The True Cost of a Cesarean

….may never be known.

There are so many different factors — some financial, some health-related, some emotional. While not everyone agrees with this, many studies show a higher death rate for both mothers and babies with a C-section. Some C-sections are done for failed inductions; and the inductions failed because the babies weren’t ready, and many times have to spend extra time in the NICU. Many mothers are left with sadness regarding their surgeries and feel as if their bodies let them down. But here are some real stories I am acquainted with, that each show that in some ways, the C-section isn’t the end — its effects may continue to be felt for years.

1. A life-long friend had a C-section a year ago when her baby was transverse and her water broke. It was an uncomplicated C-section, and she didn’t even stay in the hospital a full 48 hours. Her bill was $25,000. This greatly surprised me because I assumed that an uncomplicated C-section would be more in the $15,000 range. While her insurance covered 80%, their portion was still $5,000. Ouch! Even worse, her recovery was so bad (couldn’t get out of bed or a chair by herself for 3 weeks), that she told me that she wouldn’t have any more children if she knew she’d have to have another C-section.

2. Someone whose blog I keep up with is currently having secondary infertility, probably due to her C-section a few years ago. In addition to the emotional toll of having multiple miscarriages, there is the added burden of going through tests (some of them expensive, some not covered by insurance), to try to find the cause of her inability to carry another child to term.

3. Another person whose blog I keep up with is currently in the midst of a (hopefully) 12-week hospital stay. She has placenta previa, which can happen even in an unscarred uterus, but is more likely to happen if you’ve had a C-section before. She was put on hospital bed-rest after having a few episodes of slight vaginal bleeding. She’s hoping to get to 36 weeks, at which point they’ll take the baby by C-section. But it’s possible that she may dilate too much before then, and they’ll have to take the baby prematurely. Now, I don’t know what the cost of her hospital stay is, but for 84 days of hospital care, and the frequent (sometimes constant) monitoring that she is undergoing cannot be cheap. Then there is the emotional toll of being in the hospital, away from her husband and daughter, and worrying or at least wondering about the health of her baby, and hoping that she’ll be able to remain pregnant long enough that he won’t have to stay extra time in the NICU.

When C-sections save lives, that’s one thing. But there is a current article promoting Cesareans on demand. It just makes no sense to me, but maybe it does to some people. Then there are all the C-sections that are made necessary because of “the cascade of interventions” that so frequently happens in a hospital setting.

In light of the long-term downsides of a C-section, just make sure the cost of a C-section is worth what you’re going to have to pay.


10 Responses

  1. Even here in Canada… where our health care is ‘covered’ and I use that term loosely!
    It has a massive impact. Seven years ago I was a part of a group who did research in to the cost effectiveness of midwifery in ALL Provinces as a primary care for all pregnant women (yes, they can risk out etc…). The numbers we generated for cost savings, bottom line showed that we could save MILLIONS on the single most impressive thing.
    That midwives have less than half of the cesarean section rate as OB’s/GP’s and whomever else ‘delivers’ babies in a hospital.
    Too bad the federal government didn’t take notice of it.
    I wonder if anyone looks at the emotional cost too. The therapy, the anti-depressants, the lost work, marriage issues…

  2. Yes, I imagine that the OB of the “choosy mom who chose a cesearean” didn’t take the time to tell her of all the risks of cesareans. That OB didn’t take the time either to clear up that moms concerns about vaginal birth. If only moms had all the information and ways to clear up their fear about birth… then positive changes will happen more quickly!

  3. Great thought!
    And nowadays our c/sec climbs over 31% compared to 4% in 1965 a majority are being done because of the no-VBAC policy being inforced in many hospitals across the country. We have one hospital in our area that will let a woman try for a VBAC. The c/sec will continue rising until the no-VBAC policy is banned and/or until more women are truly educated to the risks and start learning how to take back birth.

