Cesarean Sections: The Easy Way Out?

Ask any first time mom, and she'll probably tell you the same thing. Most of us only skimmed over the chapters on cesarean birth in the pregnancy book. Yet, over 30 percent of births in the U.S. were by c-section last year. Seems like a high number? The World Health Organization thinks so. In fact, they recommend rates of no higher than 15 percent in any country. This brings up many questions, namely, what constitutes the necessity of this procedure, and are patient-requested cesarean sections a serious danger?

Cesarean section, as defined by American Heritage Science Dictionary: A surgical incision through the abdominal wall and uterus, performed to deliver a fetus. According to the American College of Obstetrics and Gynecology (ACOG), there are many reasons why a woman would need to deliver her child by cesarean section. If a woman is carrying more than one child, it may be necessary if the babies are being born too early or are in unfavorable positions for a natural birth. If a woman's labor is not progressing, if her blood pressure is too high, or if fetal heart monitors pick up on baby's distress, these may medically warrant a cesarean section being performed.

There is also a condition known as placenta previa, where the placenta is blocking the cervix, preventing the baby from exiting the uterus. Placental abruption is another dangerous condition where the placenta separates and cuts off the baby's oxygen supply, requiring immediate delivery. Other reasons include baby's size, being breech, and some maternal infections, such as HIV.

Of course, after the first c-section, it is likely another will be performed, as it is currently viewed as the safest way to deliver after a previous c-section. There are, however, mothers who opt for VBAC, or Vaginal Birth After Cesarean. For many mothers, this has been a very safe and successful method after a c-section (60-80% of mothers who attempt it are successful), yet many doctors and hospitals refuse to allow this method of childbirth to be attempted. Why? It can of course be quite risky, especially in cases of mothers who had placental problems in past pregnancies, women with high vertical incisions, and the risk of uterine rupture is real (though rare). So why are doctors and hospitals opting to not even take it on? For the hospitals equipped to perform an emergency cesarean and choosing not to allow VBAC, what message does this send to pregnant women?

For the doctors, the risk of a malpractice lawsuit is very real. While the U.S. continues to debate the current laws of negligent torts (malpractice lawsuits), the truth is that some physicians are practicing what is known as defensive medicine. By performing procedures having little or no medical benefit to a patient, but keep them safe from a lawsuit, one can imagine the increase in patient's insurance costs, but also something even more serious for the practicing physician. Loss of confidence and self-respect. One would think that a doctor who is too scared of a malpractice suit would be more inclined to perform a procedure purely at a patient's request, rather than for medically necessary reasons.

Regardless of the reason, are patient requested cesarean sections truly a danger to woman and infant? A recent conference of the ACOG decided to address the rising c-section rates and the controversy surrounding what they are calling "cesarean delivery upon maternal request" (CDMR). The worry is that some mothers are scheduling a c-section for the ease of knowing when they will deliver, having a sitter ready for other children at home, ready to walk into the hospital. Opinions aside, is this a safe way to go?

According to Dr. Mary D'Alton, director of obstetrics and gynecology at Columbia University Medical Center, the data is well, inconclusive. "There just isn't sufficient evidence at this time to fully evaluate the benefits and risks of cesarean delivery based on maternal request compared to normal vaginal delivery. "There was consensus, says Dr. D'Alton, that CDMR is not recommended for women who are planning on having several children since the risks of placenta previa and placenta accrete increase with each cesarean delivery."

Fredric D. Frigoletto Jr, MD, associate chief of staff and vice chair at Massachusetts General Hospital in Boston, says, "At this time, the best delivery mode for any woman is best decided by her and her physician, considering her individual circumstances. A woman must be thoroughly and accurately informed about the risks and benefits of each option for her as she participates in the decision," The ACOG still maintains however, that cesareans should be performed for medical reasons.

Confused? While there is no "hard evidence" that CDMR is harmful, there are some things to consider. Trained medical professionals advise cesarean sections for medical reasons only. Women who "choose" such a procedure, should be aware of the possible risks involved in what still is a serious surgical procedure. Physicians need to educate their patient of all the risks involved in the chosen childbirth method, while not being "bullied" into performing a procedure that may not be necessary. While the truth is that no childbirth is an easy way out, a great physician-patient relationship can help to ensure a safe and healthy delivery of both mother and child. Statistics aside, that is the desired outcome.