Posted on 03/30/2006 9:59:13 PM PST by neverdem
Meeting stirs debate over rocketing rate of C-sections.
An expert panel convened to advise healthy women about the risks of caesarean sections concluded that they cannot do so, because there is so little hard evidence. But at least some specialists feel that the procedure should be discouraged.
Nearly 30% of babies born in the United States today arrive by caesarean section, compared to some 20% a decade ago, and many other countries are seeing similar rises. The common perception is that more and more women are demanding elective C-sections to fit their busy schedules and bypass the pain of labour.
The phenomenon has stirred intense controversy because it is not clear whether the rise is really driven by women, or by the changing advice of doctors. Furthermore, it is not known whether mothers who have C-sections without a clear medical reason face higher health risks.
Not clear cut
To try and settle the debate, the US National Institutes of Health convened an expert panel. At a three-day meeting this week, the panellists considered a specially commissioned review of medical literature (one of the most comprehensive done so far) and heard presentations from experts before issuing a report of their conclusions.
But the final report offers little guidance because, the panel said, there is such a paucity of studies. For many women, "We don't feel [elective caesarean] should be encouraged or discouraged," says Mary D'Alton, head of obstetrics and gynaecology at Columbia University Medical Center, New York, and chair of the panel.
The panel could not conclude whether a caesarean for a perfectly healthy woman is more or less medically risky than a vaginal birth, for example. The procedure, in which the abdomen wall is cut open, is linked to problems such as dangerous blood clots, infections and babies' respiratory problems; vaginal births are associated with incontinence and fetal birth injuries, amongst others.
Early days
The panel did conclude that elective C-sections are risky for women who want to have two or three children, because the risks of placenta problems in subsequent births rise after a caesarean and with each subsequent one. They also recommended against the procedure prior to 39 weeks of pregnancy, when a baby's lungs may not be fully developed. Other cases should be decided on an individual basis by discussion between the patient and doctor, they advised.
Part of the panel's difficulty in assessing elective caesareans was that they found very few studies looking specifically at healthy women who choose this method of birth. Instead, most studies included women with medical problems that may have warranted the procedure.
One way to help resolve this would be a clinical trial in which women were randomly assigned to have a caesarean or vaginal birth. But it could be very difficult to find women willing to participate.
Doctors' advice
The lack of clear advice frustrated some experts. Carol Sakala of Childbirth Connection, a non-profit maternity care organization in New York City says that the panel were mistaken to concentrate only on women who request a caesarean. "My feeling is they squandered this opportunity," she says.
A large part of the rise in caesareans is down to doctors recommending the technique, she and others say. And, they add, perhaps this isn't justified. Doctors may be increasingly favouring the procedure for convenience and fear of litigation if things go wrong with a vaginal birth.
Sakala says that the focus should be on helping women to make an informed choice and using known measures such as labour support to cut the risks associated with vaginal births. "Unless there is a clear, compelling, well-supported reason then vaginal birth is likely to be the safest," she says.
doi:10.1038/news060327-12
And here is your trivia question for the day:
"WHO was the first baby born by Caesarean section?"
So doctors are just poor victims abused by tyrannical pregnant women?
Just from what I have seen the recovery on a c-section is more of a pain. While I was bouncing around after having my third baby, my roommate in the hospital looked so miserable.
Just from what I have seen the recovery on a c-section is more of a pain. While I was bouncing around after having my third baby, my roommate in the hospital looked so miserable. She had a c-section.
In many ways the doctors are poor victims of sky is the limti malpractice suits.
This article is missing two very important factors.
Malpractice Insurance.
and
Tort Reform.
It is already severely affecting the OB/GYN practices in NJ, the trend will go nation wide and there will be less OB/GYNs practicing, and those who do will use all possible pursuasion to get a mother to agree to the C section.
The real key was to get on your feet as soon as you could and get moving. After two days, the pain was minimal, and by a week and a half--it was all gone.
But I still had that delightful stash of Darvocet! ;-)
Still, since it's a major surgery, we'll try for one more bio-baby, and then look into adopting.
Atom Breaks Rules, Beats Friction
Greenhouse theory smashed by biggest stone
Why intelligent design will change everything
FReepmail me if you want on or off my health and science ping list.
My last one was a C-section because she decided to turn sideways a few days before she was to be induced. The worst thing about it was the itching from the anesthesia wearing off. The pain wasn't that bad at all. I took 4 big Ibuprofrens the first week I was home--2 of those were for headaches and not the pain of the incision.
Are you speed reading?
"Doctors may be increasingly favouring the procedure for convenience and fear of litigation if things go wrong with a vaginal birth."
It wasn't Caesar as many believe. It was an unknown Roman woman who had died and they saved the baby by performing a c-section. Until recently, the mothers almost always died (or were already dead) when a c-section was performed.
Well my doctor told me straight up, he could try to turn the baby back to the head down position or just go for the c-section but he wasn't birthin' no breech baby! Turns out we made the right decision to go with the c-section, because with all her acrobatics at the end in there she had tied her cord into a knot and also had it wrapped around her neck. I don't blame doctors for being cautious. On one baby board, a woman was contemplating suing because the doctor didn't tell her she was having a 9 pound+ baby and the baby tore her a new one.
You better believe those in private practice make more money; it's considered major surgery.
C sections are de facto legaly mandated by our utterly corrupt lawyer industry on the bogus theory that a LACK of a C-section is the cause of Cerebral Palsy. This made John Edwards and number of other democrat party trial lawyer sc*mbags multi-millionaires.
"And here is your trivia question for the day:
"WHO was the first baby born by Caesarean section?"
I'm not neverdem, but I'll make a wild guess and say it was Julius Caesar or his son Ptolemy XV Caesar.
Both of my kids were C-Sections. Compared to labor pains that I experienced w/ the second one, post-operative C-Section pain is a walk in the park.
I think it depends on where they do the cutting. My twins were both breech and (thankfully) the first one along was not descended when my water broke, so they decided to do a C. I said thankfully, because even if I would have delivered her, the second one had the cord wrapped twice around her neck and I would probably have ended up with an emergency C-section with her.
As it turned out, the "bikini cut" was nothing-I don't think I took a single pain pill. By contrast, I remember feeling like my bottom was going to fall out for months after delivering my first.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.