  4. i find the topic of c section very interesting, particularly vbac vs repeat c. i am currently 34 weeks pregnant with my second child. i had a c section with my 3 year old. water broke, no labor. i am sure the cascade of interventions did have something to do with surgery. however, i have never doubted my doctors decision. after 12 hours there were no alternatives left other than surgery and we needed to save the baby. i did feel traumatized at that moment, upon hearing that i would have an unplanned c section. however, after meeting my daughter and being cared for by hospital staff-i was fine. elated even to see my baby after the anticipated 9 months. recovery was not bad, i was walking within hours and everyday felt better and better. no anti depressants, no therapy. in fact i was shocked at the women’s last comment about a woman needing anti depressants after a c section. why would one assume that a woman would need these interventions only after a c section? the reasons for depression after child birth are many and are not directly correlated with c section rates.
    i am having a repeat c. i am a 30 year old woman, very interested and capable of making my own informed decisions. i have a masters of science and in grad school became extremely well trained on reading medical and science journals. i have read many medical articles, i am fully aware of the risks involved with my upcoming surgery. i do not feel i am making some kind of convenient choice, it is not about scheduling or time, and i am not relieved at all with my decision. however, the trauma of laboring for 12 hours with no effects, of knowing and seeing your baby’s vitals become chaotic, and the effects of not being able to control your body are terrible on a woman. i did not feel guilty, i felt i wanted to take care of my baby and get her out, and have her healthy. the chances of this taking place the end of my current pregnancy again are certainly present. the risk is higher than my death or my babies in this surgery. and i decided along with my doctor that a repeat c is best for me and my baby. so as an informed and capable woman-i feel a bit threatened or even disappointed reading through all of these posts and comments and blogs. it comes off as one sided and at times even tyrant-like. the statistics are well known the risks understood. i am not some thoughtless mother nodding to all my doctor’s decisions. i am grateful for the opportunity to make my own. in some cases there is false information being discussed on this web page, such as miscarriages rates being higher because of c sections. so while suggesting mothers should have all the information to clear up their fears of childbirth, i find it ironic that on the same page she reads that having a c section will make her need anti depressants or therapy or miscarriages. women’s issues have always had this problem, someone telling them about they have choices but some are better, some are worse-give a woman and her ability to exercise free thought more credit. c sections are not purely the dangerous offerings of big insurance companies and hospitals and cold doctors, they are a choice for some educated women, and these women should not have their rights taken away because others feel personally involved. there must be more room and space to discuss the choices in childbirth for women. each women different with her own history and her own way of dealing with pain. there is something to be said for evolving as the time brings new technologies-they are not all bad just because it is not as you would have it, or because childbirth is not as traditional as you would have it. i feel there is some assumption being made here about women having c sections-that they are careless or uneducated or somehow less. where is the universal respect?

  5. I appreciate the time you took to tell me about your experience and your plans.

    I don’t think that women would suffer from postpartum depression or need anti-depressants or therapy only after a C-section — but I do think it is more likely for women to suffer from emotional problems after a traumatic birth (vaginal or C-section) than after a non-traumatic birth (vaginal or C-section). I also have found that more C-sections than vaginal births would tend to be traumatic on the mother. (Here’s another link.) I also believe that how a woman feels about the care she receives is more important to her feelings than the actual care she receives. In this post I discuss a woman’s C-section and her subsequent depression, and at the end I contrast that with my sister-in-law. I conclude that the nameless woman was coerced into her surgery and was angry about her experience and upset with the way her birth experience was forced to go; but Ellen was not upset (details follow). She had planned a home birth, but for whatever reason after 40+ hours of hard labor, her baby wasn’t being born. She went to the hospital where they tried several things, including forceps, to get the baby out. Finally, C-section was the only option. But every step of the way, Ellen was in control of what happened — she chose the interventions and ultimately the C-section. When contractions started for her 2nd labor, she opted for a C-section, rather than risk a repeat of birth #1. But she chose. You chose. Many women do not get the choice, especially when it comes to VBACs.

