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Elective Cesarean: Babies On Demand

C-Sections are on the rise and moms are getting blamed, but is it really the woman's fault?

What Mothers Say continued...

In fact, in two surveys aptly titled, "Listening to Mothers," Childbirth Connection says they found that the numbers prove this is so.

Referring to the group's latest survey, released in March 2006, Corry says, "Despite some professional and mass media discourse about 'maternal request' or 'patient demand' cesarean ... just one woman (0.08%) among 1,315 survey participants who might have initiated a planned primary cesarean ... did so."

According to the report, of 252 survey participants who had a primary, or first birth, cesarean, only one woman (0.4%) initiated it.

Applying these numbers to the most recent figure for annual births, Corry estimates a scant 2,600 out of 4.1 million pregnant women actually requested a C-section.

Moreover, while in March 2006, the National Institutes of Health held a state-of-the-science conference entitled "Cesarean Delivery on Maternal Request" to address the issue of rising C-section births, officials were not able to pin the rise on moms, according to Corry.

"They failed to report a single study citing the extent to which American women are initiating C-sections and revealed only 'limited evidence' suggesting that mother-requested cesarean deliveries are what are spiking the rise," says Corry.

She says many women are curious enough about a C-section to question their doctors, but, she adds, "being curious and requesting a C-section are two very different things."

So if mothers aren't responsible for the burgeoning C-section trend, who is?

An alternative answer, Bernstein says, can be found in the medical-legal climate pervading every labor and delivery floor.

The Labor Room: Who's Really Pushing?

In the not so distant past, the drive to reduce cesarean deliveries caused hospitals in many states to require the signature of two obstetricians before this surgery could be performed.

"There was this notion out there for awhile that doctors were doing C-sections for their own convenience ... for financial reasons, for social reasons ... and so the push was on to lower the rates," says Porto.

Even though the general birthing rule had long been "once a cesarean, always a cesarean", by the 1980s the drive to push rates down was so great that doctors developed the VBAC -- vaginal birth after cesarean. It soon became the default procedure for the next birth after every cesarean delivery.

Unfortunately, studies began to show that women undergoing VBACs had the highest rate of complications, including uterine rupture, hemorrhaging, and sometimes the need for a total hysterectomy. Moreover, babies didn't do so well either, frequently landing in neonatal intensive care immediately after birth.

It wasn't long before hospitals and insurance companies began refusing to back a doctor doing a VBAC. The end result: The idea of performing a cesarean delivery went from a medical decision to a legal one -- and the VBAC died.

"The medical-legal climate on labor floors became such that many doctors no longer went out of their way to convince a woman to have a vaginal delivery, particularly if she had a C-section in the past," says Bernstein.

The "Listening to Mothers" survey seems to second this opinion, finding that "9% of mothers reported experiencing pressure to have a cesarean -- far outweighing the number of mothers who voluntarily chose this procedure."

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