Almost daily, my Ob/Gyn colleagues and I have risks vs. benefits conversations about scheduled cesarean (C-section) deliveries with patients 35 and older.
Women who request a planned C-section are often professionals who want to coordinate their maternity leave from work. Many are having their first babies and are not planning to have more. They’ve often read up on C-sections and learned that, in general, the procedure is fairly low risk. So, what could be the harm?
Until recently, these were tough points for doctors to counter. We know that women 35 and older already are at greater risk for maternal morbidity than younger women. And we know that C-section generally carries more risk than vaginal birth. And the bulk of previous research has assessed C-section risks only as related to future pregnancies.
But a 2019 study published in the Canadian Medical Association Journal (CMAJ) suggests that the trade-off of risk vs. convenience of scheduled C-sections for women in this age group is dramatically skewed. Researchers found that women 35 and older who have scheduled C-sections might be at double the risk for severe maternal morbidity – delivery-related health complications in the mother – than women of the same age who deliver vaginally. What’s more, their doctors are agreeing to it.
C-section facts women 35+ should know
As mentioned, previous research has assessed C-section risks in the view of future pregnancies. However, this study examines risks related to the current pregnancy. Researchers found that women over 35 who had planned C-sections were at greater risk for a range of severe maternal morbidities, including:
- Blood clots in the lungs
- Kidney, liver, and cardiac dysfunction
- Admittance into the intensive care unit
While the exact reason for the weight of risk to women in this age group is not yet known, researchers in the study suggest potential pre-existing conditions or age-related surgical recovery complications might play a role.
In recent decades, the maternal age at delivery has increased in higher-income countries. The CMAJ study states that approximately 17 percent of pregnancies in the U.S. are to mothers older than 35. In this same age group, the C-section rate is nearly double that of younger mothers at 43 percent. And the primary (non-emergency) C-section rate is almost 30 percent. In other words, women over 35 are opting for elective C-sections without understanding the inherent risks.
Certainly, there are medically necessary reasons for planned C-sections, such as protecting the health of the mother and baby. However, given these new data, it’s important for women 35 and older to carefully consider whether the convenience of a scheduled delivery is worth risking their health or even their lives.
Related reading: Having a C-section? What pregnant women should know
Balancing patient rights with health care education
The bulk of evidence shows that, in general, interventional C-section – in the case of medical need or emergency – is a relatively safe procedure. As such, some Ob/Gyns feel comfortable consenting to the desires of patients who want a scheduled C-section.
But C-section is a surgery that can cause serious health implications. And this study suggests that doctors should not so easily agree to schedule elective C-sections without first having ample educational conversations with their patients.
UT Southwestern is an academic medical center. As such, we empower our patients to make the best choices for their health with our medical knowledge as a guide. Spontaneous labor is the safest route for most patients and their babies. However, if planning time away from work or for other life responsibilities is deeply important to a patient, less invasive methods such as induction of labor might be a better choice. Induction typically results in vaginal delivery while still allowing some maternal control over the timing of the birth.
A few closing thoughts
I hope this study will help doctors impress upon patients the wisdom of their choice of elective C-section. Women in this age group are powerful. They are professionals. They are frank about their wants and needs. But sometimes it’s appropriate to rely on the recommendations of people who are there to educate, support, and provide care. In my mind, fully weighing the risks of scheduled C-section is one of those times. If you want to discuss your delivery options with a doctor, call 214-645-8300 or request an appointment online.
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