September 17, 2018


Although the origins of the term caesarean section are widely disputed, the procedure has been practiced across the globe for thousands of years. From Julius Caesar’s alleged surgical birth in ancient Rome to desperate husband Jacob Nufer’s first ever recorded successful surgery on his pregnant wife in 16th century Switzerland, the caesarean section was designed to save lives during life-threatening labor. With the technological and medical advancements of the 21st century, caesarean sections, also known as c-sections, are still common practice for women with high-risk labours. Unlike the past however, it’s not uncommon for doctors to perform elective surgeries on healthy women who, for a variety of personal reasons, choose to opt-out of giving birth naturally.


If you’ve watched the news or surfed the internet recently, you’ve probably heard that c-section rates are at an all-time high. Like most unexpected medical trends, the increased rate of elective c-sections across the globe can’t be easily explained. From a human evolutionary perspective, surgical births take place today because of anatomical changes, such as bipedalism and larger brained babies, which have resulted in a tighter fit between unborn babies and the maternal birth canal. However, these long-term physiological changes don’t account for the substantial rise in modern c-section procedures as most women are still capable of safely giving birth naturally.


From 1990 to 2014, the global average rate of c-section birth increased from 6.7 percent to 19.1 percent, with an average annual increase of 4.4 percent. According to the international healthcare community, the ideal percentage of c-section births is between 10 and 15 percent. Despite this, women are undergoing surgical births at an unprecedented rate; one in every five births worldwide. In North America, c-sections account for 32.3 percent of all births. Recent studies reveal that when caesarean section rates rise toward 10 percent across a population, the number of maternal and newborn deaths decreases, but when c-section rates rise above 10 percent, there is no evidence that mortality rates improve.


When necessary, c-sections save lives


When medically necessary, c-sections can be a lifesaver for both the mother and child. It’s nearly impossible to deny the legitimacy of a procedure that is designed to save lives, and in emergency situations, almost all women will agree to a c-section if it increases the chances of a safe birth for themselves and their baby. Approximately 40 percent of c-sections are unplanned, often performed during what are considered emergency or medically necessary circumstances. The most frequently cited reasons for medically necessary c-sections are prolonged labour, abnormal positioning, fetal distress, and birth defects. In contrast, roughly 60 percent of c-sections involve some level of planning by clinicians and their patients.  


Women continue to choose surgical birth over natural birth


Staggering statistics like these beg the question: Why are so many women choosing to have non-medically essential c-sections? The answer is complex. In modern times, women have c-sections for a variety of socio-economic, cultural, political, legal and personal reasons. According to a study published in Evolution, Medicine, and Public Health, many women choose c-sections over vaginal birth because they have unalleviated concerns about pain and loss of control, bodily harm, and trauma or tissue damage that might make them less sexually desirable to their partners. To put it simply, many women are very scared to birth their babies vaginally despite being perfectly capable.

Today’s drastic increase in elective c-sections can partially be attributed to the medical community. In many cases, doctors are driven by insurance companies and the fear of malpractice liabilities to encourage scheduled non-essential c-sections, and many ob-gyns are becoming increasingly impatient with prolonged labour. It’s no secret that doctors have a strong influence on their patients’ medical choices, especially those in vulnerable positions. Research shows that insecure women often develop doubts about their ability to give birth and lack the confidence to challenge or question clinicians who vouch for non-essential surgical options, even though continuing to labor may have resulted in a healthy infant born vaginally.


When given a choice, vaginal birth is the best option


When it comes to giving birth, women want the safest birth method possible. We know that not all women have the option to give birth naturally, even if they really want to. But for women who do have the option, the benefits are substantial. Take for example, an increased ability to breastfeed successfully, a shortened physical and psychological recovery period after birth, and a rush of labour hormones that enhances mother and baby attachment. Not surprisingly, mothers are not the only ones who benefit from vaginal birth as it boosts their baby’s body systems, making it easier for them to cope with the change from womb to world.


So, what’s the safest option for mothers who have a choice? Contrary to popular belief, planned c-sections can pose a serious risk to mother and baby. A Canadian study of all women who gave birth from 1991 to 2005 reported that the risks of severe complications during planned c-sections are three times more likely than those of planned vaginal births. Other studies have found a link between c-sections and postpartum depression, as well as long-term effects from repeated surgical births. Due to inadequate colonization of the infant gut, babies born via c-section are more likely to experience negative short-term effects, as well as long-term risks than their naturally birthed counterparts.

Facing childbirth fears

By recognizing the countless benefits of a natural birth, women are one step closer to making an informed birth decision. It’s also important for women with childbirth anxiety to know that they’re not alone. It’s normal for women to be anxious about childbirth, especially when it’s their first time. But anxiety and fear are two vastly different emotions when it comes to vaginal birth. One study conducted in 2012 found that between five and 20 percent of pregnant women are scared of childbirth. This fear was derived from several factors including young maternal age, first-time motherhood, pre-existing psychological issues, lack of social support, and a history of abuse or adverse obstetric events. Interestingly, the study determined that women who have a fear of childbirth endure a longer labour than women who do not. This is likely due to the fact that humans have evolved to give birth in a social and cultural context. For instance, research suggests that women who are emotionally supported during labour experience lower rates of medical intervention in the birth process.  


Medically necessary c-sections have been around for much of human history and will continue to be performed for as long as lives need saving, but elective c-sections are a relatively new medical phenomenon that if continues, will have significant implications for the future of childbirth. Expectant mothers who can give birth naturally should have the autonomy to make their own childbirth decisions without being pressured by the medical community or their peers. However, to make a well-informed decision, women must educate themselves on the benefits and setbacks of both surgical and vaginal birth and feel supported by trusted friends, family, and medical professionals throughout their childbirth journey.


Shawna King