Did you know that women who experience cesarean birth (c-section) are less likely to have another baby? Cesarean sections impact far more than the birth experience- they impact fertility too.
This post first appeared on the Mama Birth Blog.
I talked to not one but two women this week who had one child but had wanted to have more. What happened?
The thing that made them change their minds was giving birth to their first child. And they gave birth via emergency cesarean section. They were both so disturbed by the experience that they decided that they would have no more children.
We often talk about the impact of the ever-present c-section in our culture. People talk about how it can impact the breastfeeding relationship or recovery time or the difficulties in VBAC and even how lifesaving and wonderful it can be. These are all important factors. But there is something that is often overlooked.
The c-section is a cruel form of birth control.
I have talked to dozens of women who limit their family size because of c-sections. Sometimes it is because their c-section was unexpected, scary, and traumatizing. Sometimes it is because they were told that they "had" to have repeat sections and that they should limit their family size to three or fewer children for their own personal safety.
Whatever the reason, we must talk about this issue.
Roger W. Harms, M.D. of the Mayo Clinic, when asked how many c-sections a woman can safely have says this: "Most women can safely have up to three C-sections. Each repeat C-section is generally more complicated than the last, however."
He goes on to mention some of the risks of numerous abdominal surgeries. They include:
"Primary concerns with repeat C-sections include:
- Weakened uterine wall. Each uterine incision leaves a weak spot in the uterine wall. This may interfere with future attempts at vaginal birth.
- Problems with the placenta. The more C-sections you've had, the greater the risk of developing problems with the placenta - such as when the placenta implants too deeply and firmly to the uterine wall (placenta accreta) or when the placenta partially or completely covers the opening of the cervix (placenta previa).
- Heavy bleeding. The risk of needing a hysterectomy - removal of the uterus - to stop excessive bleeding after delivery increases with the number of repeat C-sections."
I have met so many women though who never move past that first traumatic birth experience. To me, this is one of the unspoken tragedies and cruelties of modern birth. Whatever you think of family size and population control, it is exceptionally distasteful that the way we damage women at the time of birth is so traumatizing both physically and emotionally that they actually change their life and family plans because of it.
We can talk all day about the monetary cost of the c-section or about how it saves lives or about bacteria in the birth canal and trouble breathing, but you can not put a price on the damage we are doing to women.
This is cruel. This is abusive. This is wrong. And, this is how we are treating women at the time of their baby's births. We are literally hurting women so deeply that they are scared to ever bear another child.
I want to share some comments from a mom forum regarding this subject. These women say it far better than I ever could.
"My doctor has said that since I had so much scar tissue from my third c-section, that he doesn't recommend that I try it again. We've decided to take his advice. Our third child died because of malformed kidneys, and my heart is longing for him, but we are blessed with two others, and God has seen us through it all. I know that if He means for us to have another, thought it may not be ours biologically, it will be a gift from Him. My advice to those who really want another child, but the circumstances don't favor it--pray for guidance, listen to your doctor, and be content with the blessings that you do have."
"i had two c-sections so far i am pregnant now and having 3rd c section soon. my dr keeps pushing me to have my tubes ties but i am married and only 25 i dont want to get tubes tied dont know what i should do???i have 2 boys dont know what this is? should i risk a 4th? or get tubes tied??"
"I am absolutelty scared to give birth, my husband and i trying to get pregnant again, i had c-section in August with my first baby and the recovery was horrible thanks to a hospital error that resulted in sever staph infection and blood infection. I really want to go naturally next time but im scared to death, especially since DD's head was 15 inches when she was born,"
I must not be the only person who finds these sentiments so incredibly tragic. Women are yearning for more children. Women are being pushed into not just unwanted c-sections, but unwanted tubal ligation. Can we even describe how cruel this is?
Lest it seem like I am just inventing this problem after talking to a few women (in fact I have talked to numerous women through the years who get their tubes tied after their 2nd or 3rd c-section or who are so upset by the ordeal of the first birth that they simply stop trying on their own) let's look at a huge documented study supporting this fact: women who have c-sections have fewer children.
In fact, the study found that, "women who underwent C-section to have their first baby were 12 percent less likely to have another child than women who gave birth vaginally."
You can read the study in full here, which concluded, "This suggests that the reduced fertility was to a large degree voluntary and not related to the indication, nor to any physical consequence, of the cesarean delivery."
There are women who have half a dozen or more c-sections safely. There are women who love their surgical births. There are women who have traumatic births and go on to have wonderful empowering births later. But we can not ignore the fact that the impact of the prominent cesarean section is far deeper and damaging than anybody cares to admit.
We are talking about a surgery that is done about 30% of the time in the USA. We are talking about surgery that is the most common surgery for women. This is also a surgery that not too many years ago was done only about four percent of the time. The fact that the c-section is limiting family size is no laughing matter.
We can not ignore the impact of modern birth on the modern woman. We must take back our choices, our bodies, our births and our families. I wish I could say that there are others out there that will help us do this, but I just don't believe it any more. We must own our choices, face our fears, and give birth under our own power.
We understand that c-sections, VBACs and so much more when it comes to birthing are very personal issues, individual to each woman. And, while we still stand by natural births being the safest and healthiest for the baby in most situations, we'd be remiss to imply that they were the safest and healthiest in ALL situations.
For instance, my first son died because I did not have a c-section. Of course, had I or any of my providers known that I had a condition called vasa previa, we most certainly would have scheduled one. Vasa previa is a condition in which fetal blood vessels cross or run near the internal opening of the uterus. They are not contained in the cord, and when you go into labor and/or your water breaks, they rupture and you and your baby begin to bleed to death.
In my situation, there was only one blood vessel not contained in my umbilical cord. One little broken blood vessel (I'd been highly monitored and screened for vasa previa, but it's unique presentation evaded the screening) made my son essentially bleed to death and me nearly bleed to death. He was delivered in an emergency c-section and then whisked away in a helicopter to a hospital an hour away while I lay there, paralyzed from the drugs and the blood loss, wondering what the hell had just happened. He died from blood and oxygen loss the next day.
Management for vasa previa is hospitalization/bed rest around 32 weeks and delivery typically around 36 weeks so as not to get near labor or those vessels rupturing. You most definitely schedule a c-section.
Related: When a Traumatic Birth Story Leaves You Ashamed
My birth story is extreme, I know, but it's not isolated. There are MANY reasons a woman may need a c-section, and too often, she's shamed when she has one.
That is not the intent of this article, nor our reposting of it.
Yes, vaginal births are the optimal situation, and yes, c-sections for convenience or ease of mother or practitioner should be avoided. Yes, c-sections are happening too much, and yes, they may be affecting future births for women who have them.
Let's just be gentle as we remember all that as well as situations in which they're life-saving.