Too Posh to Push?
Cesarian sections have spiked dramatically. Progress or convenience?
The fact is indisputable: The number of babies being delivered by cesarean section is rising sharply. But beyond that fact are vast uncertainties, including the cause of the increase and even whether it's a good or bad thing. Some blame a generation of new mothers unwilling to endure the pain and inconvenience of having a baby the old-fashioned way. Accustomed to controlling every detail of their lives, these women are too impatient for the uncertain timing of labor and too pampered for hours of contractions. They are, in short, too posh to push.
But not everyone is ready to blame the mothers. Others say it's doctors who are cloaking their own preference for C-sections in "women's choice" rhetoric. Worried about malpractice suits and protective of their own free time, OB-GYNs are telling prospective mothers that cesarean sections today are safe--or at least safer than vaginal deliveries. Indeed, some may be using the pain of contractions as a tool to coerce women into surgery, critics say. "You can take almost any laboring patient and talk her into a C-section," says Green Bay, Wis., obstetrician Robert DeMott. "That's part of the reason why we have a tremendous variation in C-section rates in the country."
Trend spotting. Whatever the reason, the U.S. rate of cesarean section spiked in 2001, up 7 percent since 2000 to the highest rate since the government began keeping tabs. Today, 1 in 4 babies in the United States is delivered by cesarean section. The rate of first-time C-sections, at 16.9 percent, is also the highest ever reported, up from a low of 14.6 percent in 1996 and 1997. Adding to the trend is a drop in the rate of vaginal births after a previous cesarean, which fell from 20.6 percent in 2000 to 16.5 percent in 2001.
Certainly, there are good reasons for a C-section, and the availability of the surgery has saved countless lives. A rise in the rate of herpes and in the number of first-time mothers at risk because they are older could account for some of the rise. But not all, and that's why experts are focusing on legal concerns and our culture of convenience and control. The debate among women can be as heated as among doctors. "This is a horrible trend that is in total opposition to natural law," says Anita Woods, vice president of the International Cesarean Awareness Network. Moya Cook of Marion, Ill., has a rebuttal: "I'm a nurse, and I've seen a lot of complications such as prolapsed uterus, prolapsed bladders. When I found out that I was having twins, I up front told them I wanted a C-section." Cook did indeed have the C-section she wanted.
In her case, the twins presented breech--feet first, a difficult vaginal delivery. Fortunately for Cook, this is a medical indication for the procedure that satisfied insurers. Without a medical reason, physicians cannot ethically perform a cesarean section simply because a woman wants it, says David Walters, Cook's obstetrician and author of Just Take It Out!: The Ethics and Economics of Cesarean Section and Hysterectomy. But that doesn't necessarily stop a doctor, Walters notes: "What people do is they'll make up some kind of bogus reason, like `the umbilical cord is in front of the head.' "