The primary c-section obstacle to large families

This one will be a quickie because state level data is a huge headache to assemble, but nationally, about 20-25% of first births are primary c-sections. About 33% of births each year are c-sections, but the exact amount which are first births varies more year to year.  Further, starting that way limits the feasible number of births to no more than 6, with 3-4 being much more typical.  After four c-sections, the risk of death to either/both of mom and baby or catastrophic surgery like a preterm c-section/hysterectomy combo gets up to the level of open-heart surgery (well north of 20%, far, far, far higher than the half a percent (.5%) risk of rupture only (not death and not catastrophic surgery, rupture may mean forceps or vacuum delivery for the infant and/or another c-section) for VBAC after one section that leads many hospitals to deny women access to VBAC .

Some women (pretty much all conservative Christian or Mormon women) successfully find a doctor willing to perform the surgery after 4 c-sections, and some of those women die.  It’s a small group, so I’m not going to claim you’re guaranteed to die if you have five or six c-sections and zero vaginal deliveries.  So few women “go there” it’s not easy to know.  But you will struggle to find a doctor to take on your pregnancy past four and increasingly past three sections and you will be very very very strongly pushed to have a hysterectomy or tube tying after the second, third or fourth c-section delivery.

I basically hear zip, zilch, zero about this from conservatives claiming people have smaller families these days due to selfishness and love of money and vacations.  You’d think they would pay attention to this sort of massive obstacle to a plurality of women having large families.

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9 thoughts on “The primary c-section obstacle to large families”

  1. This issue shows up a lot on CAF. You never know who is trolling and who is real, but having 4-6 c-sections and a paper thin uterus is a huge problem when your religion does not allow artificial birth control, you have no or little history of success with NFP, and you’re not that old.

    I strongly believe that anybody who is opposed to birth control should try to space HARD after a c-section to avoid this kind of problem. The longer the spacing between each pregnancy, the less chance of catastrophe.

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  2. Midwives (CNMs) are becoming more common for Medicaid recipients, and the Affordable Care Act has provisions that seem to be intended to move most low-income births to out-of-hospital birth centers: funds for midwife training, Medicaid reimbursement for birth center births, “birth center” leniently defined. I expect the c-section rate for the hospital birth population with OBs to continue to increase.

    The local newspaper had an article on home birth several years ago, with a pie chart of home births in the state by parity. First child maybe 35-40% of the pie, second and third child another 30% or so, and the rest sliced up as four, five, six, seven+, with none of those slices super-thin. (I found the article online recently, but this chart was not included.) Definitely a much larger proportion of larger families than hospital births would show in this state.

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  3. I’ve read the main reason why C-sections are so high is because a lot of first-time mothers are electing them. As in, they’re scheduling in the procedure like an appointment, instead of allowing a C-section to be something due to an emergency.

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    1. No, that’s not true, elective primaries are a few percent. However, increased immigration from countries where high rates of elective primary c-section do occur could be impacting the numbers and wouldn’t show up for a while. It is mostly anecdote in the USA though.

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    2. “Elective” is kind of misleading, though.

      It doesn’t mean that there isn’t a solid medical reason to do the c-section–it just means that it’s scheduled and orderly, not an emergency situation.

      (And everything I’ve heard about emergency c-sections makes that sound way better.)

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  4. I had multiple c-sections and I agree with this post. It was without question the recovery form the first section that led to a marked decrease in enthusiasm to the idea of having more children. I’m not even sure how we manged to eke out 5 given the distaste I have for sections and the associated recovery from them.

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  5. There’s also a bad interaction between the prevalence of c-sections and the mama-doesn’t-need-any-help-ever ideology that our blog hostess critiques. Women do need a lot of help after c-sections and if they don’t get it, that is also going to put a cap on their ability to have more children, even if they have super robust uteruses.

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