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When Is a C-Section the Best Delivery Option?
Oct. 19, 2000 -- Though many experts say the U.S. rate of cesarean deliveries, or C-sections, is too high, a growing number of women are actually choosing to have their babies this way, either because they fear the pain and possible complications of a vaginal delivery or because they want to be able to choose their delivery date.
Now there's a new twist to the vaginal-vs.-C-section debate. A recently published study shows that cesarean deliveries are far safer for babies who are in the breech position (positioned in the birth canal with the feet or rear end pointing down).
Approximately 22% of all U.S. births are by cesarean delivery, but government experts say that figure should be closer to 15%. C-sections are typically meant to be used only in cases of complications that threaten the life of the mother or the baby.
Although many women are now opting for C-sections even when there's no medical reason, some experts argue that elective C-sections are too costly, and that women who get them have more complications -- including life-threatening ones -- and are more likely to be rehospitalized after giving birth. Studies suggest that women lose about twice as much blood during a C-section as with a vaginal delivery, and some women have reactions to the anesthesia or develop infections.
Still, some doctors think it's time to give women a choice.
"It's a matter of what women want," says Mary Wilson, MD, a New York obstetrician who says she often sees women who have relatives or friends who have had difficult vaginal deliveries and, as a result, have a prolapsed -- or sagging -- uterus or permanent rectal injury. More C-sections also are being done these days for large babies. Still another group of women who may prefer C-sections are those who have had a previous cesarean. The current medical thinking is that such women should try to deliver vaginally, but not all of them want to because of a slightly higher risk of uterine rupture.
"If she is afraid of that, if she doesn't want to take any risks whatsoever, I will go with a second C-section. But most women go with a [vaginal delivery]," Wilson says.
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.
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