Elective C-Sections in the Spotlight
Women Planning Large Families Should Avoid Elective Surgery
March 29, 2006 -- Women should avoid purely elective cesarean (c-section)
deliveries if they are planning to have other children in the future, an expert
advisory panel concluded Wednesday.
Cesarean (C-section) births raise the risk of placental complications in
later pregnancies. For that reason, experts strongly recommended that women
planning on becoming pregnant later avoid C-sections when doctors see no
medical need to perform them.
A cesarean delivery on maternal request, or CDMR, is defined as a C-section
on a mother's request of a full-term, single-child pregnancy without a medical
reason for doing so.
"If a woman is planning to have several children, we clearly feel women
should not opt for cesarean delivery at maternal request," says Mary E.
D'Alto, MD, head of obstetrics and gynecology at Columbia University and
chairwoman of the panel.
Elective cesarean should also be avoided before 39 weeks or if the baby's
lung maturity cannot be verified due to risk of respiratory complications for
The recommendations came as part of a scientific review on elective cesarean
birth sponsored by the National Institutes of Health.
Elective cesarean births appear to be on the rise in the U.S. despite a lack
of evidence about their potential risks and benefits, the panel said.
Nearly 30% of all live births in 2004 -- around 1.2 million in total -- were
by C-section. Still, there are no solid figures on how many of those C-sections
are at the request of expectant mothers when no medical problem indicates
Studies estimate that up to 18% of all cesarean births may be because of
CDMR, but the actual figures are not clear. There are many explanations for
CDMR including mothers' concerns about complications, pain and trauma of
vaginal birth, control in the ability to schedule a delivery, and avoidance of
complications of a vaginal delivery due to possible weakening of pelvic
Another influence stems from the recommendation of providers and provider
attitudes toward CDMR.
Insufficient Evidence of Benefits, Risks
Experts concluded that there is not enough scientific evidence available to
fully evaluate the overall risks and benefits of CDMR and that more studies are
"Until quality evidence becomes available, any decision to perform a
CDMR should be carefully individualized and consistent with ethical
principles," the panel wrote in its draft conclusions.
The advisors stressed that women considering elective C-sections have
multiple discussions with their doctors over the benefits and risks of the
surgery and that doctors' convenience and payment level should be left out of
"We used the word 'discussions.' We used it plurally," says Vern L.
Katz, MD, a professor of obstetrics and gynecology at the Oregon Health &
Science University and a member of the expert panel.
The committee wrote that women seeking elective C-sections should consider a
number of important issues with their doctors. They wrote:
"For example, if the woman has a fear of the pain during labor, pain
management strategies should be addressed. If her concern is about future
pelvic floor disorder, her provider should discuss labor and delivery
management to minimize these risks as well as well as a summary of the relevant
"In every case, discussions should maximize her understanding of the
issues and should be specific to her personal needs, such as future
reproductive plans, medical risk factors, psychological needs, social and
family situation, and other factors."
Experts also called for more research into the actual number of these
procedures and the financial costs associated with elective C-sections.