Caesarean section, a medical procedure far from trivial
Cesarean sections are increasingly common among women in France. This operation is sometimes the only solution to protect the health of the mother or child.
But why has it increased so much in recent years? The older age of women at childbirth, the increase in high-risk pregnancies, and changes in medical practices partly explain this trend, according to the French National Academy of Medicine. While cesarean sections save many lives each year, they remain a procedure that also carries risks. What are they really? What preconceived notions still circulate? And in what cases is this operation truly necessary? Three specialists from the Nice University Hospital—Dr. Cynthia Trastour, obstetrician-gynecologist, Prof. Jérôme Delotte, head of the women-mother-child unit, and Dr. Hervé Haas, pediatric infectious disease specialist—shed some light on this practice.
What is a cesarean section?
This is a surgical procedure that allows the baby to be delivered through an incision in the abdomen. It is performed when the baby cannot follow the natural route and come out through the vagina. A cesarean section is a very controlled procedure, which is performed under local anesthesia in the majority of cases, allowing the mother to be conscious.
In what cases is a cesarean section decided upon?
The decision is based on two main situations. The first is a scheduled cesarean section, planned in advance for medical reasons such as a low-lying placenta that could hinder the delivery of the infant, poor baby position, a narrow pelvis, or a history of multiple cesareans. The second reason is a cesarean section during labor, often performed as an emergency when a vaginal delivery is not progressing or the baby is showing signs of distress. In all cases, this decision is made based on the health of the mother and child.
What are the risks associated with this type of intervention?
Converting a natural process into a surgical procedure is not without consequences. While a cesarean section can be lifesaving in some situations, it exposes the mother to complications: hemorrhages, infections, digestive wounds, adhesions, abscesses, or intestinal obstructions. Recovery is generally longer than after a vaginal delivery, sometimes with prolonged hospitalization and persistent pain. A cesarean section also leaves a scar on the uterus, which weakens the organ for future pregnancies and increases the risk of complications such as placenta accreta (1).
And for the baby?
The main immediate risk to the baby is respiratory distress, especially if the procedure takes place before 39 weeks of pregnancy. This is because the natural birth prepares the newborn's lungs by facilitating the evacuation of amniotic fluid, which is not the case with an abdominal birth.
Additionally, these children do not acquire the same bacterial flora as those born vaginally, which can affect their digestion and the development of their immune system. This difference in microbiota may be associated with the risk of allergies and asthma during childhood.
This is why resorting to an intervention for comfort or convenience, without medical reason (see box) must be carefully considered in light of the potential risks for the mother and child.
Can you give birth vaginally after a cesarean?
Yes, and it's even recommended in the majority of cases. Three out of four women who have already had a cesarean section can give birth vaginally during their next pregnancy, provided their medical situation allows it. However, the first cesarean increases the risk of having a second one, due to the scar on the uterus, which requires special monitoring.
What are the psychological consequences of a cesarean section for the mother?
Although in the majority of cases, cesarean sections go well and are well accepted, this procedure can have a strong impact on the mother, especially when it was not planned. Some women feel a sense of failure or frustration because the birth did not go as they had imagined. Furthermore, even under anesthesia, the sensation of being "cut open" or manipulated can be difficult to cope with and leave a lasting impression. In these situations, appropriate psychological support is essential, as each experience is unique.
1. When the placenta attaches abnormally deeply to the wall of the uterus, which can cause difficulty in detaching it after delivery and lead to hemorrhage.
Comfort caesareans requested by the mother, without medical reason, exist in France but remain rare. " These requests are most often motivated by fear of childbirth, the desire to choose the date of birth, or by certain preconceived ideas, such as the fear of perineal complications (such as tears or incontinence) linked to a vaginal delivery." From the obstetrician's point of view, this intervention can also have the advantage of facilitating personal and departmental organization.
French regulations are nevertheless clear: a cesarean section must be based on a medical indication to ensure the safety of both mother and child. " In practice, elective cesareans can be performed. However, once the real benefits and risks are explained, the vast majority of patients reverse their initial decision and opt for an attempted vaginal delivery."
While it only affected 5% of births in the 1970s, caesareans now represent 20% of births (one in five), or around 150,000 operations each year.
This rate varies depending on the region and the degree of specialization of maternity wards: in level 3 establishments, which deal with high-risk pregnancies, serious maternal pathologies or even situations of extreme prematurity, specific to a university hospital, it can even exceed 25%.
At the Nice University Hospital, the caesarean section rate is around the national average of 20%.
Globally, some countries such as Brazil and Turkey have rates above 50%, while the World Health Organization (WHO) estimates that an optimal rate should be around 15%, beyond which no additional benefit is observed in terms of public health.
Var-Matin
