When Heidi Johnson, 34, was expecting her second baby, she worried about what that might mean for work.
The Harrisburg high school health and fitness teacher was anxious about when the baby would come and how it might disrupt her classes and schedule at the end of a harried semester.
So Johnson and her husband, Robert, also a teacher, took guesswork out: She scheduled a cesarean section – or C-section – to have Emma Faith delivered at 7 a.m. on Jan. 14.
That put Johnson in a small but growing group of women who have elective C-sections, at least in part because it’s more convenient. Sometimes the reason is a fear of the unknown or apprehension about complications. Johnson’s first child was delivered by emergency C-section.
Convenience wasn’t the only factor in her decision, said Johnson, who was also worried about potential complications. Still, she said, “I knew that on Jan. 14 that I was going to have my baby. It was nice being able to plan that.”
Doctors say more women request C-sections today than ever before, although the number is difficult to track. And it’s not only moms who find them convenient. Understaffed hospitals and doctors with busy practices are more likely to consider scheduled deliveries.
But C-sections come at a cost. The surgery can be 50 percent more expensive than a natural birth. Recovery time for the mother is usually longer. Some moms feel the sting of judgment from others who might scoff at their decision.
A soaring trend
C-section deliveries were once an emergency procedure of last resort. In 1965 only 4.5 percent of U.S. deliveries were C-section.
A due date could be estimated, but the actual time of arrival remained a surprise. But as medical advances decreased the risk – and both doctors and mothers became more comfortable with C-sections – the rate rose to nearly 25 percent by the mid-1980s. By 2007, one in three births in North Carolina were cesarean.
Of all C-sections in the U.S. today, an estimated 2.5 percent are considered maternal request. “There’s a whole mindset that’s changed,” said Dr. Joseph Ernest, chairman of the obstetrics and gynecology department at Carolinas Medical Center in Charlotte.
Ernest trained in the 1970s and has watched the trend change over time. “People are choosing it, and most doctors are happy to do it,” he said. “We want patients to be satisfied with their care, but we must also be medically prudent.”
Higher cost of C-sections
The average costs associated with cesarean births are about 50 percent higher than vaginal births. Commercial insurance figures show natural deliveries cost around $18,000, while C-sections run nearly $28,000. For Medicaid reimbursement, it’s about $9,000 for natural vs. $13,600 for C-section, according to a Truven Health Analytics market study.
Though small in number, convenience-based C-sections are more popular during the holidays, medical experts say.
“There’s this holiday cycle that we haven’t overcome,” said Dr. Martin McCaffrey, a neonatologist at UNC’s N.C. Children’s Hospital in Chapel Hill.
Hospitals are short-staffed that time of year, he said, and many moms don’t want to spend the holidays in a hospital bed.
But he cautions against judgment without considering the many reasons a woman and her doctor might schedule a C-section.
Avoiding Christmas delivery
Erin Timon, 34, a day-care worker from Monroe, had C-sections with all three of her children. The first was an emergency, but the second and third were scheduled partly for convenience.
“I chose to have a C-section because my due date was Christmas Day,” she said of her second C-section. “I didn’t want to be (in the hospital) on Christmas.”
Timon scheduled another C-section three years ago not only to miss Valentine’s Day, but also to avoid labor and to get a tubal ligation following delivery.
Still, the C-section came with its own drawbacks, she said. Recovery was difficult, and the pain medication prescribed by her doctor caused nausea.
Heidi Johnson, the Harrisburg teacher, took the opportunity to have a tubal ligation after her delivery. And she, too, struggled with the pain of a major surgery.
“The C-section was awful afterwards because they cut open your body, and they cut the abdominal muscles. It feels like everything is ripping,” she said. “It’s hard to connect with your baby because you’re in so much pain.”
C-section deliveries pose a higher risk for infection and require longer recovery time than vaginal deliveries, medical experts say. Multiple C-sections increase the likelihood that a mother will experience complications with excessive bleeding, scar tissue, and abdominal weakness.
Having a C-section isn’t always an easy choice. It’s common for women to plan to have their babies naturally, but then wind up having a C-section – much to their disappointment – because labor becomes overwhelming or other issues arise.
And sometimes, women who choose to have elective C-sections feel judged or second-guess themselves.
Amy Ehrlich, 40, wanted a vaginal birth with her second child, but in the end, she chose a C-section because laboring with a nearly 9-pound baby was more than she could handle.
“To this day, I still talk about it in my head – ‘Did we do the right thing?’ – because that’s not what I wanted to do,” said the Huntersville mom of two. “In my heart, I didn’t want to go that way, and to this day, I sometimes feel like I chickened out. But my doctors really helped me with acceptance.”
Rachel Van Buren, 34, works among medical professionals as a pregnancy coach, or doula, and says the issue of elective C-sections is polarized.
The Charlotte mother of four birthed all of her babies naturally, but her own mother had only C-sections. She remembers her mother as a guidepost not to judge other women for their birth choices.
Some women “who have natural birth think that women who have had C-sections are failures,” Van Buren said. “They villainize women who have had C-sections.” Rather than criticizing, mothers should support one another in the important decision, she added.
“We all want healthy babies,” she said. “Hopefully one day we will all be on the same page.”
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