BY LUCHEN (LOU) WANG
Published February 3, 2013
The Caesarean section is by far the grandest way for a person to enter the world. If it weren’t for C-sections, many babies wouldn’t have been born. Shakespeare’s "Macbeth" would have been a very different kind of tragedy if Macduff hadn’t been ripped from his mother’s womb. In fact, some of us can attribute our existence to this procedure. Our modern acceptance of the C-section is remarkable because of historical aversion to it.
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In the past, only brave souls performed C-sections in order to save an infant from a dying mother. C-sections posed a dangerously high risk of infections and hemorrhage. In the 1970s, C-sections accounted for only about five percent of deliveries in the United States, even after the invention of antibiotics, anesthesia and suturing that prevent hemorrhage. Obstetricians instead delivered with forceps. Only ten years later, the landscape for childhood deliveries began to change dramatically.
According to the National Institutes of Health, by 1988 nearly one in every four babies was delivered by C-section. By 2010, obstetricians delivered 32.8 percent of babies by C-section, and virtually none by forceps. Many critics suspect these numbers are exaggerated.
Like all surgeries, C-sections come with complications. They increase the chance of infection, hemorrhage, re-hospitalization and the likelihood that the uterus will rupture in subsequent pregnancies.
Even the expenses are higher. According to the CDC, hospital charges for a Caesarean delivery are almost double those for a vaginal delivery. Critics attribute this trend to physicians’ growing fear of malpractice lawsuits. We can also contend that we’ve reached a point in medicine where, for many mothers, the risks of surgical delivery are equal to, or less than, those of vaginal delivery. According to the authors of “Elective Primary Caesarean Delivery," a study published in the New England Journal of Medicine, “accumulating data have suggested increasing potential benefits and decreased risks associated with its (C-section’s) performance.”
The likelihood of a Caesarean is also increased due to maternal age, bigger babies and obesity. In addition, 90 percent of women who have C-sections end up repeating the procedure for subsequent births because of high risks associated with vaginal birth at that point. This trend is on the rise in the developed and industrialized world.
There’s a key message in our shift towards Caesareans best illustrated by the decline of the forceps. At one point, obstetricians employed forceps in 40 percent of deliveries in the United States. Forceps were actually associated with equal or better outcomes for the baby and mother compared to C-sections — but only in the hands of talented obstetricians.
Learning how to use forceps required a kind of intuition that didn’t always come naturally to trainees. As thrilling as it might be to perform a skill accessible only to a select group, leaders in obstetrics needed to improve the skills of every obstetrician in the country, and thus improve the health of every baby and mother. Obstetricians, as well as patients, need reliability and consistency. The C-section has become the answer to this dilemma.
Once uncommon, the Caesarean section has — in just 10 to 20 years — become a staple in obstetrics. In the near future, C-sections may be even safer for both the mother and child. Would more mothers prefer C-sections without trying vaginal delivery?
The authors of the New England Journal of Medicine article seem to suggest that this will become increasingly acceptable. “Although the evidence doesn’t support the routine recommendation of elective Caesarean delivery, we believe that it does support a physician's decision to accede to an informed patient's request for such a delivery. “Will our society ultimately choose to forgo our natural ability to give birth for what may in the future be an equally safe or safer process? And what will be the effects of that decision?
In "Macbeth", Macduff — a man untimely ripped from his mother’s womb by a C-section — kills Macbeth at the end of the play, fulfilling the witches’ prophecy that no one born of woman could kill Macbeth. If Macbeth took place in a world where Caesareans were common, Macduff would have still fulfilled the prophecy and slain Macbeth, but the prophecy would be a lot more mundane. And for good or for bad, there would be a little less drama.
Luchen (Lou) Wang is an LSA senior.