About a quarter of all babies in Germany are delivered with the help of a Caesarean section or c-section, a surgical incision made through the mother's abdominal and uterine walls.
Originally a life-saving procedure for mother and child, c-sections are increasingly being performed "just to be on the safe side."
Many women know little about their consequences, however.
For medical reasons some women have no choice but to have a c-section. If, for example, the baby's heart rate changes during labour, then a c-section is unavoidable. There are also a number of prenatal indications necessitating a c-section, including transverse presentation (the baby lies crosswise in the uterus) and women with extremely deformed pelvises.
Doctors assess some medical indications differently.
"One of them is breech presentation" (the baby's buttocks are at the bottom of the uterus, its head at the top), said Klaus Vetter, vice president of the Berlin-based German Society of Gynaecology and Obstetrics. When a c-section is merely optional, more and more women and their doctors opt for the procedure nowadays.
Women with no medical grounds for a c-section are also opting for the surgery more frequently.
"There are women who are very afraid of pain or who have had a traumatic childbirth in the past," noted Ines Albrecht-Engel of the Berlin-based Society for Prenatal Preparation, Starting a Family, and Women's Health. Another reason is the desire to plan the delivery date.
It is important to consider the consequences of a c-section. They include an increased chance of embolism and thrombosis. "The woman needs to know that the scar in her uterus is a weak spot," Vetter said. In subsequent pregnancies there is a greater risk of placenta accreta (abnormally firm attachment of the placenta to the uterine wall) and uterine rupture.
During a normal, vaginal birth, maternal-behaviour and bonding hormones are released. A c-section interferes with this process.
"Whenever mother and child are separated, as they are for minutes, or days after a Caesarean section, bonding between them is retarded and made more difficult," said Katrin Mikolitch, a physician and founder of the Duesseldorf-based organisation Caesarean Section Network.
A sense of alienation from the baby and difficulty in breast-feeding can result.
Expectant parents can prepare for a planned c-section. "They should look for a clinic that performs a lot of Caesarean sections and is very familiar with any medical indication that the woman might have," advised Albrecht-Engel.
General anaesthesia is no longer necessary. Peridural or spinal anaesthesia allows the woman to remain conscious. "It's a good opportunity to ask that the child not be washed and dressed, but simply warmed. As soon as the mother comes out of the operating room, it can immediately be laid naked on her skin," Mikolitch said.
Emergency c-sections are much more complicated. Women who have them are usually unprepared. Since any pregnant woman could be affected, it is a good idea to be informed about the basics.
After a c-section, every mother is somewhat restricted, by the incision and scar, and often psychologically as well. It is important that her partner be at her side for support. A clinic that allows family members to stay overnight is therefore a good choice.