    I’m sorry you feel “a bit threatened or even disappointed” about what you’ve read. Perhaps what I present is one-sided; yet I know of many doctors who have been every bit as much one-sided or even more so, but they pretend to be “balanced” or “objective” or “neutral.” When the current U.S. C-section rate is at or slightly above 30% while the WHO says that no area can justify a rate more than 10-15%, it bothers me that doctors don’t seem to care about lowering the C-section rate. When I read stories of women who were coerced, manipulated, or forced into interventions including C-sections that they did not want and may have been unnecessary, it bothers me. I at least admit my biases, and am working to balance out a lot of the main-stream view that it doesn’t matter how you give birth. I’ve read too many stories that show that to be not the case. And when it comes down to it, you and not the doctor and not me are going to be the one giving birth and undergoing the surgery. You know these risks and accept these risks; many women are not even informed about the risks. That bothers me.

    As far as the “false information” — here is a link to the CIMS fact sheet which gives the references for the statements I made regarding miscarriage. There’s also this, this, this, and this.

    I certainly don’t assume things about women who have C-sections. Once I hear or read their stories and learn something about them and their decision-making process, then I understand more about them and what made them make the choices they did. I do not pretend that all choices are created equal — take smoking, for example. If this blog were focused on smoking, would you expect me to present a “balanced” perspective, showing the positives of smoking (that some people find it relaxing, a way to “bond”, a sign of maturity) along with the negatives (risk of death from all kinds of cancer, premature aging, increased likelihood of lung problems including emphysema for yourself and asthma in your children)? If I focus solely on the negatives of smoking, would you find that I was “making assumptions” about smokers — that they are careless or uneducated or somehow less? Would you accuse me of not being respectful of their choices? If I wrote posts about my time working at a pharmacy, and telling stories of children having rounds upon rounds upon rounds of antibiotics and asthma medication and asthma treatments, and having to give these medications to these people who were smoking in the car with these children who were sick because of the smoke — would you say that I should give a “balanced perspective,” and include stories of children who did not get asthma from the smoke?

    When the evidence shows that C-sections and repeat C-sections are riskier for mother, baby, and future babies, I will say so. Until the evidence shows that C-sections and vaginal birth are equivalent, I am not going to pretend that they are.

  6. kathy-
    its really wonderful to see your concern and your passion about this issue. and of course in my above comment, i was not addressing your words per se, but the overwhelming feeling i received by reading the majority of responses on c sections on many web sites. c sections and vaginal births will never be equivalent. there is no use in pretending that they are. but there are dangers involved in all births, and some woman who make the decision for vbac are putting their lives at risk, although it is a small percent-it is still a danger that exists. a woman must really read and read and ultimately rely on her own instincts. not your or the details another’s experience, or even facts in some cases can be responsible for making this tough decision. i am finding it difficult to appreciate your smoking analogy. we are talking about healthcare here. the choices involved are in many ways beyond an impulsive decision like smoking. point is to try and speak as objectively as possible about both sides of the issue (vaginal versus c section). so smoking and its negatives are easy objectives, facts proven time and time again, an immediate direct correlation. having a c section is for some woman the best or only alternative-smoking is never the best and only alternative for any individual. but a c section-this is not a desirable choice or a craving or an individual addiction. it is a medical procedure, very obviously different that a behavior like smoking.
    i think if women are being coerced or manipulated into having c sections, this is sad and it bothers me as well. just as the coercion and manipulation delivered by many others on some women to have vaginal births or vbacs bothers me too. and this is the general feeling i get when researching what women feel about c sections. its an interesting perspective, and does show me there is little balance on the issue. i think many women are informed about he risks. just doing a simple search on the internet shows over and over the risks involved with c sections. i have a hard time believing there are many doctor’s who do not inform their patients that a c section is major abdominal surgery. i do not think that is the problem. look at the history of childbirth, the many deaths that were once associated with vaginal births, the interventions in hospitals that have saved lives. there are problems in any systems but it is not all negative dark conspiracy about doctor coercion and legality. there may be more complex reasons for the rise in c section rates.
    thank you for reading about my experience and my plans, i like so very much that there is this discussion and hope to see more like them. there may need to be a greater understanding of why the c section rate is so much higher, not just an attack of it. i do not see how this form of speaking on the issue will change it much. it is fearful for some women to go through their pregnancies reading all of these horrible opinions and scary facts about c section-when in the end for whatever reason (usually beyond their control and out of necessity) they are placed on the operating table. yes, this could lead to depression and feelings of guilt, and perhaps if there were other perspectives these women would not feel so terrible. my point is there is much more room for balance in the discussion posted here. there are surely many situations where c sections and repeat c’s were the best decision to be made at the moment. and at that moment it really does not matter what the evidence shows, it matters to get baby out and relieve mom from the trauma. this is an issue much more dimensional than smoking, this is much more complex.

