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Going Cesarean
More and More Mothers Are Opting to Deliver Through C-Section; Is It a Triumph of Modern Medicine or an Unhealthy Luxury?

June 18th, 2004

By Ken McGrath : eCureMe Staff Writer
June 17th, 2004 : Physician Reviewed

Births by cesarean section reached a record high in 2002, accounting for 26.1% of all deliveries in the U.S. This, and similar trends across much of the world, has touched off a fresh controversy between mothers, ob-gyns and researchers on the risks, benefits and proper role of this once little thought of procedure.

Going Cesarean

"Too Posh To Push"

Cesarean section procedures (otherwise known as c-sections), remove babies through surgical incisions in the mother’s abdomen in cases when a vaginal birth would risk the health of either mother or child. That the operation has been rising in popularity all across the globe is one of the few solid facts in the burgeoning debate. According to the Maternity Center Association only 5.5% of all births in 1970 involved c-section. The latest government numbers, indicating over a quarter of all American children born in 2002 were born via c-section, aren’t unique. In Brazil, almost a third of births are caesareans. Hong Kong has reported rates of up to 27%. In Canada the number is 22.5% and in the U.K. it’s 22%.

World Health Organization guidelines assert that no more than 15% of deliveries should involve the surgery. So why the increase?

Some reports have suggested that the trend towards women bearing children later in life, and being heavier than they used to be during their pregnancies, has created more complications in the birth process that doctors turn to c-sections to remedy. Bolstering that assertion have been recent technological advances that allow doctors to better detect when a baby’s health is going to be at risk from a vaginal birth. Other reports have suggested that, in an environment where malpractice suits are common, doctors are encouraging women to have c-sections in order to be able to say they took the safest course of action, should complications arise. No hard numbers are available on either of these possibilities.

What statistics can confidently point to is that, at least in the U.S., expecting mothers are increasingly undergoing the procedure as a matter of choice, rather than of necessity. In recent years, studies have shown a 20% jump in the number of c-sections performed at the patient’s request. The phenomenon has lead some tabloids to declare, dismissively, that moms who opt for a cesarean " are too posh to push" and stirred controversy in the medical community. On one hand, the American College of Obstetricians and Gynecologists has come out supporting c-sections as a matter of patient choice, while other organizations have publicly argued that the procedure isn’t the natural way to give birth, and women who choose to deliver surgically are putting their health in danger.

Making the Choice

It’s difficult to say who would win the argument because the reasons some women opt for c-sections aren’t well defined. In some cases, mothers like the predictability of being able to schedule their child’s birth. Others want to avoid the possibility that the physical trauma of vaginal birth will damage their abdominal structures; damaged pelvic muscles can result in urinary incontinence, even months after delivery. When a pregnancy is complicated, a mother may opt for a c-section just to be on the safe side, even if the child could be delivered naturally. It’s even possible, as the tabloids suggest, that some mothers are intimidated by the pain involved in labor.

There is firm data on the medical consequences of going through with a c-section, but still, it doesn’t seem to give definitive support to either side of the debate.

On the one hand, when a mother or baby’s health is at risk because of complications with the pregnancy - such as breech births, where a baby’s feet enter the birth canal first, instead of its head - the procedure is literally a lifesaver. It does also reduce the potential for post-partum incontinence: only 5% of mothers who had a c-section suffered from a loss of bladder control, whereas 22% of mothers who delivered traditionally did. The procedure can cut down on potential complications in the labor process and reduce the possibility of an unanticipated stillbirth.

The benefits, however, have to be weighed against the proven risks. Cesareans aren’t as safe for the health of the mother as vaginal births. Women who choose the surgery are twice as likely to die during the procedure as women who undergo labor. The potential for complications arising from the cesarean procedure, such as bleeding and scarring, are ever present. Blood clots and uterine infections are also possible. Babies delivered by c-section have higher rates of breathing difficulties than vaginal birth babies. C-sections also cost more than vaginal deliveries, require a longer stay in the hospital to recover and, though less intense than labor, aren’t completely pain free.

With the scientific scales more or less balanced, deciding whether or not too many c-sections are being performed becomes an ethical one: are the risks of a c-section worth taking when, instead of the health of the mother or child at stake, it’s a matter of preference and convenience? Until some consensus emerges among doctors, it’s a question that mothers will have to ask, and answer, themselves.

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