More Women Want Cesarean Sections

Report Shows Complication Rate No Higher Than With Vaginal Delivery

From the WebMD Archives

June 30, 2004 - Although the numbers are still small, expectant mothers are increasingly choosing to have their babies delivered by cesarean section. A new report shows that one in 50 U.S. births in 2002 involved the controversial practice of elective C-section.

That represents a 25% increase in the elective surgery over the previous two years, with older mothers more likely to opt for surgical deliveries than younger ones. Surprisingly, the review of insurance data from 16 states also found a slightly lower risk of complications following the procedure among women who had planned elective C-sections.

"Complication rates for the two procedures are pretty comparable, which makes me wonder what all the debate is about," study researcher Samantha Collier, MD, tells WebMD. "Both of these delivery methods involve complications, but we haven't told women to stop having babies."

Delivery by Surgery on Demand

Roughly a quarter of the 4 million births in the U.S. in the year 2002 involved delivery by cesarean section, but the vast majority were considered to be medically necessary. While the idea of C-section on demand was considered a radical one just a few years ago, more and more pregnant women are discussing it with their doctors.

Twenty-six-year-old Jeanine Sowers, who is due to give birth to her first child in mid-October, says she plans to do so when she sees her obstetrician a few weeks. An analyst who worked on the new study, Sowers says the data convinced her that she should at least consider having an elective C-section.

"It is tempting for me because it is planned, and I am a big-time planner," she tells WebMD. "I wouldn't say that I necessarily have a fear of vaginal delivery, but I recognize that there are issues to consider on both sides, complications wise."

The new study, conducted by Colorado medical practices research company HealthGrades, is one of the first to outline the major immediate complications for the two procedures. Researchers compiled data from 1,684 hospitals nationwide, representing roughly half of all births in the U.S. during the period under study.

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The overall complication rate among women who delivered vaginally was 12%, with vaginal tearing -- the most frequent complication -- occurring in roughly 6% of cases. Just under 3% of vaginal deliveries involved pelvic floor or organ injury and 2.5% involved postpartum hemorrhage.

Anemia was the most frequent complication among women who opted for elective C-sections, occurring in about 5% of cases. Postpartum infections, postpartum hemorrhage, and surgical wound complications all occurred in fewer than 2% of cases. The overall complication rate for elective C-section was 8.4%.

Researchers reported that in 1999, elective C-sections accounted for 1.56% of all deliveries in the U.S., but by 2002 the figure had risen to 2.21%.

Evidence 'Incomplete'

Last October, the nation's largest group of ob-gyns weighed in on the issue of elective C-section -- albeit tentatively. An American College of Obstetrics and Gynecology ethics committee declined to endorse or condemn the controversial practice, leaving the decision to individual physicians and patients.

The report noted that an increasing number of women are requesting elective cesareans in the belief that the surgery will lower their risk for delivery-related incontinence or sexual problems, while many physicians were still unwilling to consider the practice.

"ACOG cautions that both sides of this debate must recognize that evidence to support the benefit of elective cesarean is still incomplete and that there are not yet extensive morbidity and mortality data to compare elective cesarean delivery with vaginal birth in healthy women," the report states. "With better data, there may be a shift in clinical practice."

Robert Lorenz, MD, who helped write the report, says it also included language stating that in the face of inadequate information, the "burden of proof" should lie with those who want to replace the natural process of vaginal childbirth with major surgery.

"A woman considering an elective C-section should consider her doctor a resource to help explore her feelings," he says. "If she is worried about the pain of labor, we can address that. If she is worried about her baby's welfare, we can address that to, and she may decide that she doesn't really want surgery."

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Sources

SOURCES: Collier, S. HealthGrades Quality Study on "Patient Choice: Cesarean Section," June 2004. Samantha Collier, MD, vice president of medical affairs, HealthGrades, Lakewood, Colo. Jeanine Sowers, data analyst, HealthGrades, Lakewood, Colo. Robert Lorenz, MD, vice chief of obstetrics, William Beaumont Hospital, Royal Oak, Mich.
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