Patient Choice Cesarean Section (PCCS): Look Before You Leap
The March 2, 2009 article in Time Magazine on VBAC's and the January 2009 New England Journal of Medicine (NEJM) study on elective cesarean delivery give you much to consider as you evaluate your options for delivery.
What is patient choice cesarean section (PCCS)?
PCCS, also termed "cesarean delivery on maternal request" (CDMR) is "defined as a primary cesarean delivery at maternal request in the absence of any medical or obstetrical indication". (ACOG--American College of Obstetrician and Gynecologists, Committee Opinion, Number 394, December 2007)
PCCS a movement that originated in the 1990s in South America in which women opt to have a cesarean section without labor, rather than go through labor.
Why do women choose PCCS?
"Avoiding vaginal birth prevents trauma to the vagina and perineum"
--Myth or Fact?
Cesarean section prior to onset of labor reduces stretching of the vagina, and a few studies have shown it decreases the incidence of incontinence in the first year after birth. Studies comparing rates of incontinence in women who've had cesareans without labor vs. women who've delivered vaginally show a five to ten percent reduction of urinary incontinence in women who delivered by cesarean without labor.
However, other studies on the pelvic muscles and nerves have shown that twenty-five percent of the weakening of the pelvic floor muscles occurs during pregnancy before labor. The weight of the pregnancy stretches and strains the nerves that innervate the pelvic muscles. So just carrying a pregnancy to term affects pelvic floor muscles and nerves.
Maternal Risks of C-Section vs. Risks of Incontinence
A study reported in the February 2009 issue of Obstetrics and Gynecology evaluated 32,276,863 deliveries between 1998 and 2005. The study notes that the cesarean delivery rate increased from 21% in 1998 to 31% in 2005. Attending this increase in the cesarean delivery rate was an increase in the following severe (some potentially fatal) complications of delivery:
Kidney Failure--20% increase
Respiratory Distress Syndrome--20% increase
Shock--20% increase
Pulmonary Embolism (clot in the lungs)--52% increase
Blood Transfusion--92% increase
History of cesarean delivery increases a woman's risk in future pregnancies of abnormal implantation of the placenta including: placenta previa, placenta accreta, and vasa previa. These placental abnormalities increase the risks of all the scary things above.
Timing of Elective Cesarean Delivery at Term Greatly Impacts Newborn Health
The study on timing of elective cesarean delivery and impact on newborn health published January 2009 in the NEJM revealed an increase in all of the following adverse outcomes for newborns delivered prior to 39 weeks gestation (35.8% of cesareans in that study of 24,077 births) up to 150 to 400 percent, depending on gestational age and outcome:
Adverse respiratory outcomes
Mechanical ventilation
Newborn sepsis (infection)
Low blood sugar in newborn
Admission to the Neonatal ICU
Hospitalization for 5 days or more
So, while cesarean before labor may reduce the risk of urinary and fecal incontinence, is it worth the increased risks to both mom and babe?
Incontinence can be prevented by pelvic floor muscle training (PFMT-Kegel exercises) and it can be treated with these and other conservative measures--more on this next week.
What has your experience been with:
vaginal birth
cesarean birth
repeat cesarean birth
incontinence of gas, urine, and stool after birth?
Want more info on pregnancy, birth, and post-partum? check out DIY Baby: Your Essential Pregnancy Handbook
P.S. If anyone bothered to check out the article in Time, they incorrectly reported my location as "Colorado Springs" rather than "Glenwood Springs". Hey, it's Time Magazine, I'm not complaining.
