Choosing a C-section: Who knows best?

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Almost 32% of babies born in the United States today are delivered by Cesarean section, a huge increase from even 10 years ago. Multiple factors seem to be driving this trend, although it’s clear that there is no scientific evidence to support the notion that it’s generally healthier, safer or better for a mother and her baby to deliver by C-section, say doctors meeting this week in Chicago at the annual meeting of the American College of Obstetricians and Gynecologists.

Women may be choosing a route of delivery without having full knowledge of all the pros and cons of each, says Dr. John R. Fischer of the Walter Reed Army Medical Center in Washington, D.C.’To say patient-choice Cesarean section is controversial is minimizing the issue.’ Fischer’s analysis suggested that opting for a Cesarean section does lower the risk of incontinence until age 65, when incontinence doesn’t seem to be linked to childbirth. Elective C-section also lowers the risk of later fecal incontinence.

However, C-sections increase the risk for other complications, such as hysterectomy, blood loss and injuries to internal organs, says Dr. Dotun Ogunyemi, of Los Angeles’ Cedars-Sinai Medical Center, who also spoke at the meeting. According to Ogunyemi, before the first C-section, women should consider how many other children they may have. Doctors are becoming concerned that, as more women have C-sections, they will see women who are having their third, fourth or fifth child by C-section. Studies indicate that the risk of complications during delivery increases as the number of C-sections rises.

Doctors agree that much more study should be done on the medical, social and economic costs and benefits of patient-choice C-section. There is some evidence that women are growing more confused about the option. A study presented by Dr. Kenneth Barron of the University of Massachusetts Medical School surveyed 273 women early in their pregnancies and found only 12.5% said they wanted a C-section -- far fewer than the number who can be expected to have a Cesarean. Moreover, the women who expressed a preference for Cesarean cited convenience, fear of labor, pain and their doctor’s recommendation as their major reasons for wanting a C-section. Almost none of the women said they wanted a C-section to avoid later pelvic-floor problems, such as the risk of incontinence, the main reasons doctors give for justifying patient-choice C-sections.

Younger doctors, noted Ogunyemi, aren’t learning how to deliver babies vaginally in all types of situations. When complications arise in labor and delivery, they are more likely to perform a C-section. ‘I think rates of C-sections will keep going higher,’ he said.

-- Shari Roan