Elective C-sections: Making an informed choice: SouthFlorida.com

The right to choose your birthing procedure.

There's no doubt times have changed. Women today have many more options when it comes to birthing methods than women did 100 years ago. But is the advancement of technology in medical procedures a good enough reason to elect to have a C-section versus a vaginal birth?

In the journal Bioethics, several academics looked at the issue of women's autonomy as it relates to elective C-sections. The authors concluded, "The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices and social conditions will best promote and protect women's full inclusion in a safe and positive birth process."

Philosophical and ethical arguments surrounding a woman's right to choose how she births her child can be made on both sides of the issue.
The American College of Obstetrics and Gynecology formally supports a woman's right to choose a birth procedure.

Many women, because of work and other family obligations, do not have the luxury of waiting to go into spontaneous labor. They diligently clear their schedules so that they may have a few weeks of maternity leave. Family members may be flying in from out of town or going overseas with the military, and women may want these loved ones to be part of the birth.
Some reasons for the increase in the number of C-sections include more mothers 35 and older giving birth, obesity and multiple births.
"Women getting elective C-sections are usually over 35, more affluent and planning only one child," said Dr. Samantha J Collier, of Health Grades, a company that studies health care.
Many women, motivated by fear of pain associated with natural labor and the potential risks associated with a vaginal birth seek to go under the knife. But make no mistake; a C-section is a serious surgical procedure with consequences for both the mother and child. And unfortunately, many of these surgical deliveries are done without any medical necessity.
The Centers for Disease Control's National Center for Health Statistics reported that U.S. C-sections had reached an all-time high of 31 percent in 2006 -- a 50 percent increase over the previous 10 years.
Florida Health News reported that three out of 100 Florida births were elective C-sections between 2001 and 2003 (the highest in the country that year.)

What's at Stake? Risk to the Mother

Although there are risks associated with a vaginal delivery, including infection, prolapsed bladder, uterus or rectum, and urinary incontinence, having a C-section does not necessarily minimize the risks associated with natural delivery. Sometimes the risks of additional complications are increased both for the mother and newborn. Dr. Tara Solomon, an obstetrician and gynecologist practicing in Broward County, will do elective C-sections, but she insists that the patient understand all the possible consequences, desire no more than two children and be at least in her 39th week of pregnancy.
Solomon said the risks from a C-section are bleeding, damage to the bladder, the bowel, uterus and rectum, and the possibility of urinary incontinence. There is also the increased possibility of placenta previa, a condition in which the placenta is below the baby in future pregnancies, or of placenta abruption in which the placenta separates before the baby is born, cutting off the flow of oxygen to the fetus. Scarring can create serious problems for future births, as well. There is also new evidence that suggests women who deliver by C-section are at greater risk for stroke than those who deliver vaginally.

Today there are hardly any vaginal births after C-sections performed, as the ACOG has issued guidelines that require a doctor and a surgical team to be present in the hospital while a patient labors in an attempt to have a VBAC. "If you are in private practice, and you have patients in the office waiting, as well other patients laboring, it is impossible to close up the office and attempt a VBAC," said Dr. Michael Fleischer, an OBGYN in Boca Raton. "You can't run a practice and not be in the office."

VBACs carry the risk of hemorrhaging, risking the lives of both mother and baby. The fear of a lawsuit can push a doctor to perform a C-section. According to a study published in the American Journal of Obstetrics and Gynecology, 80 percent to 90 percent of obstetricians have experienced complaints and lawsuits.
Fleischer said it is unusual to do a vaginal breech birth these days because of lawsuits. Most doctors will not even wait for the baby to turn and will move to a C-section.
"You could perform a perfect breech, and if anything then goes wrong, with lawsuits, it is easy to loose," Fleischer said. "Everyone thinks there is a problem with a breech birth and that it shouldn't even be tried."

What's at Stake: Risks to the Newborn

A new study in the Journal of Pediatrics on childhood asthma and C-sections found that of the 1,756,700 single births examined from birth up to 18 years of age, "Children delivered by C-section had a 52 percent increased risk of asthma compared with spontaneously vaginally delivered children."
Studies have also shown that babies born through C-section were more at risk for respiratory distress than those delivered vaginally.
Other studies found that the risk of death for newborns was greater than those delivered by vaginal birth.
Choice comes with responsibility. Educating oneself about the pros and cons of an elective C-section is crucial. Making an informed decision is your right and should be supported by your obstetrician.