Wednesday, February 4, 2004

More moms choosing C-sections

Surgery may prevent physical damage, some women believe

By Kathleen Doheny

Not so long ago, many women who had their first baby by Caesarean section pleaded with their obstetrician to let them try a vaginal delivery for the second baby.

In 2002, the national birth rate for babies delivered by Caesarean section was 26.1 per 100 live births. That year, 2.9 million babies were delivered vaginally. More than 1 million babies were delivered by C-section that year.

In the Tristate, 2002 birth rates by C-section were:

Ohio: 23.6 per 100 live births

Kentucky: 28 per 100 live births

Indiana: 24.8 per 100 live births

Source: The National Center for Health Statistics

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 not debatable 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 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.

Preventing problems

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 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.

Not 'cut-and-dried'

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 choose one - in consultation with her doctor - if labor becomes too difficult, Parker notes.

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