THURSDAY, June 1 (HealthDay News) -- Increasing advocacy for patient-choice Caesarean delivery may create an environment that makes it difficult for women to choose vaginal delivery, particularly if they have had a previous Caesarean delivery or present with a breech fetus, according to an essay published in the May/June issue of the Annals of Family Medicine.
Caesarean delivery rates have increased from 4.5 percent in 1965 to 29.1 percent in 2004, and patient-choice Caesarean delivery accounts for more than 2 percent of all births, note Lawrence M. Leeman, M.D., of University of New Mexico in Albuquerque, and Lauren A. Plante, M.D., of Thomas Jefferson University in Philadelphia. They also note that the vaginal birth after Caesarean delivery rates have decreased from 28.3 percent in 1996 to 9.2 percent in 2004 and that vaginal breech birth, commonplace before 1970, is now rarely performed.
Leeman and Plante warn that a widespread policy of allowing patients to choose Caesarean delivery without a medical indication may shift expectations away from any concept of normal birth and that labor and delivery will become the province of the surgical suite.
"Before we enthusiastically adopt the universal right of women to choose elective primary Caesarean delivery, we must ask ourselves whether this issue is really about patient choice," the authors conclude. "If we agree that it is, then we ought also to support patient choice in situations that allow them to choose vaginal birth."