Re-evaluating elective C-sections

Health Progress, Mar/Apr 2001

After seeing a seven-year decline, the rate of C-sections per live births is once again on the rise, reports Deborah L. Shelton in American Medical News. This decline is due, in part, to more women requesting C-- sections as an elective procedure. Rates have increased to 22 procedures per 100 live births in 1999, despite the U.S. Public Health Service's Healthy People 2000 target rate of 15 percent.

Many doctors now believe that women should have the right to refuse vaginal birth just as they now have the right to refuse a cesarean delivery. Some doctors believe that while there are dangers related to C-sections for both mother and baby, the dangers of vaginal births are underplayed. As risks and benefits as well as costs become more balanced between cesarean and vaginal delivery, perhaps the deciding factor should simply be the mother's preference.

Vaginal birth after C-section (VBAC) is declining even though some doctors have often felt forced by insurers to push patients into VBAC. As VBACs became more prevalent, however, lawsuits related to uterine rupture increased as well, encouraging doctors to take a more cautious approach that may also have had an impact on the rising rate of C-sections.

Citing an article in the New England Journal of Medicine, Shelton notes that four Harvard Medical School physicians called for a moratorium on efforts to reduce C-section rates, arguing that patient well-being rather than economic forces should be driving the goal to reduce C-sections. Many obstetricians and gynecologists were relieved that they no longer felt forced to conform to the Healthy People 2000 target rate. Whether or not patient-- choice cesareans have really arrived, the continuing upward trend in C-sections means that the 15 percent target goal may never be met.