past. Furthermore, there is no conclusive evidence which demonstrates that cesarean section prevents pelvic floor damage. To quote from What Every Pregnant Woman Needs to Know About Cesarean Section (2006), published by the Maternity Center Association:

    Is vaginal birth in and of itself harmful? It is common to hear that “vaginal birth” causes pelvic floor problems. Of hundreds of studies examined, however, not one attempted to avoid or limit the use of practices that can injure a woman’s pelvic floor to try to determine whetehr vaginal birth itself plays a role. It is wrong to conclude at this time t hat the cause of pelvic floor problems is giving birth through the vagina….

    Is “vaginal birth” the culprit in the high levels of incontinence that women experience later in life? Studies that take a longer view find that new problems with urinary incontinence that appear after birth lessen over time. These problems tend to completely disappear by the time of menopause. Older women experience high rates of incontinence, but this appears to be due to other factors. For example, excess weight and smoking play a role.

    Does cesarean section prevent incontinence? Routine cesarean section would only prevent continuing symptoms of incontinence in a small portion of birthing women. For most women, it would pose numerous risks without benefit. And it would offer no protection against experience incontinence in later years. As no research has found that vaginal birth itself causes incontinence, there are more sensible ways to prevent these problemss: 1) avoid when possible the use of birth interventions that can injure the pelvice floor, and 2) focus on keeping a healthy weight, avoid smoking and other risk factors.

(Still not convinced? Check out the following studies:

[1] Shorten, A, Donsante, J. & Shorten, B. (2002) Birth position, accoucheur and perineual outcomes: Informing women about choices for vaginal birth. Birth, 29(1), 19-27.

[2] Terry, R, Westcott, J, O’Shea, L., & Kelly, F. (2006). Postpartum outcomes in supine delivery by physicians versus nonsupine delivery by midwives. The Journal of the American Osteopathic Association, 106(4), 199-202.

[3] Soong, B., & Barnes, M. (2005) Maternal position at midwife attended birth and perineuam trauma: Is there an association? Birth, 32(3), 164-169.)

The point being, I can’t believe such a mainstream publication could write such an imbalanced, one-sided and poorly researched article. I think I feel a letter to the editor coming on!

This entry was posted in Cesarean Birth, Complications, Hospitals, Research. Bookmark the permalink. Trackbacks are closed, but you can post a comment.


  1. hannah banana
    Posted May 4, 2008 at 4:50 pm | Permalink

    I hope that you did write a letter to the editor – the story was so very poorly presented. But don’t lose faith, you are making a difference – even on the days that it feels microscopic it’s a big difference.

  2. k
    Posted May 7, 2008 at 12:01 pm | Permalink

    You know… I’ve been bashing my head over this article for a while now! surprising I know!
    I wonder what would happen if an article came out ‘woman are forced to have elective repeat cesarean due to hospital rules.’
    Wonder what would happen then? If they were to use the excuse given to those who question the vbac bans, we need 24/7 anaesthesia for an emergent situation…
    Wouldn’t someone clue in to the fact that NO ONE should give birth there, just in case there is an emergent situation?
    as usual, ranting in your space. Apologies.
    And yes, one more midwife practising DOES make a MONUMENTAL difference!

  3. med school mama
    Posted May 9, 2008 at 7:50 am | Permalink

    I learned in school that simply carrying a pregnancy was what put women at risk of urinary incontinence later on, and so kegals seem essential to working around this. That is what I plan to work on with my patients. I agree, promoting elective cesareans is really shameful and bad for women, babies and our culture.

  4. Posted May 11, 2008 at 9:39 pm | Permalink

    Happy Mother’s Day. Thank you for helping women become mothers.

  5. sec2118
    Posted June 5, 2008 at 9:39 am | Permalink

    Glad to know that others were also outraged by this article based completely on hearsay…

    I did write a very long letter to the editor, which was too long to ever get published, but filled with cited information,and recommendations of responsible organizations she could contact for future research but who knows if the author will even see it.

    Interestingly, and rather upsetting, I recently heard Eugene DeClerque (sp?) from the BC school of public health speak, and he actually said that he spent hours on the phone with this writer,after she contacted him top talk about writing the story, telling her that she can not write the article, that it wasn’t true, all about the research and “Listening to Mothers” survey etc, and she said she had already decided to write about this and so was going to write it anyway!!!!!!!!
    Ugh, such a poor example of journalism, and an example of the huge problem with public information.

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