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When Is a C-Section the Best Delivery Option?


According to Wilson, a marked change is under way in medical attitudes toward cesareans. As evidence, she points to comments made by W. Benson Harer Jr., MD, president of the American College of Obstetrics and Gynecology, that the final decision on a C-section should be left to the woman. Wilson says doctors have a responsibility to make sure women have all the facts and says she will counsel a woman against a C-section if she feels it is unnecessary or not a good choice. But, she says, if women have a good reason for wanting a cesarean, doctors should not be so quick to overrule their decision.

More evidence that women are choosing cesareans comes from a London study showing that one-third of female obstetricians would choose a C-section for themselves, even if there was no medical indication for one. In Brazil, the C-section rate is estimated to be as high as 60% in the general population and 90% among the most affluent women.

Breech birth is one medical indication for C-section, but not everyone agrees that it is the best way to proceed. Some obstetricians may try to turn a breech baby from the outside in a technique known as ECV, then have the woman deliver the baby vaginally. This, however, does not work in all cases.

Tom Howard, MD, a practicing specialist in complicated pregnancies in Fort Worth, Texas, says ECV has "gone in and out of fashion," over the last 15 years or so but remains a popular choice with some doctors and patients.

But a study just published in the journal The Lancet may change the minds of some doctors who still perform vaginal deliveries for full-term breech babies, study author Mary Hannah, MD, tells WebMD.

In the study of more than 2,000 women with babies in the breech position, who were randomly assigned to a planned delivery either vaginally or by C-section, the stillbirth and newborn death rate for C-section babies was three times lower. The C-section babies also had fewer serious illnesses as newborns. The results were so much better with cesarean sections, in fact, that the study was stopped early.

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