If you’re a faithful reader of this blog and/or a fellow birth junkie, the following article will not come as a big surprise — Cesarean Sections Linked to Future Birth Risks. It warns of the dangers of placenta accreta or percreta in future pregnancies (accreta is when the placenta implants too deeply into the uterine wall; percreta is when the placenta actually grows through the uterine wall and attaches to other organs). The only surprising factor to me was that it was an article in a non-birth publication which strongly warned of the danger of C-sections. All too often, the standard argument in most mainstream articles (and by that, I mean non-birth-oriented publications) is a “balanced” picture of C-sections versus vaginal birth, with the pros and cons of both sides being presented as basically equal. There are pros and cons to both sides, but that doesn’t mean that they are balanced or roughly equal. If a mom or baby truly needs a C-section, then obviously, the balance tips dramatically in the favor of a C-section; but if the surgery is not medically necessary, then vaginal birth obviously is favored for both mom and baby.
The first mom mentioned had placenta percreta (in which the placenta grows through the uterine wall, and in her case invaded her bladder), forcing the doctors to end her pregnancy 4 months early. Her baby is still struggling to survive, and she lost her uterus. She wanted four children. She says after her first baby was born by C-section, she expected “lots of C-sections” in order to have the size of family she wanted — I guess she was told “once a C-section, always a C-section,” because it doesn’t sound like she even thought of attempted VBAC. Not that it ultimately mattered in her case, since her first post-op pregnancy cost her her uterus, but placenta accreta and percreta increase exponentially with every additional surgery, so for many women, it may be their 2nd, 3rd, or 4th unnecessary C-section which costs them their ability to bear children, and possibly the life of their baby, and even potentially threatens their own life.
The article also quotes the rate of placenta accreta as being 1/30,000 in the 1950s, but current studies show a rate of 1/2500-500! Yikes!
I’ve seen some “VBAC Consent Forms” which pretty much magnify the risks of VBAC, particularly uterine rupture, which can be devastating or even deadly for the baby. But the risk is small, especially in labors that are allowed to begin or continue naturally; and if the care providers are monitoring the mother and baby, they can usually get early warning that something is wrong (like the mother feeling the pain of her uterus splitting, or the baby’s heartbeat showing signs of distress), so the absolute risk of death or severe morbidity to the baby is low. Often the consent forms tell the mother that if she has a VBAC, her baby is the one that will be put at risk, whereas if she chooses a C-section, then she’ll be the one that has more risks (from the actual surgery, which has a higher rate of blood loss necessitating transfusion, risk of hysterectomy, infection, etc.). Put that way, most women will feel selfish for wanting a vaginal birth, so sign up for a repeat C-section. However, this article points out that even one C-section increases the risk of future placenta accreta/percreta, and each repeat C-section increases the risk exponentially, so mothers may be choosing a repeat C-section to keep their current baby from the 1/200 risk of uterine rupture (with an even less risk of death or severe morbidity), while setting up a future baby to be in the position of the first baby mentioned in the article — being born much too early, and possibly dying or having severe long-term difficulties. Plus the mother may hemorrhage and necessitate a blood transfusion (perhaps even massive), and/or lose her uterus.
Read the entire article, because it is very informative. I wonder how many women are truly given informed consent before their first C-section, or any subsequent ones. Time for a VBAC-lash!