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More Women Opting for Caesarean Sections

While experts debate the issue, all agree the decision must be tailored to each woman

SUNDAY, Feb. 8, 2004 (HealthDayNews) -- Not so long ago, many women who'd had their first baby by Caesarean section pleaded with their obstetrician to let them try a vaginal delivery for the second baby.

Now, an increasing number of women, including some first-time mothers, are requesting a C-section, even when it's medically unnecessary.

The reasons range from the convenience of choosing the time of delivery to avoiding potential health problems related to prolonged labor, such as incontinence and tissue tears.

While there are many opponents of so-called "elective" C-sections, the practice has its backers.

"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," says Dr. Samantha Collier, vice president of medical affairs for HealthGrades, a Denver-based consumer watchdog agency.

What is undeniable is that more American women are having C-sections. From 1999 to 2001, the rate of such births increased by 20 percent in 18 states surveyed by HealthGrades.

On one point all doctors agree: The decision to have a Caesarean section must be tailored to each woman, taking into account her medical history, risks and other factors.

A C-section, which involves a surgical incision in the mother's abdomen and requires anesthesia, is viewed as major surgery.

Proponents of "elective" C-sections say they spare the woman some of the trauma associated with vaginal delivery, such as incontinence due to pelvic floor damage.

In a study of 318 women presented last year at the American Urological Association's annual meeting, researchers reported that 4 percent of women who had elective C-sections suffered from incontinence 12 months later. But 14 percent of those who had C-sections after a prolonged delivery experienced such problems, as did 12 percent of women who delivered vaginally.

Last fall, the American College of Obstetricians and Gynecologists (ACOG) issued an opinion designed to help a doctor guide the thought processes for C-sections and other surgeries. The gist: If a doctor believes a C-section would promote the overall health of the woman and her fetus more than a vaginal birth, the doctor is ethically justified in performing it. But if the physician believes performing it would be detrimental, the doctor can refrain from performing it. If the patient still wants a C-section, the physician should refer her to another doctor.

Physicians say the matter is best discussed on a case-by-case basis.

"People say if you have vaginal delivery you have more pelvic floor damage," says Dr. Laura Riley, chairwoman of ACOG's Obstetrics Practice Committee. "But a C-section may leave you with pelvic floor damage, too."

Often, Riley finds, women come in with an unrealistic view of what an elective C-section can do.

Dr. William Parker, a gynecologist at Santa Monica-UCLA Medical Center in California, says the debate over elective C-sections is far from cut-and-dried. "There's not 100 percent definitive evidence that multiple vaginal delivery and labor cause incontinence," he says. "I have a patient who has had 11 children; she is now about 75, and not a drop [of incontinence]."

Rather than opt for a C-section ahead of time, a woman can always choose one -- in consultation with her doctor -- if labor becomes too difficult, Parker notes.

"You need to go through everything with your doctor," Parker says. While the decision isn't easy, time is often on a woman's side. "You don't have to decide at month three," he notes.

Predicting who is at risk for pelvic floor damage also isn't easy, says Dr. Kristene Whitmore, a urologist and director of the Pelvic Floor Institute at Graduate Hospital in Philadelphia. "We know there are risk factors but can't give percentages" of women who end up with pelvic floor damage after vaginal birth.

"If you have a very large baby, connective tissue disorder, an autoimmune disorder, you may be at higher risk," she says. "What I tell my patients is, discuss this with your obstetrician."

More information

For a discussion about C-sections, visit the American College of Obstetricians and Gynecologists. The college also has lots of information on pregnancy-related issues.

SOURCES: Laura Riley, M.D., maternal-fetal medicine specialist, Massachusetts General Hospital, Boston, and chairwoman, obstetrics practice committee, American College of Obstetricians and Gynecologists; William Parker, M.D., gynecologist, Santa Monica-UCLA Medical Center, Los Angeles; Kristene Whitmore, M.D., urologist, director, Pelvic Floor Institute at Graduate Hospital, Philadelphia; Samantha Collier, M.D., vice president of medical affairs, HealthGrades, Denver
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