Q&A: Fearful mom-to-be wants a C-section

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By By Dr. Judith Reichman

Q: Though my doctor doesn't anticipate any problems, I'm terrified about going through labor and delivery. Can I ask for a Cesarean section?

A: Yes, you can.

Traditionally, obstetricians — and, of course, midwives — have been trained to allow women every opportunity for a vaginal delivery. Cesarean deliveries were thought to be associated with more complications (and even maternal death due to bleeding and infection).

But these higher complication rates were due in part to the fact that C-sections were often performed under difficult conditions — after long hours of labor, ruptured membranes or fetal distress. When researchers compared complication rates of elective C-section with vaginal delivery, there was little difference.

There’s no question that there can be long-term side effects to vaginal delivery — especially a difficult one, with a large baby exiting a small pelvis. Women whose children are delivered vaginally, compared with those who deliver by C-section, have a 2.2 times higher risk of moderate to severe urinary incontinence. (Because urinary incontinence increases with age in all women, these differences disappear after age 50.)

A comparison of women with no children and women who have delivered at least one child vaginally shows that vaginal delivery doubles the risk of uterine prolapse, rectocele and cystocele. (These refer to relaxation of the pelvic support, so that the uterus, rectum and bladder descend and/or protrude from the vagina.)

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After vaginal delivery, women with prolonged labor or a family history of pelvic-organ prolapse are indeed more likely to develop the above-mentioned problems 10 or 20 years down the road.

That said, C-sections are not to be taken lightly. Having one raises the risk of complications in later pregnancies. These risks include placenta previa (the placenta covers the cervix) and placenta accreta (the placenta is abnormally attached to the uterine wall). Both can cause hemorrhage.

There's also a 1 in 200 risk that the internal C-section scar will rupture during a subsequent labor, putting both you and your next baby at risk.

Last year, the American College of Obstetricians and Gynecologists published the opinion that it is ethical to perform elective C-sections, stating “If the physician believes that Cesarean delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing a Cesarean delivery."

Many physicians, myself included, feel that that justification should include your mental well-being and your fears about vaginal birth.

You and your doctor should discuss this important decision not just for this delivery but with regard to your future reproductive career. In addition, you should bear in mind that if your fear of a vaginal delivery is caused by concern about pain that this can be effectively and safely controlled with appropriate epidural analgesia.

For those of us who take satisfaction in completing nature's cycle, vaginal delivery should certainly be considered the norm; however, a C-section should not be ruled out should circumstances arise where it might be the preferable option.

Dr. Reichman's Bottom Line: It's okay to discuss your trepidation about vaginal delivery with your obstetrician and to broach the idea of a labor-less birth. There are certainly pros and cons. If your doctor is unwilling to let you consider this, you might want to seek a second opinion.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.