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The Complicated Truth About C-sections
Your friends and the internet are not the best source for up-to-date information
When I was pregnant with my first child — my daughter — I embraced the assumption that, if at all possible, it’s best to avoid having a Cesarean section. I made a lot of choices which I believed were in the service of trying to avoid one, including not having a potentially labor-extending epidural. And I was lucky in that, in this particular domain anyway, things went according to plan.
The history of the Cesarean section is rooted in myth and ancient storytelling. While the backstory is tough to untangle, C-sections are thought to have been performed for millennia, with the earliest procedures attempted on dying mothers in hopes of saving their infants. It’s believed that the first “successful” Cesarean — where both the mother and infant survived — was performed by a pig gelder named Jacob Nufer in the 1500s, though historians question the veracity of this story.
What is certain is that the reliable and consistent use of the C-section came hundreds of years later. It took improvements in wound management and the creation of better antibiotics before the Cesarean became a medical mainstay. But in making up for lost time, C-sections are now both common and routine. Roughly 30 percent of births in the U.S. are performed this way, and the figures are even higher elsewhere: In China, only about half of births are vaginal.
It’s become fashionable of late, at least in the U.S., to malign this high C-section rate and argue that we must decrease the number performed through better doctor and patient education and less continuous fetal monitoring. But this argument hinges on the presumption that it is best to avoid having a C-section, if you can.
Several years ago, inspired equally by my pregnancy and my love of data, I wrote a book — Expecting Better — that used statistical evidence to help women and their partners make better decisions while expecting. In the case of C-sections, I took my assumptions and the received wisdom, effectively, for granted. I dismissed the Cesarean as something every woman would like to avoid, if at all possible.
