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.
"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.
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
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
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
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