Birth by Cesarean Section

An unborn child lives and grows in its own world, enveloped, cared for and protected. It is intimately connected with its mother. It also perceives something of the outside world, at first vaguely and then increasingly more clearly. Its reactions to voices, touches and sounds become more and more noticeable. When the time is ripe, a not quite fathomable subtle interplay of impulses begins, enabling the process of birth to get underway.

Every birth is a challenging and existentially significant experience and a unique event. The organism of mother and child is designed to use the power of labor to realize the child’s impulse to come into this world. Overcoming the narrow and dark path of birth completes the child’s transition into the earthly world. 

We can trust that this natural transition process will have a good outcome, especially if the mother giving birth and the child being born are not disturbed, and if the overwhelming power of birth is appreciated and respected. 

Obstetrical emergencies

In individual cases birth is nevertheless sometimes connected with special difficulties. This can be for general human, individual or socio-cultural reasons. Our upright gait requires special pelvic statics and thus demands optimal obstetrical conditions, such as a lot of movement and avoidance of a long supine position. The current tendency towards a lack of exercise in everyday life and problematic nutrition can individually reinforce this susceptibility to difficulties in the birth process, since it leads, among other things, to an increase in the child’s body weight while at the same time decreasing the flexibility of the maternal pelvis. 

The socio-cultural reasons lie in our understanding of birth conditions and the birth environment: often the idea of birth is determined by questions of security and fear and the birth is shifted to a medically dominated room – which can shake the mother’s confidence in her ability to bear children and often neglects the necessary reverence for the intimacy and shieldedness required by mother and child.

If the birth becomes too much of a burden for either the mother or the child, it can threaten their health or even their life. The possibility of bypassing the vaginal birth route in such situations and saving the child through cesarean section was one of the outstanding advances in obstetrics. With the improvement of surgical and anesthetic techniques as well as better hygiene, cesarean section has become an effective instrument for reducing the frequency of birth-related diseases and death. 

As with all new procedures – and cesarean section must be regarded as such despite its ancient roots – the problematic aspects of the operation were initially unknown or ignored in the euphoria about its great benefits. This led to a continuous increase in the rate of cesarean sections, so that today about every fifth child (1) worldwide is born in this unnatural way (16.1% in Europe, for example, 56.9% in Iceland (2)). The World Health Organization states that with a cesarean section rate of more than 10–15%, the health disadvantages for mothers and children are already greater than the health benefits (3). 

Evidence of the long-term health consequences of such an “epidemic” of cesarean sections is constantly growing: children born by cesarean section have an increased risk of developing diabetes (4) and are more likely to suffer from allergies (5), asthma (6), obesity (7) and cardiovascular diseases (8) in later life. Mothers can also find it difficult for years to integrate this potentially traumatizing experience (9). They have longer-lasting pain, suffer more often from postpartum depression (10) and have more complications in subsequent pregnancies (11). 

The undisputed benefits of surgery in reducing mortality and morbidity in obstetric emergencies are offset by considerable epidemiological disadvantages that go far beyond the immediate consequences of surgery for mother and child. Cesarean sections that are not absolutely necessary have therefore become a serious problem today.

If the way in which we are born is already so important for us individually, the question arises as to how the various experiences of a birth by the vaginal route or even by cesarean section will affect our children, grandchildren and great-grandchildren – and society and humanity in general. 

However, cesarean sections cannot be assessed uniformly. They are carried out from fundamentally different motivations which have nothing to do with each other and which should be discussed strictly separately. Various possibilities for creating good conditions for the birth during pregnancy are also of great importance. Contributing factors include physical awareness exercises, a good connection between mother, partner and child, exercise, plenty of sleep and a balanced diet. In the case of special problems, there are many other possibilities for positively influencing the stability and health of mother and child. 

If a cesarean section does become necessary, the possible consequences mentioned above can be counteracted by empathic and mindful accompaniment and therapeutic measures.
For more information, see
https://www.anthromedics.org/PRA-0649-EN.

1 Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, Moller AB, Say L, Hosseinpoor AR, Yi M, de Lyra Rabello Neto D, Temmerman M. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018;392(10155):1341-1348. [Crossref]

2 Franke T. Vaginal-operative Geburt: Zahlen, Daten, Studien. Deutsche Hebammenzeitschrift 2019;71(6):14-17.  

3 World Health Organization. WHO statement on caesarean section rates. WHO reference number: WHO/RHR/15.02; 2015. Available at https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/ (16.11.2020)

4 Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, Goldacre MJ, Parslow RC, Pozzilli P, Brigis G, Stoyanov D, Urbonaitė B, Šipetić S, Schober E, Ionescu-Tirgoviste C, Devoti G, de Beaufort CE, Buschard K, Patterson CC. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 2008;51:726–735. [Crossref]

5 Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clinical and Experimental Allergy 2008;38(4):634-642. [Crossref]

6 Chu SY, Chen Q, Chen Y, Bao YX, Wu M, Zhang J. Cesarean section without medical indication and risk of childhood asthma, and attenuation by breastfeeding. PLoS One 2017 Sep 18;12(9):e0184920. [Crossref]

7 Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Medicine 2018;15(1):e1002494. [Crossref]

8 Taoac K, Harab Y, Ishiharaa Y, Ohshima Y. Cesarean section predominantly affects right ventricular diastolic function during the early transitional period. Pediatrics & Neonatology 2019;60(5):523-529. [Crossref]

9 Weidner K, Garthus-Niegel S, Junge-Hoffmeister J. Traumatische Geburtsverläufe: Erkennen und Vermeiden. Zeitschrift für Geburtshilfe und Neonatologie 2018;222(5):189-196. [Crossref]

10 Xu H, Ding Y, Ma Y, Xin X, Zhang D. Cesarean section and risk of postpartum depression: A meta-analysis. Journal of Psychosomatic Research 2017;97:118-126. [Crossref]

11 Daltveit AK, Tollånes MC, Pihlstrøm H, Irgens L Cesarean Delivery and Subsequent Pregnancies. Obstetrics & Gynecology 2008;111(6):1327-1334. [Crossref]