Does on-demand caesarean section expose you to risks for subsequent pregnancies?

The issue of on-demand caesarean section has been extensively examined, not only in the obstetric gynaecological profession, but also in case law. A request for a caesarean section that comes from a patient cannot fail to be accepted or evaluated, if not contraindicated, because for every medical procedure, including a natural birth, which is a physiological event if you will, consent is required. There are cases in which there are objective medical contraindications and it must be explained to the woman why this request is not accepted. Caesarean section on demand includes 3 to 5% of deliveries in our Centres.

Today we know that vaginal birth is good for the fetus. Over the years, an opinion has been established that it is the caesarean section that is good for the fetus. This is another matter, that is, the caesarean section allows you to plan the birth in the useful time and, therefore, certainly appropriate for the fetus.

Why, then, is vaginal birth good for the fetus? Firstly, crossing the vaginal canal improves the respiratory performance of the fetus; secondly, it improves the response of the fetus's immune system, which, crossing the canal, comes into contact with the mother's microbiota. The first is clear evidence, while the second is still being studied and the evidence is getting stronger.

Why is there this tendency to prefer caesarean section? There is a problem of fear and not full awareness of the personal ability to give birth, although today there are analgesic conditions that greatly improve the compliance of vaginal delivery. In addition, the experiences of women in one's family and friends increase this fear. There is also a form of excessive protection, especially when the woman is older or has managed to get pregnant as a result of artificial insemination techniques. It is as if the baby could be better protected with a caesarean section. These are complex anthropological and psychological aspects, which must be addressed starting from the early days of pregnancy. All this leads to more subsequent caesarean sections and this exposes the mother and fetus to greater risks, both related to placental anomalies and bleeding risks.

We must start, from the first visits, with speeches to our patients that make them understand that safety in the delivery room is now at high levels both for the humanization of childbirth, which is the basis of everything, and for the application of technologies and analgesia that we have available today.