What Doctors Don’t Tell You About C-sections

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I was six months pregnant when a smiling stranger on a bus asked where I was delivering. Within minutes, this woman was sharing intimate details of her own birthing experience—the water breaking, the contractions that failed to get closer together, and the way her doctor deftly sewed up the four-inch incision from her Cesarean section. “I’m telling you, this guy was good,” she said. “Next time, I’m just scheduling my C-section. None of this pushing stuff.”

I reached my stop before I could probe her for more specifics. But, I have to admit, her ringing endorsement made C-sections seem pretty appealing. After all, for most of us, the thought of pushing a baby through a centimeters-wide opening is at least daunting, if not downright terrifying. And, the fact is, a C-section is so routine these days that many regard it as simply an alternative to vaginal delivery, not major abdominal surgery.

Except that’s exactly what it is. And today, one in three babies are born via C, according to the most recent data—a 50% increase over the previous decade. “We think the rate is going to go up even more,” says Hope Ricciotti, MD, associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School in Boston.

When the procedure is needed—when the mother or baby is in distress or other factors make a vaginal delivery hazardous—it can be a lifesaver. But only about 5% of C-sections are true emergencies, estimates George Macones, MD, chairman of the depart­ment of obstetrics and gynecology at the Washington University in St. Louis School of Medicine. Around 3% are completely elective, meaning there’s no medical reason whatsoever, but the vast majority of C-sections actually fall into a gray zone: the baby looks big, mom is past her due date, labor isn’t progressing well.

A growing group of critics are now questioning whether so many of these healthy pregnancies should be topped off with surgery. “There’s no question that there’s a basic, irreducible number of C-sections we need to do for women’s health,” Dr. Ricciotti says. “But there’s also no question that we’re doing too many in the United States.”

It takes at least four weeks to recover from a Cesarean section—which involves cutting through the skin, tissue, and uterine wall, extracting the baby and placenta, and sewing the incision—compared with one or two weeks for vaginal deliveries. The surgery carries with it the risk of infection, blood loss, and blood clots, as well as other potentially fatal complications.

While we’ve all heard that type A moms and profit-seeking doctors are fueling this trend, the truth is far more complex. Here’s the real story, and what every woman needs to know before she gets pregnant.

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