Florida is second in nation for C-sections: SouthFlorida.com

Doctors feel pressure for surgical deliveries

The number of South Florida babies born by Caesarean section is rising so fast that even some obstetricians say surgical births are out of hand.
New state figures show 43 percent of Broward County births and 41 percent in Palm Beach County were done by C-section in the year ended June 30, 2008 -- far above the national average of 31.8 percent, and a record high. Florida, at 39 percent, ranked second highest in the nation, behind New Jersey.
Contrary to common belief, Caesareans cause slightly more complications and side effects for the mother and the baby than do natural births, and they pose increasing risks with every subsequent pregnancy, researchers said. C-sections also drive up the price of health care for everyone; they cost twice as much because of surgical fees and longer hospital stays.
"Absolutely, something has to change," said Lake Worth obstetrician Sam Lederman, chief of OB-GYN at Good Samaritan Medical Center. "The C-section rate is three times higher [than 20 years ago], yet babies are not healthier. It's not helping.
"I think it's because we are still generalists. We don't have doctors who specialize completely in labor and delivery. They would have more experience with every situation that can arise. They wouldn't resort to C-sections as fast. The average OB-GYN does 10 to 12 deliveries per month. Wouldn't it be better to go to a doctor who does 80?"
C-section rates vary sharply. A few South Florida doctors deliver three-fourths of their babies by Caesarean, and a few do almost none, state figures show. About half the births at Holy Cross Hospital in Fort Lauderdale and Palms West Hospital in Loxahatchee were by C-section, yet others do two-thirds naturally.
Because of medical malpractice fears, obstetricians and hospitals in South Florida order C-sections for any irregularity before or during labor, doctors and researchers said. Almost no doctors let women try a "vaginal birth after Caesarean," or VBAC. About 95 percent of Florida women who have Caesareans will deliver every other baby that way. The stress from a VBAC can cause uterine rupture, a complication in less than 1 percent of births.
Also, more moms than ever have diabetes, obesity and other issues that lead to C-sections.
Doctors also may push mothers to C-sections if the labor drags on for 12 hours, if drugs fail to induce the baby or if the baby is big, said Lorie McCoy, co-owner of Amazing Births midwife practice in Boca Raton.
One factor that gets too much buzz: A few parents and doctors decide to have C-sections in advance to fit busy schedules. Researchers said this is a tiny factor.
Doctors contend they are under pressure to deliver surgically. If they don't and something goes wrong, they are sued. As a result, almost no doctors do natural delivery for breech or multiple births.
"If there's any untoward event, the first thing they ask is, 'Why wasn't there a C-section?'" said Coral Springs OB-GYN Bruce Zafran. "If there's any doubt, there's no incentive to take a chance."
Most doctors avoid an immediate risk by doing a C-section, even though it may raise the risk of problems in future births, Lederman said. "The philosophy is, you will never be sorry you did a C-section, but the reverse is not always true." But doctors who deliver half of babies by C-section cannot possibly find medical reasons to justify them all, said Eugene Declercq, a researcher at Boston University School of Public Health.
Babies born by Caesarean are more likely to go to intensive care for reasons such as lung infections from fluids not squeezed out by natural birth, a National Institutes of Health advisory panel said in 2006. Surgical births, like any operation, risk infections and anesthesia reactions. And mothers who have repeat C-sections are more prone to have abnormal placenta growth that causes bleeding and complications.
The first Caesarean is now the key decision, said Dr. Sarah Kilpatrick, of the American College of Obstetricians and Gynecologists, who favors a reduction in C-sections.
"Patients have the conception that C-section is a simple surgery. They just cut me open, take out the baby and sew me back up," Kilpatrick said. "Every subsequent surgery for C-section has more risk."
Even insurers such as United Healthcare have been pressing doctors to halt excessive C-sections because of the high costs and the chance of more complications in future births.
Hollywood mother Nermar� Broderick said her doctor pushed her toward a Caesarean even though she didn't want it and had no medical risks. So she had two sons at a natural birth center.
"I said I really don't want a C-section," Broderick said. "He said, 'Well, we'll see.' I thought, 'This doctor is not going to do what's right for me.'"

Bob LaMendola can be reached at blamendola@SunSentinel.com or 954-356-4526 or 561-243-6600, ext. 4526.