Study Shows Steep Rise in Elective C-Sections
Trend Most Prevalent Among Older, First-Time Moms
Sea Change in Attitudes
The findings suggest a sea change in attitudes and practices regarding elective surgical delivery around 1996, but Declercq says this is just speculation.
"We can't say for sure that these figures absolutely show a rise in elective cesareans, and that is why we avoided that term," he says. "Having said that, we do think that a significant proportion of this increase is patient and doctor driven."
Declercq adds that the increase in surgical births among low-risk women corresponds with a decline in so-called vaginal birth after cesarean (VBAC) deliveries. Women who have had previous surgical deliveries are less likely than they were a decade ago to attempt a subsequent vaginal birth.
"It could be that the waning popularity of VBACs has led to a rethinking of cesarean delivery for (first-time) births," he says.
New York obg-yn Howard Minkoff, MD, says doctors are struggling with how to best counsel their patients about elective C-sections. In an effort to help them do this, a government-sponsored conference is planned for sometime next year, he says, to "try to come up with some sort of consensus about the appropriateness of this trend."
Those who favor choice say C-sections are far less risky than they were even a decade ago and that the evidence suggests women who have them have a lower risk of urinary incontinence and other pelvic issues as they age. Minkoff counters that there is growing evidence that surgical delivery increases the risk of stillbirth and other problems in later pregnancies.
In a New England Journal of Medicine editorial published last year, Minkoff wrote that the evidence still favors vaginal deliveries over elective C-sections for uncomplicated labor. But he added that women who are informed about both procedures should be allowed to make up their own minds about their method of delivery.
"Elective C-section certainly shouldn't be routinely recommended," he tells WebMD. "But it also wouldn't be unethical to accede to the wishes of a woman who wants one if she has educated herself on the issue."