Cesarean Awareness Month was initiated by the International Cesarean Awareness Network to bring attention to the high number of cesareans performed in the United States and the lack of access to medical care for VBAC. The cesarean rate rose to 32.9 percent in 2009, another record high for the U.S. The percentage of cesarean births has been rising steadily for over a decade, and is up nearly 60% since 1996 despite evidence of the increased risk of maternal and neonatal mortality when healthy women agree to a scheduled surgery.
The number of women who are having an elective primary cesarean (with no medical indication) is increasing. For a woman to make a truly informed decision about whether or not to choose a cesarean she needs access to the full range of potential risks for herself and her baby. She also needs to have the opportunity to discuss her fear of childbirth with a health professional.
This proposed Informed Consent/Refusal form for elective primary cesarean was first published in Birth: Issues in Perinatal Care, Putting Mothers and Babies At Risk: Promoting the Illusive “Cesarean Delivery On Maternal Request.” The form reflects the potential risks of a cesarean section with no medical indication. Expectant mothers may want to discuss these risks with their careprovider.
FOR ELECTIVE PRIMARY CESAREAN SECTION
WITH NO INDICATED MEDICAL RISKS*
I have never had a cesarean. I had a healthy pregnancy and my baby is in excellent health. I told my physician, Dr._______ that I wanted to schedule a cesarean section because_________. My physician gave me a comprehensive patient education pamphlet to read and took at least 15 minutes to speak with me and explain the possible health risks for my baby and me associated with cesarean surgery. He/she also explained the average cost difference between a vaginal birth and a cesarean section and the potential cost of NICU (neonatal intensive care unit) services if my baby developed serious complications as a result of the cesarean section.
I am afraid of the physical pain and suffering I may have if I labor. I am also afraid that I may hurt by baby while giving birth. Other reasons are_______. My physician has referred me for psychological counseling to help me work through my fears and asked that we talk about these issues again after I have completed counseling.
I understand that a cesarean section is major abdominal surgery and compared with a vaginal birth, my baby and I will be exposed to additional risks. I understand that the following physical complications from surgery are more likely:
- The doctor can cause unintended surgical injury to my internal organs, including my gastrointestinal tract, bladder, and urinary tract.
- I am at higher risk for wound, uterine, pulmonary, and bladder infection. Infection can develop within a couple of days of surgery or up to 6 weeks after the birth. Although all women who have a cesarean should be given antibiotics before the procedure, there is no guarantee that they will be available to me before my cesarean and antibiotic-resistant infections are not uncommon in hospitals.
- I am obese (or I am diabetic) and therefore more susceptible to infection.
- I will lose about twice as much blood and may need a blood transfusion.
- I am more likely to be admitted to intensive care.
- I am more likely to suffer complications from anesthesia.
- I am more likely to be readmitted to the hospital days or weeks after the birth for complications directly related to the cesarean.
- I am more likely to develop a blood clot that can travel to my lungs and cause my death.
- I am more likely to experience significant pain 2 to 6 months after the surgery.
- I am significantly more likely to suffer complications, such as increased hemorrhage and injury to my bladder or intestines, if I have a vaginal hysterectomy in the future.
- I am likely to develop pelvic adhesions (scar tissue) that will cause me abdominal pain later in life and complicate any future abdominal surgery that I may need, including another cesarean section.
- I am more likely to suffer from intestinal or bowel obstruction months or years after the cesarean section.
- I am twice as likely to die from a cesarean as from a vaginal birth.
- If I choose to become pregnant again, I am more likely to have fertility problems.
- With my next pregnancy I am more likely to have problems with the location of the placenta, and more likely to have bleeding problems, a miscarriage, and give birth preterm.
- With my next pregnancy I will be at risk for a placental abruption and a uterine rupture.
- If I give birth in the United States, I am highly likely to have no other option than a repeat operation with my next pregnancy.
- Complications from a cesarean delivery increase progressively with each additional operation.
Compared with a vaginal delivery, I understand that the following risks to my baby are more likely with a cesarean section:
- With a scheduled cesarean section my baby is more likely to be born preterm and to be physiologically and metabolically less mature, and may have difficulties with digestion, dehydration, infection, regulating his/her blood glucose level and body temperature.
- A preterm baby is more likely to have breathing difficulties when breathing on his/her own. Respiratory complications can be serious enough to require admission to a special care nursery. My baby is more likely to be at higher risk for persistent pulmonary hypertension, a potentially life-threatening condition.
- With immature liver function my baby may accumulate high levels of bilirubin (a neural toxin) and become jaundiced.
- If my baby is born preterm, he/she is more likely to have learning and behavior problems at school age.
- Being born only 1 week earlier can make a difference to my baby’s health.
- My baby and I are less likely to have skin-to-skin contact immediately after birth, an important factor for maternal-infant attachment and the initiation of breastfeeding.
- Anesthetic drugs used during surgery cross the placenta and can make it more difficult for a baby to breastfeed.
- With a scheduled cesarean section my baby is more likely to die in the first 4 weeks of life and in the first year of life.
I have discussed these risks from cesarean section for my baby and me with my physician, and at this time:
____I want to think more about having a scheduled cesarean.
____I no longer choose to have a scheduled cesarean
____I choose to have a scheduled cesarean.
*Informed Consent/Refusal form, modified from Jukelevics N. Understanding the Dangers of Cesarean Birth: Making Informed Decisions. Westport, Connecticut: Prager, 2008:53–76.