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C-Sections By Request

Caesarean births are on the rise, but some doctors still are cautionary

SATURDAY, Nov. 10, 2001 (HealthDayNews) -- In the not-too-distant past, you'd have been hard pressed to find a woman who would argue for a caesarean delivery, particularly if there was a chance for a natural, vaginal birth.

Today, however, a whole new trend is emerging. It's called "Patient Choice Caesarean" -- C-section deliveries requested by the mother, even when there's no medical justification for the surgery.

"The pendulum has swung in the opposite direction. More and more women are requesting a C-section delivery, and as the medical profession continues to honor a mother's birthing preference, the patient choice caesarean has emerged as an acceptable option for us as well," says Dr. Bruce Flamm, spokesman for The American College of Obstetricians and Gynecologists (ACOG).

In fact, not only is "patient choice caesarean" now considered acceptable, but an editorial published last year in the ACOG Clinical Review suggested that doctors should encourage women to exercise their right to choose.

"Perhaps the risks, benefits and costs are so balanced between caesarean and vaginal delivery that the deciding factor should simply be the mother's preference for how her baby is to be delivered," wrote Dr. W. Benson Harer Jr., in the editorial, "Patient Choice Caesarean."

Federal statistics seem to show that more women are opting for C-sections. In 1996, caesarean sections accounted for 20.7 percent of births in the United States. But that number has been slowly rising slowly, and health experts predict the figure could reach 30 percent by next year.

But do the risks and benefits of either a caesarean or vaginal delivery really stack up as equal? Some doctors say they don't, and they won't endorse the new trend.

"A C-section delivery is a surgery and no matter how you look at it, there are always going to be more risks than there are with a vaginal delivery," says Dr. Caitlin Fiss, assistant professor of obstetrics and gynecology at Weill Cornell Medical College in New York City.

To subject a patient to those risks for no reason is bad medicine, she adds.

There are risks involved with both types of deliveries, ACOG says:

  • A vaginal delivery can result in future episodes of sexual dysfunction, pelvic organ prolapse (causing the pelvic organs to be out of alignment), and urinary or fecal incontinence.
  • A caesarean section can lead to: a pelvic infection, blood loss significant enough to require a transfusion, potentially deadly blood clots in the legs, pelvic organs or lungs, and injury to the bowel or bladder.

"As a doctor my first responsibility is to 'do no harm,' and an unnecessary surgery is tantamount to doing harm," says Fiss, who adds that patients have left her practice because she refuses to do C-sections that aren't medically justified.

The issue is less clearly defined for Dr. Gina Brown, assistant professor of obstetrics and gynecology at Columbia Presbyterian Medical Center in New York City.

"Every delivery is highly individualized, taking into consideration not just what is best for baby's health or Mom's obstetrical needs, but also Mom's overall mental and physical health, her personality, and, of course, her personal birthing choice," Brown says.

Often, however, if a doctor probes just below the surface, he or she will discover it's a fear of pain, fear of labor or just a fear of the unknown that's behind a mother's desire for a C-section birth, Brown adds.

"Addressing those issues and offering reassurance and options is sometimes all that's necessary to put the C-section idea to rest," she says.

But what if it's not?

"I'd seriously consider the mother's wishes and together we would make the right choice for her," Brown says.

For Flamm, the real issue isn't so much how a woman wants to have her baby, but that she discuss her desires with her doctor long before delivery day arrives.

"So often prenatal visits are spent talking endlessly about things like whether to take one prenatal vitamin or two, when in reality at least some of this time should be devoted to how a woman feels about her delivery -- what she wants, needs, fears and what she expects," Flamm says.

What To Do

If you're among the growing number of women considering a C-section delivery, experts say you shouldn't make the decision without talking to your doctor. And consider the following:

  • A previous C-section doesn't mean you're locked into this option for all subsequent pregnancies. Today, a vaginal birth after a C-section (called VBAC) is an acceptable and safe option for many women.
  • If labor pain is your main concern, talk to your doctor about the latest pain-control options, including new drugs that are safe for mother and baby. There are also non-drug alternatives like a labor tub (a Jacuzzi-type bath now available in many labor suites), or even an underwater labor and delivery.
  • There are also medical considerations to weigh. They include a large baby relative to the size of the mother's pelvis; failure of labor to progress; concerns for the baby's health, like a weak heartbeat; placenta-related problems that can block the birthing process or reduce the baby's oxygen levels; and general maternal health concerns like high blood pressure, an active herpes infection, or diabetes.

For a fact sheet explaining more about caesarean births, visit this site. And this site answers a wide variety of questions about caesarean births.

To learn more about the medical procedures involved in a caesarean delivery, visit this March of Dimes site. To read about how to avoid an unnecessary caesarean delivery, click here.

SOURCES: Interviews with Caitlin Fiss, M.D., assistant professor of obstetrics/gynecology, Weill Cornell Medical College, New York City; Gina Brown, M.D., assistant professor of obstetrics/gynecology, Columbia Presbyterian Medical Center, New York City; Bruce Flamm, M.D., professor of obstetrics/gynecology, University of California at Irvine, and spokesman, The American College of Obstetricians and Gynecologists, Washington, D.C.
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