Posted on: Sunday, May 12, 2002

Busy women requesting more planned Caesareans

By Marilyn Elias
USA Today

More women are asking for pre-scheduled Caesarean births even if there's no medical reason for them, and doctors are deeply divided over the ethics of these elective surgeries.

"Very few are neutral about this," says Michael Greene, director of maternal-fetal medicine at Massachusetts General Hospital in Boston. He spoke on a panel May 7 at the American College of Obstetricians and Gynecologists meeting in Los Angeles.

Although there are no hard figures on requests for C-sections, obstetricians are reporting an upswing in demand. For many busy pregnant women, "it's sloppy and inconvenient to have an unplanned labor," Greene says.

The Caesarean rate (including emergency Caesareans) peaked at 25 percent in 1988, slipping to 21 percent in 1996. But now it's rising again, to 23 percent in 2000.

The evidence showing that C-sections are more dangerous for women and babies might not apply to surgeries that can be penciled in on a woman's planner weeks in advance, Greene says. Traditionally, Caesareans were done only after trouble surfaced during labor. No studies compare risks of vaginal births with non-emergency C-sections, he says.

One sure benefit of planned Caesareans is less anxiety for the mom, Greene says. And there are benefits for the family. "The in-laws get to use super-saver fares," he adds jokingly.

Surveys suggest that people want doctors to decide for them on serious health problems but prefer more say-so on "lifestyle" choices with little medical risk, says obstetrician Robert Resnik of University of California-San Diego.

Some patients definitely could benefit from such surgeries, says Joseph Schaffer of University of Texas-Southwestern in Dallas.

Women with urinary incontinence or tissue tears from past vaginal births double their risk for incontinence by having more vaginal births, Schaffer says.

Repeated vaginal births can increase the chance of prolapse, a condition in which the uterus and other organs start to drop in the pelvis.

Many physicians attending the panel argued against allowing elective Caesareans.

For one thing, a C-section costs about $4,500 more than a vaginal delivery. Caesareans also carry a higher risk of potentially life-threatening complications in later births, he says. And after one elective surgery, if a baby is truly in medical trouble during a second labor, "it's much harder to cut through the layers of the scar that's already there. You're more likely to cut through the bladder or cut the baby. ... These elective Caesareans are just asking for trouble," he says.