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
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
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
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.