  7. […] C-section, complicated or uncomplicated. Finally! (I’ve previously blogged about this subject here and here.) The chart lists average costs in 2003, 2004, and 2005. These costs do not include any […]

  8. Ruth said “i have a hard time believing there are many doctor’s who do not inform their patients that a c section is major abdominal surgery”.

    The extent of my doctor’s “informing” me prior to being taken to surgery was “Honey, let’s go down the hall and have a baby.” After I had been prepped, had the epidural turned up so high that I was having difficulty concentrating, and my arms had been strapped down against my wishes, he said “now, you know this is surgery, and like all surgery it has risks: nerve damage, blood loss and all that. so let’s go.” He never mentioned any of the risks in subsequent pregnancies: secondary infertility, placenta accreta, placenta previa, placental abruption, uterine rupture. He barely touched on the basics for normal surgery and totally left out any mention of postoperative infection.

    Yes, some doctors DO practice this way.

  9. I can tell you right off the bat why the cesarean rate is higher now. Doctors are tired of getting sued when vaginal deliveries go wrong. They focus so much on the safety of the unborn child that often the mother’s well being is overlooked with the risk of surgery. I can’t say this is true for all cases though, mine being one of them.

    I had a cesarean with my first child because of cephalopelvic disproportion, meaning my pelvis is too small to deliver vaginally. When I was trying to deliver, the doctors were unaware of this. So yes, had they opted to do a vac assist with my son, which the option was given to me, no doubt I would have suffered severe trauma along with severe trauma and even the possible death of my child. Had I focused more on my own well being at that time, I would have chosen to do the vac assist. But that is not me. My children will always come first and I’m so glad that I chose to focus exclusively on the safety of my unborn child. I would not have been able to forgive myself if I had chosen vac assist and my child suffered trauma or even death from that. Even if it means risking my own life. I would die for my children and thus the reason why I chose the C. When I had the surgery is when they discovered that my pelvic outlet was too small to deliver a baby vaginally. For those of you thinking it, no my son was not a large baby, 7 lbs 7 oz, very average size. During surgery, just moments after my son was delivered, my epidural wore off and I began to feel horrible pain while my uterus was still sitting atop my abdomen. I don’t remember this part, but appearently I tried to sit up on the operating table and rip my arms out of the restraints. BTW Traci Perg, that is the reason why they strap you down, not because they are mean and are doing it for kicks, but it is for your safety and the doctor’s saftey. For some unfortunate few like myself, the epidural can wear off, have a bad reaction to medication, etc. causing the mom to lash out. Could you imagine trying to do surgery on someone who is thrashing around on the table? I don’t remember this because they gave me Versed to knock me out and give me amnesia. I don’t remember a whole lot after surgery until the next day. It saddens me that I can’t remember much after the birth of my son but I would still opt to have the Versed again because I wouldn’t want to remember trying to rip my arms out of restraints while they sew up my uterus. Had I known this was going to happen, would I have still chosen to do the C? Definitely, because my children’s safety will always come first. I peronsally know a woman who chose vac assist and her daughter who is now 22, suffers from cerebral palsy and has a permanent disability because of it. 22 years later, the mom still feels guilt because of that. Yes, there are always risks with surgery, but one needs to weigh the risks with the benefits.

    • I’ve since had a repeat section delivering my second child, and they did not strap down my arms. In fact, I found out since that it is very uncommon to do so, especially if the patient requests that her arms remain free.

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