A cesarean birth (the birth of a child through an incision in the mother’s abdomen and uterus) is major surgery that is sometimes necessary for the health and safety of the baby or mother: to save a baby that might be in fetal distress, to deliver an exceptionally large baby or one in a breech position, or to save a premature baby under stress from the trauma of vaginal birth.
In these circumstances, a C-section is not a choice; it is not a matter of being green or nongreen. It is a medical emergency and is not something that can be predicted or therefore approved beforehand in a birth plan.
But there is a circumstance in which an expectant mom who has had one previous cesarean birth has the option to choose a vaginal or cesarean birth for the second baby. In this case, a green delivery may call for VBAC: vaginal birth after a cesarean. (More pregnancies or more babies, as you might expect, change the situation considerably.)
After a woman has delivery by cesarean, some physicians insist that all future births also be by cesarean. There is a concern that in very rare circumstances a vaginal birth after cesarean could cause the uterus to rupture. But there is no evidence from randomized controlled trials on which to base any such practice recommendations regarding planned cesarean section for nonmedical reasons at term.1
Despite this lack of evidence, fewer than one in ten women these days have a vaginal birth after a cesarean delivery. The statistics on cesarean deliveries are just as startling: the most recent data from the Centers for Disease Control and Prevention show that the cesarean delivery rate in the United States has climbed to 29.1 percent of all births, the highest in our history.2
There are good reasons to avoid cesarean delivery if possible. It is major surgery and therefore it requires a longer, more expensive hospital stay, a greater need for blood transfusions, and a prolonged recovery period.3
A C-section affects the baby as well. The sterile environment required for the surgery can change or delay the ability of beneficial bacteria to make their home in the baby’s intestinal tract. Growing evidence suggests that these beneficial bacteria can improve health. For example, in one small study of 865 healthy, full-term, breastfed babies with a family history of allergies, the babies were about half as likely to develop food allergies if they were delivered vaginally.4
A cesarean birth scheduled before labor begins also increases the risk that the baby will be born suffering from respiratory distress syndrome. If the gestational age of the baby is miscalculated, the lungs may not be fully mature, and upon cesarean birth the baby will experience problems of prematurity that he would not have had had he been allowed to develop fully until labor contractions began. This can keep him on a respirator and out of his mother’s arms, and prolong his stay in the hospital.
You want the baby’s first interaction with the environment to be as natural as possible, and that comes by whenever possible entering the world through the birth canal where the mom’s body and the baby’s body are joined together in a way that prepares the baby for life outside the womb. That’s why, unless there’s a good reason for a cesarean, a vaginal birth is a solid first choice.
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