Why so many women have C-sections

What part does malpractice concerns play in decisions to perform a Cesarean delivery?
There is no question that malpractice issues play a part. Many lawsuits are about failure to perform a “timely” Cesarean delivery. A recent survey performed by the American College of Obstetricians and Gynecologists (ACOG) on professional liability of its members found that obstetricians average three lawsuits during their years of practice. This may cause many of them to change the way they practice or even to decide to give up delivery of high-risk patients (or any patients). Insurance rates have risen and in states where there is no cap on medical lawsuit amounts for pain and suffering, obstetricians’ insurance rates can be hundreds of thousands of dollars a year. These are probably the chief reasons that the average age at which physicians stop practicing obstetrics in the US is 48. Considering the years of training and the need to practice to become truely expert, this is a terrible shame.

How many Cesarean deliveries are currently done on demand?
We actually don’t know. CDMRs are not tracked separately and often are not reported as such. The only way to “guesstimate” the number is to look at state records and see when a cesarean delivery was done without labor and without a medical indication or when it was done on a very low risk patient, again, with no stated indication. In New Jersey, in 2000, records show that this accounted for six percent of deliveries. The National Institute of Health recently estimated that 2.5 percent of all births in the U.S. in 2004 were CDMRs. Most of our knowledge about the possible pros and cons of CDMRs is indirect and is based on data from C-sections done for a myriad of reasons compared to vaginal deliveries.

What are the potential advantages of cesarean delivery on demand?

• Convenience factor. This allows patients to know when and how long to take time off, get help from relatives, especially if there are other children at home, and ensures that their preferred physician is present at time of delivery. It also gives a woman the feeling that she has a degree of control of the birth process.
• Fear of pain.  Some women feel that if they have a Cesarean delivery they will have epidural anesthesia throughout the procedure without the potential of having to deal with labor and delivery pains.
• Fear that the consequences of labor and delivery may compromise the health and quality of life of the mother.
• Pelvic prolapse and urinary or rectal incontinence. There are at least nine articles that deal with the issue of urinary incontinence (loss of urine with coughing or sneezing) subsequent to vaginal versus cesarean delivery. There is indeed more documented urinary incontinence immediately after a vaginal delivery (23 percent), forceps (35 percent), than Cesarean section after labor (nine percent) and elective cesarean sections (four percent). One year later  these differences continue, but are less frequent; 10 percent of women who had vaginal deliveries had some urinary incontinence where 3.4 percent with elected c-sections complained of this problem. However, studies have shown that subsequent to menopause there are few differences between the two modes of delivery and then its menopause and age that really determines whether a woman will have prolapse and incontinence.

There is also a question as to whether sexual function and vaginal contraction is diminished after vaginal delivery; but there are few studies that looked at this concern and those that have been reported show only a weak correlation. (Although anecdotally, women do tell me they feel different after delivering a large baby, and go on to say that their ability to contract the vagina or feel pressure during intercourse has diminished.)

MORE FROM HEALTH

Health Section Front

It's down to the final four on 'Biggest Loser' Being thankful ... you’re not like mom and dad Woman meets the stranger who saved her life 6 tips for overcoming holiday diet fears   One girl’s wish for an organ transplant   Supporting St. Jude’s Children Hospital   Getting out of a workout rut Holiday gatherings could spread swine flu   Women bare all for prostate cancer Gasp! Babies’ fat rolls being airbrushed away? Health Section Front   Add Health headlines to your news reader: