Posted on 03/27/2006 9:40:52 PM PST by neverdem
AP MEDICAL WRITER
WASHINGTON -- Nearly three in 10 U.S. mothers are giving birth by Caesarean section - a record number - and more and more of them seem to be choosing a surgical birth even when there's no clear medical need.
No one knows exactly how many C-sections are purely elective. It's an intense controversy: Some estimates suggest there could be tens of thousands annually, and critics say many of those women were pressured into surgery or didn't know the risks.
Amid the uncertainty, the National Institutes of Health opened a three-day meeting Monday to determine just how much is known about the risks and benefits of a pre-planned Caesarean - and how to ensure that mothers-to-be get all the facts.
"We all have noticed that women are asking for Caesareans more often. I don't think they always have the best information in making that decision," said Dr. Cathy Spong, pregnancy chief at NIH's National Institute of Child Health and Human Development.
A Caesarean can be life- or health-saving for many mothers and babies. Fetal distress, twins or more, or diseases that make labor risky for the mother are important reasons to have one.
At the same time, it is major abdominal surgery that poses some rare but serious, and occasionally life-threatening, side effects, such as hemorrhage, infection, blood clots. In addition, a prior C-section increases the risk of complications in future pregnancies, such as stillbirth or problems with the placenta, Spong says.
So what's the lure if it's not medically necessary?
Convenience plays a role for busy women. Maybe mothers need to schedule delivery so relatives can visit to take care of older children, or they live far from a hospital and worry about arriving in time. Or they fear something will go wrong and they'll wind up with an emergency Caesarean, considered far riskier than a planned one, especially if performed by a tired physician.
Others worry that vaginal deliveries can cause incontinence, although some studies dispute that the method of childbirth plays any role.
"Women deserve to know that. Whatever their decision, they need to know what the data is," said NIH's Spong.
In 2004, the latest data available, 29.1 percent of the nation's 4 million births were by Caesarean. That's the highest rate ever recorded, a 40 percent rise since 1996.
The rise is partly due to repeat surgeries: Some hospitals fearful of lawsuits refuse to let women who had a prior C-section attempt vaginal delivery with future babies, because about 1 percent may suffer a ruptured uterus, a potentially lethal complication.
But even among first-time mothers considered at very low risk for childbirth problems, the Caesarean rate is rising among every age group - from 21 percent of low-risk women under age 30, to 47 percent of those over age 40.
How many were pre-planned solely at the mother's request? The government figures can't say. A handful of recent studies that examined birth certificates and insurance claims estimate that roughly 80,000 women a year have elective C-sections.
Complicating the issue is the definition of elective, says Dr. Wendy Wilcox of New York's Montefiore Medical Center: More pregnant women are obese, for example, something that can increase childbirth complications but that medical records don't traditionally record as a Caesarean factor.
"I think the American pregnant woman is becoming a lot more high risk," says Wilcox.
There's little good data comparing mothers and babies who have elective Caesareans with healthy women who choose a vaginal delivery - as opposed to a C-section planned because of medical problems or an emergency one.
But proponents of elective C-sections say the worst risks are extremely rare, especially for a healthy, rested woman, and that vaginal birth has its own problems, such as vaginal tears or the use of forceps.
"At the end of the day it should be the mother's decision," said Linda Dyson, a New York public relations executive whose first baby was born by a medically necessary C-section but chose to have her second child the same way. "Honestly for me, I thought a C-section was safer."
On the other side is Barbara Stratton of Baltimore, who says a preventable Caesarean - required after her doctor induced early labor that stalled - left her in pain for months.
"I don't believe that any women should go through this major surgery unnecessarily," Stratton told a news conference organized by midwives who say women aren't adequately warned of Caesarean risks.
EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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Whatever perverts nature the most, prevents general happiness, and fosters resentment of the child... the NIH and AMA will both strongly endorse that option.
Just a guess here, but I think the answer my very well be related to increase in C-sections.
I met a woman once who had a ruptured uterus and lived to tell the tale. They went through 26 pints of blood trying to save her. A potential ruptured uterus is not something to fool with.
That said, I'm sure there are lots of Britneys who just think it will be more convenient. But for the many women out there who have a legit reason for a C-section, I'm glad it is easily available.
How 'bout asking for a C-section to avoid "kill me now" pain?
I had a C-section with my daughter, then had an 18 hour, induced, "dry" birth with my son.
I'd go through ten C-sections before I'd go through *that* again. And, if I ever did get pregnant again, I'd insist on a C-section.
That has to be one of the worst experiences a person can go through. For mother *and* baby. Simply horrifying pain that pushes you right to the brink of death. Today, I'd consider that unnecessary risk and suffering.
I was in labor for hours before my son was delivered by c-section.
He was really large(9Lbs 13OZ) and had a 16 inch HEAD!
YIkes!
THANK GOODNESS FOR THE C-SECTION!
My second son was smaller in size, but had a bigger head (good grief!)
I thought that the scheduled C-Section was WONDERFUL!
And I didn't think the recovery was bad either!
Very intresting.
C sections are much less risky than they used to be. They do leave the huge scar they used to.
How do I know this ? (my mom is a nurse)
I'm so very sorry about your sister's first baby. That must have been an awful blow. I don't blame you for choosing C-sections too.
Creating life is a risky proposition. I knew another woman who died in childbirth, of a brain aneurism. You just never know.
I've often thought about how things might have been for me a couple of centuries ago. Between the difficult deliveries and various infections over the years, I figure I would have been dead or substantially disabled many times over. Modern medicine has saved many lives, and I'm glad to be living in a time when we have access to excellent care.
Wow, I had 2 natural and one C-section. My son was also a dry birth and it hurt like hades but nothing compared to the surgery. The morphine made me throw up most of the day the cut hurt when I walked or coughed, I couldn't pick up my baby for something like 24 hrs. I had to have someone there to carry him to me. He had to stay in the nursery overnight because I couldn't take care of him overnight.
I would take the natural birth over C-section any day. I was up walking and doing my normal stuff within an hour after giving birth.
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