More First-Time Moms Opting For C-Sections

Patient-choice cesareans up nearly 40 percent, report finds

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By Serena Gordon
HealthDay Reporter

MONDAY, Sept. 12, 2005 (HealthDay News) -- More and more first-time mothers are choosing to deliver their babies by Cesarean section, even when there's no medical need for the procedure, researchers report.

A new report from HealthGrades found that patient-choice C-sections for first-time mothers with no medical need for a cesarean increased 36.6 percent from 2001 to 2003. While the absolute numbers are still low, accounting for only about 2.5 percent of U.S. births, the decision still remains a controversial one.

Some doctors support the idea of patient choice, while others feel it's nearly impossible for women without medical training to truly comprehend the risks involved with Cesarean births.

"I think women understand more now than they ever did, but do they understand the real risk? Probably not," said Dr. Samantha Collier, author of the report and vice president of medical affairs for HealthGrades, in Golden, Colo.

"The bottom line is that patient-choice C-section is an unnecessary surgery. And, there's an alternative to it, which women have been doing since the beginning of time. Plus, it may or may not be covered by insurance since it's not necessary," said Collier.

Collier said she wasn't against patient-choice C-sections -- just that women need to be as informed as possible. And, she added, women need to understand that their physicians will likely have a bias either for or against a patient-choice C-section, and it's important for women to know how their doctor feels about the issue.

Having a C-section is considered major abdominal surgery, according to Collier. The risks for the mother include hemorrhage, pain, infection and placenta-implantation problems in subsequent pregnancies. For the baby, risks include respiratory problems, accidental surgical cuts and an increased risk of breastfeeding problems and asthma, according to the report.

The risk of complications from a C-section has decreased dramatically, even in the last 10 to 20 years, said Collier. "While C-section complications are higher than for vaginal delivery, they're still so, so low," she said.

That reduction in complication rates may be one of the driving forces in the increase. Collier said women are also more educated on the issue and are demanding patient-choice C-sections. Plus, they're getting support from medical groups such as the American College of Obstetrics and Gynecology, she said.

In 2001, the rate of patient-choice Cesareans was 1.87 percent. That number rose to 2.55 percent in 2003, according to the HealthGrades report. These figures come from 1,500 hospitals in 17 states. Over the three years the report encompasses, 267,340 patient-choice C-sections were performed, according to the report.

There was significant variability in the patient-choice C-section rate from state to state. Nevada had the largest increase (56.7 percent), followed by Washington (53.6 percent) and Florida (47.6 percent) in elective first-time C-sections.

The states with the lowest change in the percentage of elective C-sections performed were Iowa (28.2 percent), New York (26.3 percent) and Arizona (15.7 percent).

Florida, New Jersey, New York and Nevada had the highest rates of patient-choice C-section, with each state having slightly more than 3 percent of births performed by elective cesarean.

Collier said she's not sure why there's such a difference from state to state, but said it may have something to do with physician training, or it could be more culturally accepted in some areas.

Dr. Kim Warner, an obstetrician/gynecologist for Kaiser Permanente in Denver, said, "The numbers of patient-choice C-sections probably are increasing, but I haven't seen it much here in Denver."

"We're very stringent in our indications for patient choice C-section and convenience is never one of them," she said.

Warner, incidentally, had an elective C-section for her first birth, and said that as many as one in three obstetricians chooses this option, hoping to prevent later problems, such as urinary or fecal incontinence. She is quick to point out, however, that there's no solid proof that vaginal delivery can cause such problems.

"For the majority of women, vaginal delivery is still the standard of care and is usually indicated, but you can definitely have a discussion about how you want to deliver your child with your doctor," said Warner.

Collier advised that, "if you decide that patient-choice C-section is something you're very, very interested in, collect information and talk to your doctor. Make sure you really understand the risks. It's often a tradeoff -- do you want pain now or later?"

"While you might get out of labor pain, later, when you're caring for your baby, you'll have a harder time picking up and caring for the baby because you're recovering from major abdominal surgery, which can impact bonding with the baby during the perinatal period," she said.

More information

The Journal of the American Medical Association offers more information on C-sections.

SOURCES: Samantha Collier, M.D., vice president, medical affairs, HealthGrades, Golden, Colo.; Kim Warner, M.D., obstetrician/gynecologist, Kaiser Permanente, Denver; HealthGrades Quality Study, Third Annual Report on Patient-Choice Cesarean Section Rates in the United States, September 2005

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