The Case Against Cesareans on Demand

In many countries all over the world, cesarean (C-section) birth rates are rising. In some countries, like Brazil or Taiwan, C-section birth rates are skyrocketing up to 60 percent because giving birth this way is considered to be fashionable. In the USA, more than one million women, 1 in 3, give birth by cesarean every year. The WHO has stated that about 10 to 15 percent of all births should be C-sections. This raises the question about what factors play a role in the rising C-section rates and in these differences.

Reasons for ever more frequent C-sections

Factors that seem to influence the rising C-section rates are the growing average age at which women become pregnant, the fact that better-insured women can afford more C-sections (the higher the socio-economic status of the woman, the higher the C-section rate), medical protocols like "once a C-section, always a C-section," or "breech is equal to C-section," the surging rates of electronic fetal monitoring, escalating health problems in women (e.g., diabetes and obesity, more prenatal stress linked to more birth complications, role models like media stars and "influencers" who choose a C-section as a "lifestyle choice," women and their partners who want to keep the "honeymoon vagina" intact (Barber, Emma L., Lundsberg, Lisbet,… Illuzzi, Jessica L, et al., 2011) and finally, and perhaps most importantly, because cesareans are seen as "the easy and comfortable way" not only by the woman but also by her doctor.

The negative impact of C-sections

Many women choose to be delivered in hospitals by C-section in the belief that this method is safer and less painful than vaginal unassisted delivery in a hospital or at home. These women, like their doctors, are unaware of how such a decision may negatively impact the health of their children. One of the reasons for that is that women in labor routinely receive antibiotics to ward off infection after a C-section.

Antibiotics are also used to prevent serious infection in newborns caused by Group B strep, a bacterium that 25 to 33 percent of pregnant U.S. women carry. Antibiotics are broad in their effects, not targeted. While they kill Group B strep, they also kill friendly bacteria, thus selecting resistant ones.

Another reason is due to the fact that the first microbes colonizing the newborn begin a dynamic process. They instruct the developing immune system about what is dangerous and what is not. In this way, we develop adaptive immunity that will clearly distinguish self from non-self. C-sections and antibiotics disrupt this process with potentially detrimental long-term effects (Shane, A. L. 2014).

We need to remember that the founding populations of microbes found on C-section infants are not those selected by hundreds of thousands of years of human evolution. Babies born by C-section harbor bacterial communities found on the skin, dominated by Staphylococcus, Corynebacterium, and Propionibacterium. Their gastrointestinal tracts do not get colonized by their mother's lactobacilli. As a result, these babies will have difficulty digesting their mothers' milk, which will lead to further problems.

Looking at C-section through the prism of mental health, the following brief reports speak volumes. After 19 hours of labor and an eventual C-section, Kristen Kjerulff, Ph.D., a professor of public health sciences and obstetrics and gynecology at Penn State College of Medicine, in Hershey, Pennsylvania, said, "I felt as if I had failed, while the women I knew who delivered vaginally were quite proud." Kate Winslet reportedly said of her C-section: "I was so completely traumatized by the fact that I hadn't given birth."

Women who deliver by cesarean section have more negative perceptions of their birth experience, themselves (Loto, O. M., Adewuya, A. O., Ajenifuja, O. K., & Ogunniyi, S. O. 2009), and their infants exhibit poorer parenting behaviors (Cornwall, Gail 2020), and may be at higher risk for postpartum depression compared to women delivering infants vaginally (Xu, H., Ding, Y., & Zhang, D. 2017; Kjerulff, K. H., & Brubaker, L. H. 2018). By restricting the control that they can exercise under normal circumstances over birth, cesareans often violate women's expectations about childbirth.

Following most C-section births, the first body contact between mother and baby is delayed for several hours. This flies in the face of attachment studies well established for a long time. Undergoing a cesarean does not trigger the release of oxytocin, which plays a key role in shaping maternal attachment behavior (Klaus, Marshall H., Kennell, John H. and. Klaus, Phyllis H, 1996). Therefore, cesarean birth not only increases psychological risk factors in women as described above but also interferes in their bonding to their babies and thereby increases the likelihood of child neglect and child abuse.

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Summary

The main reason for the increasing rates of cesarean deliveries is a universal lack of understanding of the basic needs of women in labor and the long-term psychological consequences for them and their children. Based on the evidence, C-sections, unless indicated for medical reasons such as breech presentation, prolonged labor, fetal distress, etc., should be avoided at all costs.