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Health & Pregnancy

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More Women Want Cesarean Sections

Report Shows Complication Rate No Higher Than With Vaginal Delivery

Delivery by Surgery on Demand continued...

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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