What are the advantages and disadvantages of Caesarean section? Detailed explanation of second and subsequent births [supervised by a doctor]

What is a Caesarean section?

A “Cesarean section” is different from a “natural birth (vaginal birth)” in which the baby is born through the passageway in the mother’s body known as the birth canal. It is a birth method in which the mother’s abdomen and uterus are cut open with a scalpel and the baby is delivered through a surgical procedure. Some clinics may call it Kaiser, due to its German origin.

When people hear the word “Cesarean section,” many pregnant women think of it as an “emergency, high-risk birth.” However, according to data reported by the Ministry of Health, Labor and Welfare in 2017, the percentage of people who gave birth by Cesarean section was reported to be 25.8% of people who gave birth in general hospitals. In other words, about one in four people who give birth is by Cesarean section. Considering that the percentage in 1990 was 11.2%, this means that it has more than doubled in about 30 years.

The increase in caesarean section births is primarily due to the development of medical technology, which has reduced the risks to mothers and babies. Also, depending on the condition of the mother or baby, such as pregnancy-induced hypertension or breech presentation, it is possible to give birth safely with less risk than normal childbirth (delivery). For these reasons, it can be said that caesarean sections are neither particularly rare nor a dangerous method of childbirth at present.

Types of Caesarean Sections

There are two types of cesarean sections: planned and emergency. Regardless of whether it is planned or emergency, both types of cesarean sections are covered by insurance (30% copayment).

Planned Caesarean Section

With a planned caesarean section, the doctor will decide on the date of the surgery in advance and the surgery will be performed on that date. Since the date is decided in advance, the advantage of this is that the pregnant woman and her family can prepare mentally and prepare for hospitalization with plenty of time.

A planned caesarean section is indicated in the following situations:

• Breech
• Multiple Pregnancy (two or more children at the same time)
• Placenta previa (placenta is lower than normal, blocking the cervix)
• If you have had a cesarean section before, such as for your second child
• If the mother has a pre-existing condition such as brain or heart disease

*There are many cases where a scheduled cesarean section is appropriate in addition to the above conditions, depending on the doctor’s judgment. However, even if a scheduled cesarean section is required, if labor begins or the water breaks before the scheduled date of surgery, it may become an emergency scheduled cesarean section.

emergency emperor incision

An emergency cesarean section is a cesarean section that is performed urgently during vaginal delivery (natural birth). If there is a risk to the health of the mother or baby, or if there is a life-threatening condition, an emergency cesarean section may be performed at the doctor’s discretion.

An emergency caesarean section is indicated in the following situations:

• Prolonged labor, Cessation of labor
• Umbilical cord prolapse (the umbilical cord passes through the vagina before the fetus)
• Fetal distress
• Placental abruption
• Severe hypertension of pregnancy

Although the indications for planned and emergency cesarean sections are different, the general flow of the surgery is similar. It has also been reported that approximately 60% of cesarean sections are “emergency cesarean sections.”

Cesarean section surgery method

There are two types of cesarean section: vertical incision (a vertical incision in the abdomen) and transverse incision (a horizontal incision). In the case of an emergency cesarean section, the patient cannot choose the incision method they prefer. It depends on the policy of the medical institution (hospital) and the condition and urgency of the mother and baby.

Vertical Caesarean Section

A vertical incision is a surgical method in which an incision is made vertically about 10 cm downward from the navel.

The fibers of the abdominal muscles run vertically, so there is less damage to the muscles during the incision. Therefore, a vertical incision C-section has the advantage of allowing for a quick recovery after surgery. Vertical incision C-sections are also considered to be a relatively easy surgical method for delivering a baby.

On the other hand, a vertical incision Cesarean section involves making a vertical incision of about 10 cm in the abdomen, which means that scars are more noticeable and there is a possibility of scarring or keloids developing at the incision site.

Caesarean section via transverse incision

A transverse incision is a surgical procedure in which a 10cm incision is made horizontally in the lower abdomen.

Since the incision is made in a place that can be hidden by underwear, the scars are less noticeable, and many people prefer this method for aesthetic reasons. However, the disadvantages of a horizontal incision are that it takes longer to deliver the baby than a vertical incision, and the pain after surgery is slightly stronger than with a vertical incision.

It is also said that transverse incision cesarean sections are prone to muscle and organ adhesions. Even if organ adhesions do occur, there are cases where no particular symptoms are observed. However, there is a high possibility that the surgery will cause chronic abdominal pain and affect future pregnancies.

