Cesarean sections were once considered a last resort, when vaginal delivery was not medically safe. Today, one in three pregnancies in the U.S. are delivered by cesarean—and many maternal fetal medicine professionals believe it is crucial to reduce that number significantly, as it’s associated with an increase in complications for mothers and newborns, and even morbidities.

Debunking the myths

“If they’re done too early, they can harm both the baby and the mother,” said Dr. Vincenzo Berghella, director of the division of maternal-fetal medicine at Jefferson University in Philadelphia, Penn. “It’s a major surgery, while vaginal delivery is not.”

Misconceptions on the necessity of cesareans are prevalent. While they can be life-saving operations under many circumstances, they are often used in a preventative way based on a battery of tests that don’t do a great job of predicting the outcome of a regular delivery.

“If they’re done too early, they can harm both the baby and the mother, it’s a major surgery, while vaginal delivery is not.”

Dr. George Saade, chief of the division of maternal-fetal medicine at the University of Texas Medical Branch, said that many of those tests are up to interpretation.

An unpredictable factor

“Some doctors do the c-section because they assume there will be complications,” he said. “But the ability to predict is very weak.”

Cesareans can lead to an increased risk of complications for each later pregnancy, as well, and many people have the misconception that once a woman has one, she must for every subsequent birth, which contributes to the rise in number of cesareans each year. Of U.S. women who require an initial cesarean delivery, over 90 percent will have a subsequent cesarean. But that is not necessary for most women, said Dr. Berghella.

“In general, 70 percent or more of women who have had just one prior c-section can deliver vaginally the next time,” he said. “If they go into labor spontaneously and full term with no complications, the risk of the feared complication—uterine rupture—is approximately four in 1,000. It exists, but it’s low.”

Both doctors advise patients to do their research and seek out gynecologists and hospitals with which they’re most comfortable, and opt out when they have the chance—regular delivery could very well be the safest option.