C-section is no longer cutting edge(2)

It's best for women who want to have a second child to go through their first birth on their own if there is no compelling reason for a C-section, according to Zhang. Once surgery has been performed on the uterus, it will no longer be a perfect "home" for the baby, even if most women can still get pregnant and deliver via another C-section or a natural birth, she said.

"If fertilized eggs lodge on the scar on the uterus caused by a C-section, the patient must terminate the pregnancy, and then try to get pregnant again," Zhang said. "The abortion will be followed by the possible risk of bacterial infection and the inevitable trauma to the uterus."

The incidence of cesarean-scar pregnancy ranges between approximately one per 8,000 natural births and one per 2,500 cesarean deliveries, according to ACOG. Diagnosing the condition is difficult, and if the patient is bleeding heavily or has a uterine rupture, surgical intervention is unavoidable.

Safe, natural delivery

Although some mothers who have had a cesarean section encounter problems during second pregnancies, many still can have a second child, and doctors encourage them to try giving birth naturally.

"Natural birth, which is decided by evolution, is definitely the best choice for both mother and baby, if there are no medical reasons for a C-section. Even if they have a cesarean history, we still encourage mothers to try natural birth if the conditions allow," said Ye Ronghua, an obstetrician at Peking University Third Hospital.

According to Ye, the C-section is an intervention rooted in medical developments, and its purpose is to save the lives of both mother and child in conditions that do not support a safe, natural delivery.

"The old adage 'once a C-section, always a C-section' is no longer true. In the past, it was thought that if a woman delivered a baby by C-section, all her other children had to be delivered the same way. Today, many women can have vaginal deliveries after a C-section," Ye said.

Statistics from ACOG suggest that approximately 60 to 80 percent of women who try TOLAC are able to deliver vaginally. The association lists a number of advantages for natural delivery over C-section, such as a shorter period of hospitalization, no abdominal surgery, a faster overall recovery, and a lower risk of blood transfusion and infection. In countries such as the United States, where couples can have an unlimited number of children, natural birth of the first child may prevent multiple future C-sections.

Rise of the doula

Some medical techniques have been shown to reduce the pain and anxiety of natural birth, according to Tian Yangshun, a professor from the obstetrics department of the Fourth Military Medical University's Xijing Hospital in Xi'an, Shaanxi province.

For example, in recent years some hospitals in Beijing and Shanghai have introduced the concept of the doula, a "birth assistant" who helps to comfort and relax the mom-to-be. In many Western countries, the use of doulas has been proved to shorten delivery times, significantly reduce the need for painkilling drugs, and cut the cesarean rate by half.

In 2011, the Beijing Xuanwu District Maternal and Child Care Service Center conducted a research project on 100 pregnant women who were assisted by doulas. Only one insisted on a C-section, even though she had no supportive medical indications. When the center introduced doulas in 2006, its C-section rate was more than 50 percent. By 2011, it had fallen to about 40 percent.

Epidural anesthesia during labor is another option to facilitate natural birth, according to Tian, who said about 60 percent of women in Western countries have epidurals during labor.

"However, less than 5 percent of women in China have access to this option," he said. "Neither doulas nor epidural anesthesia have been promoted in public hospitals nationwide. More new mothers are choosing C-section, so doctors have fewer chances to practice these skills."

He said in the past three years, the National Health and Family Planning Commission has made great strides in its campaign to educate women about the benefits of natural deliveries.

"Many new mothers are better educated, and they have greater access to materials that explain the benefits of natural birth and breast feeding. The number of unnecessary C-sections will definitely fall in the near future," he said.