In both vertical and horizontal incision surgery, the incision in the uterus is sutured with medical thread. Since it is sutured with absorbable medical thread that dissolves and breaks down in the body, there is no need to remove the stitches. In addition, the incision in the abdomen is sutured with sutures and medical staples.

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Advantages and Disadvantages of Caesarean Section

A caesarean section is a birthing method in which the abdomen and uterus are cut open with a scalpel to deliver the baby. Many mothers and their families feel anxious, even after the surgery. However, there are many cases where an emergency caesarean section is performed depending on the risk to the mother and the condition of the baby.

The advantages and disadvantages of a cesarean section are as follows: A cesarean section can be said to be a different postoperative experience from a vaginal birth.

Benefits of Caesarean Section

The benefits of a Caesarean section include:

• Reduces risks during birth for both mother and baby
• Not feeling labor pains
• Time to birth is short
• In the case of a planned cesarean section, the birth schedule is known in advance.

Caesarean section is a birth method used when there is some risk to the mother or baby. It is often used in cases of breech presentation, multiple births, etc.

A Caesarean section is an open abdominal surgery using a scalpel. You will be under anesthesia until the baby is delivered, so you will not feel any contractions during labor.

Another feature of a cesarean section is that it takes a short time to give birth. Vaginal births often take several hours, but with a regular cesarean section, birth (delivery) takes just a few minutes.

In the case of a planned cesarean section, the date of the surgery is decided in advance. Another advantage is that it makes it easier for the woman and her family to plan the birth schedule.

Disadvantages of Caesarean Section

Disadvantages of a Caesarean section include:

• Risk of complications after surgery
• Wound pain at the incision site
• Scars and keloid scars at the site of a cesarean section

A cesarean section is a procedure in which the mother gives birth by cutting the abdomen. This means that the incision is painful after the operation, and there is a high risk of complications. Common complications after a cesarean section include thrombosis, which occurs when blood vessels become blocked by a blood clot (blood clot), as well as adhesions of the incised tissues and organs.

It can be said that the risk of many complications caused by cesarean sections has been greatly reduced thanks to advances in medical technology and wound care. However, because cesarean sections are a method of childbirth that involves surgery, pain can occur at the incision site after surgery, and scarring and keloids can often occur.

It is said that postoperative pain from a cesarean section lasts for about 2 to 3 days after the effects of the anesthesia have worn off. Usually, postoperative pain can be controlled with painkillers. However, if the pain does not subside after several weeks, or if any abnormalities such as inflammation or pus appear at the suture site, consult a doctor immediately.

If I have a C-section for my first child, do I have to have a C-section for my second child too?

If you have had your first baby by Caesarean section and then become pregnant with your second baby, a Caesarean section is recommended to avoid the risk of developing a uterine rupture, which may occur during delivery due to scar tissue opening.

It has been reported that the probability of uterine rupture occurring in women who have given birth by cesarean section is 0.2-0.7% if they give birth vaginally (normally). This probability is higher than the probability of uterine rupture occurring in normal birth (less than 0.1%). It is said that the risk of uterine rupture is low if the first cesarean section is a transverse incision made horizontally at the lower part of the uterus.

Depending on the mother’s condition, even if the first baby was delivered by Caesarean section, it is not necessarily impossible to deliver the second baby vaginally. However, if there is a history of Caesarean section, it has been reported that the success rate of vaginal delivery is about 60-80%. If you wish to deliver your second baby vaginally, be sure to understand these risks and consult with your doctor.

In addition, if you become pregnant before the wound from the caesarean section has healed after giving birth, there is a good chance that the wound will open up. Considering the health risks to the mother, it is generally recommended to wait about one year before conceiving a second baby.

On the other hand, there are also reports that there is no association with miscarriage or premature birth even if the interval between pregnancies after a cesarean section is less than one year. It is not necessarily true that you cannot have a second baby until more than one year has passed since a cesarean section, but since there is a possibility of risks to the mother, it is important to consult thoroughly with your doctor before deciding on the method of birth for your second child.

What happens to the scar after a cesarean section?

Among the frequently asked questions about cesarean sections, in addition to the pain of the surgery, many also mention scars and pigmentation.

Normally, scars from a cesarean section will gradually fade. However, it is said that the pain is most intense for about three days after surgery due to inflammation at the incision site. Once the pain subsides, cells are produced to repair the scar. During this cell production period, the scar may become red and itchy.

