Some doctors see problems in trend toward more C-sections
A record 30.2 percent of all births in 2005 were Caesarean deliveries in the United States, and some experts estimate about half of those are done for the convenience of doctors and patients rather than because they were medically necessary.
C-sections are the most common hospital procedure performed in the U.S., according to the Agency for Healthcare Research and Quality. Dr. Dana Stone, an obstetrician-gynecologist at Lakeside Women's Hospital, said she worries about the yearly increase in C-sections performed.
"Nationally, the trend is more common, but it will probably move to Oklahoma,” she said.
Though she has only performed a "handful” of elective C-sections in her career, Stone said she has had many patients ask about them. When a patient seems to want an elective C-section, Stone said she asks why.
"Is it because you're afraid of pain? Is it because you're afraid you won't be the same afterwards?” Stone said. "If it's a pain issue, epidurals are great. Some people are claiming that the risk of weakened bladder control and things like that are related to natural childbirth and so they make the assumption that they can prevent it by doing a C-section, but there's not good data to support that.”
There are many medical reasons a physician may recommend a C-section, and the procedure can often save the lives of both baby and mother. Prolonged labor, fetal distress, pre-enclampsia, infections and active viruses are just a few problems that could lead to an emergency C-section. However, the rise in C-sections outpaces increases of these circumstances.
"Just a couple years ago, it was not considered even maybe ethical to do a primary C-section without a medical reason,” Stone said. But The American College of Obstetricians and Gynecologists has recently decided that as long as a woman knows the risks associated with an elective C-section, it is ethical for a doctor to perform them at their patient's request.
The rate of women dying during or shortly after childbirth — 13 deaths per 100,000 — is higher now than it has been since 1977. The overall level of maternal mortality is relatively low — fewer than 600 each year, according to the National Center for Health Statistics.
Experts blame the rise in C-sections and maternal obesity for the rising death rate. The death rate among infants is also higher at 679 per 100,000 in 2004.
"I think both of those probably have some bearing on it,” said Dr. Amanda Levine, a private practice obstetrician-gynecologist in Edmond. "But also you have to think about the fact that you've got a lot of women going through assisted reproduction, women who are much older are having kids, compared to younger women in their 20s.”
Older women who undergo in vitro fertilization could face a higher risk of complications, but Levine said C-sections are generally considered safe surgeries.
"I tend to discourage my patients from having an elective primary C-section,” Levine said. Quoting her father, also a surgeon, she said, "Surgery is like Christmas presents. It's better to give than to receive.”
Another problem when the first baby is delivered by elective C-section is that subsequent deliveries will be C-sections.
It is risky for a woman who has previously had a C-section to try to deliver vaginally, doctors say. The contractions of natural labor can cause a C-section scar to rupture, possibly leading to hysterectomies, blood transfusions and brain damage in the baby. The National Institutes of Health says these complications occurred in less than 1 percent of 18,000 women.
"It's difficult to find somebody who has the insurance coverage to offer vaginal delivery after a Cesarean section.” Levine said.
"Oklahoma liability insurance doesn't cover that, so I can't offer that to my patients,” Stone said. "So, you don't want to get somebody started on C-sections if they're thinking they're going to have several children.”
According to Our Bodies Ourselves, a nonprofit women's health education organization, the rising number of C-sections may be attributed less to women requesting C-sections and more to physicians' concerns about malpractice lawsuits. Lawsuits against doctors are common when a baby is born with cerebral palsy, a disease that causes various impairments. Experts say that physician errors during delivery can sometimes cause cerebral palsy, leading some doctors to opt for C-sections to cut the risk of being blamed for cerebral palsy.
"A lot of it is because of legal concerns,” Stone said. "I mean, if you see somebody that's brought a lawsuit for a bad pregnancy outcome, almost 100 percent of the time the attorney that brings the lawsuit will say, ‘If only you had done a C-section here, then this baby would be OK.' It's not true.”
C-section appeals to some women because the procedure offers more control than vaginal deliveries. And many women believe they should have the right to choose how their babies come into the world, whether they choose a vaginal delivery after a previous C-section or want to have all their children by C-section.
"Your body is designed to have a baby. If there's a reason that the baby is not going to come out that way or is trying to bypass the vagina by acting up during labor or facing the wrong way, fine, let's do a C-section,” Levine said. "There's nothing wrong with that. But just doing it because you don't want to go through labor or because it's more convenient, that's not really my policy.”
Stone said, "I really worry that we're going to tamper with Mother Nature.”
source: http://newsok.com/article/3120422/1189394141?pg=1
More Cerebral Palsy Articals
Herpes Linked to Pregnancy Complications
Alan Bernstein joins Inspire board of directors
UCP Welcomes Donation of Medical Equipment
Documenting Data on Cerebral Palsy Essential
Judge says no settlement could compensate for boy's cerebral palsy
3.1m Damages for Cerebral Palsy Girl
Devices that help the disabled communicate
Repeat steroids to premature infants linked to cerebral palsy
Cerebral Palsy Diagnoses, Easy?
Some doctors see problems in trend toward more C-sections
Cerebral Palsy in Yemeni society
Camp helps youngsters with cerebral palsy improve skills
Chronic stress linked to cerebral palsy
Cerebral Palsy Children Have Similar Quality Lifes As Their Healthy Peers
