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Health & Pregnancy

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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?

The Labor Room: Who's Really Pushing? continued...

"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."

Where Do We Go From Here

Doctors say that while advances in C-section delivery have increased its safety profile considerably, risks still remain higher than for a vaginal delivery, and rise still higher with every C-section a woman has.

"By the time a woman gets to her third cesarean, she's at serious risk for life-changing and even life-threatening complications," says Bernstein.

In the September 2006 issue of Obstetrics and Gynecology, a group of French researchers found that the rate of maternal death from C-section was three times that of vaginal delivery, due mostly to increased risk of blood clots, infections, and complications from anesthesia.

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