Friday, March 31, 2006

Are Doctors Performing Too Many Cesareans?

Article featured in this week's Newsweek. I don't think we even need to speculate - are doctors performing too many cesareans? Good grief yes! What this country needs is more midwives, more out of hospital births, and far far fewer interventions.

Special Deliveries
Are Doctors performing too many C-sections?

A decade ago, cesarean section births were often a last resort, performed during medical emergencies or after hours of unsuccessful labor. But in recent years, C-sections, in which a baby is extracted through incisions in the mother's abdominal wall and uterus, have increasingly become a matter of choice, not necessity. Between 1996 and 2004, the rate of C-sections doubled to nearly 30% of all U.S. births - the highest figure ever reported. This despite a CDC goal, announced in 2000, to lower the rate to 14% among first-time mothers by the year 2010. Though fewer than one in 10 C-sections are estimated to be elective, the overall trend has alarmed many in the field. "It would be fine if there was no risk associated with it," says Dr. Duane Alexander, director of the National Institute of Child Health and Human Development. "But there is."

How much risk is a matter of debate, one that has roiled the world of obstetrics as the number of C-sections has climbed. This week the National Institutes of Health will host a major conference to examine why more women are having C-section births, and if they're putting themselves or their babies in unnecessary danger. [*Do they need to have a conference to figure this out?!*]

Experts worry hat some women are opting for C-sections out of convenience - deliveries can be scheduled months in advance - or to avoid labor pains. [*I would so much rather bust a baby out of my vagina in a few hours than be cut open and healing for weeks. I don't understand that argument at all!*] Deanne R. Williams, executive director of the American College of Nurse-Midwives, says malpractice fears may also explain some of the increase. Doctors are more likely to nix vaginal births now if the baby is in the breech position, or if the mother has had a previous C-section (which increases the chance of her uterus's rupturing during vaginal delivery, a rare but very dangerous occurrence) to avoid being sued for complications. "It's not an unrealistic fear, "says Williams. "But major abdominal surgery is no small matter."

C-section risks include bleeding and infection. And studies show that the more C-sections a woman has, the higher her chance of hemorrhaging during delivery or needing a hysterectomy after the birth. Serious complications are rare, however, and usually occur during emergency, not elective, C-sections, says Dr. Gary Hankins, chair of the American College of Obstetricians and Gynecologists' Committee on Obstetric Practice.

Vaginal childbirth isn't risk-free, either. Many women experience tears or lacerations. Pelvic damage, which can cause incontinence or sexual difficulties, is much less common - and usually temporary. But after a 1996 British study found incontinence was greater among women who had chosen vaginal births, obstetricians say more women began requesting C-sections. More-recent research has contradicted the earlier findings. "There are a lot of myths out there we hope to replace with strong scientific evidence," says Alexander, a presenter at the NIH conference. That's just what women, and obstetricians, want to hear.

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