As time passes, the itching from the scar will disappear, and the skin color will gradually return to normal and the scar will fade. In this way, the scar from a C-section will become less noticeable over time.

However, there are many cases where mothers end up with noticeable scars due to the development of “hypertrophic scars” or “keloids” where the incision scars become red and raised. In order to prevent hypertrophic scars and keloids, it is important to take care of the scars. Be careful not to irritate the area, and use special tape and ointments to prevent scars from remaining.

If you are concerned about scars or pigmentation from a cesarean section, you can also correct the scars with laser treatments. Note that some treatments may not be covered by insurance (private medical care), so it is a good idea to check the cost in advance.

NIPT (new type prenatal diagnosis) for twins, who are more likely to require Caesarean section, is also possible.

In the case of twin babies, most babies are born by Caesarean section. Note that many NIPT facilities do not accept NIPT (new type prenatal diagnosis) tests for twins.

In order to respond to the anxiety of as many mothers as possible, Hiro Clinic NIPT accepts not only twin NIPT (new prenatal diagnosis) but also vanishing twin NIPT (new prenatal diagnosis) . For more information, please consult with the Hiro Clinic NIPT staff.

* Vanishing twins refers to a condition in which one of the twins dies in the early stages of pregnancy and is not expelled but is instead absorbed into the uterus, seemingly disappearing.

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Risk of congenital diseases in fetuses revealed by NIPT (new type prenatal diagnosis)

NIPT (non-invasive prenatal testing) is a test that uses maternal blood to check for the positive risk of congenital diseases caused by chromosomal abnormalities in the fetus. Unlike previous prenatal tests such as amniocentesis and chorionic villus sampling, it does not involve inserting a needle into the mother’s body or collecting chorionic villus tissue via the vagina, so it is considered to be a test method that causes very little invasiveness (damage) to the mother and fetus.

What is NIPT (New Prenatal Testing)?

NIPT (New Prenatal Testing) can generally be performed from 10 weeks and 0 days of pregnancy. 10ml of blood is taken from the mother’s arm, and the risk of chromosomal abnormalities such as Down syndrome (trisomy 21) , Edwards syndrome (trisomy 18) , and Patau syndrome (trisomy 13) can be checked from the DNA fragments contained in the blood. At Hiro Clinic NIPT , we perform NIPT to check for partial deletions and duplications in all autosomal regions from the 6th week of pregnancy, so we can check the baby’s health in more detail.

The diseases that can be checked by NIPT (new prenatal testing) include Down syndrome (trisomy 21) , Edwards syndrome (trisomy 18) , Patau syndrome (trisomy 13) , whole chromosome testing, sex chromosomes, whole autosomal partial deletion, duplication diseases, etc. Although NIPT (new prenatal testing) is a screening test (non-definitive test), it is considered to be very accurate, with an accuracy of about 99.9%.

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Summary

Caesarean section has been the most common method of childbirth in the past. It can be said to be a safe delivery method for both mother and child, even if the baby is breech or multiples, or the mother has heart disease.

Caesarean sections are surgical procedures using a scalpel under anesthesia, so many mothers feel anxious about them. However, there are also cases where an unexpected emergency caesarean section may be required during childbirth. For these reasons, it is important to understand in advance the advantages and disadvantages of caesarean sections, as well as the condition and how to spend time after surgery.

If you would like to know about your baby’s risk of congenital diseases caused by chromosomal abnormalities before giving birth, please consult Hiro Clinic NIPT .

Hiro Clinic NIPT locations across the country have many doctors with extensive knowledge of NIPT (non-invasive prenatal testing) . If you have any questions about NIPT (non-invasive prenatal testing) or chromosomal abnormalities, please contact Hiro Clinic NIPT . To make a reservation, please create your own page on our website and fill out the medical questionnaire. Together we will come up with the best plan for you.

【References】

• Ministry of Health, Labor and Welfare – 2017 Survey of Medical Facilities (Static and Dynamic) and Overview of Hospital Reports
• MSD Manual – Cesarean Section
• Japan Society of Obstetric Anesthesiology – Anesthesia for Caesarean Section
• Journal of the Japan Society of Obstetrics and Gynecology, Vol. 60, No. 5 – 15. Cesarean Section
• Kanto Union of Obstetrics and Gynecology – Study on pregnancy intervals and outcomes of subsequent pregnancies after cesarean section