More Women Opting for Caesarean Sections

Doctors are divided over benefits, drawbacks of such births

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By
HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

THURSDAY, July 24, 2003 (HealthDayNews) -- More mothers-to-be are opting for a Caesarean birth -- even when it's not considered medically necessary.

That's the finding of a study conducted by the Denver-based consumer watchdog agency HealthGrades.

The conclusion was reached after analyzing the rate of C-section births in 18 states between 1999 and 2001. The research documented a 20 percent rise, a number that study co-author Dr. Samantha Collier says may only be a drop in the birthing bucket.

"The general opinion from experts in the field is that the actual increase is probably somewhat higher, and I don't think we are even close to seeing the end of this trend," says Collier, an internal medicine specialist and vice president of medical affairs for HealthGrades.

A Caesarean birth delivers a baby via a surgical incision in the mother's abdomen. The operation, which requires anesthesia and is considered major surgery, is believed to be medically necessary only when either the baby or the mother's life would be endangered by a vaginal delivery.

Because of the inherent dangers in the surgery, organizations such as the American College of Obstetricians and Gynecologists have traditionally discouraged doctors from performing unnecessary C-sections. In some states, including New York, hospitals began requiring the approval of two physicians before a C-section could be scheduled.

Now experts say the pendulum has swung in the opposite direction and Caesarean births are fast becoming a popular option once again. Only this time, it's patients -- not doctors -- who are requesting the procedure.

While this study did not differentiate who initially suggested the C-section delivery -- the woman or her doctor -- in all cases the decision was made well ahead of the due date. Collier says the study classified the option as "patient choice" because in the end, the patient had to agree.

For New York University obstetrician Dr. Michael Silverstein, patients who do agree and choose a C-section are probably not being told the whole truth about the procedure.

"I don't believe any woman would knowingly choose a Caesarean delivery if her doctor was totally honest with her about the risks," says Silverstein, an obstetrician at NYU's Medical Center.

As such, he says, it's likely the increase is more a case of women turning to a doctor for advice. And the doctor is choosing to -- as Silverstein describes it -- trade in a 20-hour labor for a fast, 45-minute delivery.

"Bottom line, these women aren't operating on themselves. So clearly, their doctor is going along with this. And in my opinion it's up to the doctor to steer the patient to the best approach for them, even if it isn't always the most convenient approach for the doctor," Silverstein says.

Experts say the trend toward C-section births began in the 1990s as reports surfaced citing vaginal deliveries as the cause of fecal and urinary incontinence, along with causing tissue tears and other injuries resulting in pain and sexual dysfunction, sometimes indefinitely. Combined with the potential for a painful and long labor, a C-section started to look like a feasible option.

Silverstein says that while the potential for all these vaginal-birth complications exist, they normally occur in only a very small group of women. Further, he says, the potential for even greater problems is present for nearly every woman who chooses a C-section.

"This is a serious surgery and it carries the same risks as every other surgery every time it's done. Plus, it is certainly not free of post-operative problems," says Silverstein.

Collier says there are strong proponents on both sides of the C-section controversy.

"There are doctors who argue vehemently against any surgery that is not medically necessary, as well as those who see nothing wrong with a surgery that can, in many instances, help a patient avoid certain labor and delivery-related traumas, both during and after the birth," Collier says.

The new study based its findings on data gathered on deliveries that took place in 1,920 hospitals in 18 states. The researchers compared the number of patients choosing a first time, pre-planned Caesarean section delivery, with those who's C-section was considered medically necessary.

The result: From 1999 through 2001, the number of women who had an elective C-section delivery jumped from 1.56 percent to 1.87 percent, a difference that researchers say represents a 20 percent increase.

In terms of the actual number of women agreeing to deliver by elective C-section, Collier says that in the 18 states studied, the number rose from 29,257 in 1999 to 35,767 in 2001.

Using these numbers, Collier and her team estimate close to 63,000 more elective C-sections were probably performed nationwide during the same time period.

More information

For a detailed list of the 18 states and the medical institutions utilized in this study, visit HealthGrades. To learn more about labor and delivery options, visit The University of Michigan Health System.

SOURCES: Samantha Collier, M.D., vice president, medical affairs, HealthGrades, Denver; Michael Silverstein, M.D., assistant professor, obstetrics and gynecology, New York University Medical Center, New York City

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