As C-Section Rate Grows, So Does Resistance
Run Date: 09/02/05
By Molly M. GintyWeNews correspondent
Caesarean section, in which a baby is delivered by abdominal surgery, has increased fivefold in the past 30 years, prompting concern among health advocates who say vaginal delivery is in many cases a healthier option.
(WOMENSENEWS)--All Jennifer Reid wants is to scream, writhe and push.
When she delivers the baby daughter who is due Oct. 7, Reid hopes to do so vaginally, forgoing the Caesarean section that she had when her son was born 10 years ago.
"When I had Cody, I was anesthetized, strapped to a table and denied the chance to hold him until the next day," says Reid, an administrative assistant in Conway, S.C. "Cody spent a week in intensive care because not being born vaginally left him with excess fluid in his chest. And I spent a year coping with an abdominal scar that kept getting infected and inflamed."
Though Reid needed a C-section during her first pregnancy because her blood pressure was dangerously high, her second pregnancy has been healthy. Even so, her doctor insists on performing another C-section because vaginal birth after Caesarean carries a slight risk--between 1 percent and 4 percent--of uterine rupture and his malpractice insurance will not cover this risk.
"Since my state doesn't allow midwives to attend vaginal births after Caesarean, my only option is to find another doctor or have the baby at home without help," says Reid. "I'm furious that there's no middle ground, because this is my body and not theirs."
At a time when C-sections account for a record 1 million U.S. births a year--and when health care policy is making the procedure more common--the issue of C-section and patient choice has become the latest front in the battle over reproductive rights.
C-Section Practice Changing
The most common form of surgery for women of childbearing age in the United States, C-section can be a lifesaving intervention for complications such as the umbilical cord preceding the baby's head, the placenta covering the cervix or the baby not being in the optimal head-down position for delivery.
Accounting for only 5 percent of births in 1970, C-section now accounts for 28 percent of total births. Health experts say it is becoming more common for a number of reasons. These include doctors who prefer the convenience of C-section to that of long labor; pregnant women who elect C-section to avoid labor; multiple births aided by reproductive technology that require surgical interventions and more sensitive fetal monitoring that means doctors are speeding delivery at the first sign of fetal distress.
While health advocates agree C-section is necessary in many cases, they are concerned by its dramatic spike in popularity.
Eleven percent of mothers have unnecessary first-time C-sections and 65 percent of mothers have unnecessary second-time C-sections, according to an April study at Tulane University in New Orleans.
"Unless a woman has a compelling reason for needing a C-section, vaginal delivery is still the way to go," says Deirdre Lyell, an assistant professor of maternal-fetal medicine at Stanford University in Stanford, Calif. "A C-section is major abdominal surgery and carries a greater risk of severe bleeding, infection, re-hospitalization and blood clots. It can leave a woman so sore for weeks that she is unable to lift her newborn."
While vaginal delivery typically requires two days of hospitalization and a one-week recovery, C-section requires four days of hospitalization and a two-week recovery. According to the Agency for Healthcare Research and Quality in Rockville, Md., the average cost of a vaginal delivery is $5,574, while the average cost of C-section is $11,361.
Procedure Being Forced
Health activists say their biggest concern about C-section is the growing number of reports that women are having the procedure forced on them against their will.
They offer the example of Amber Marlowe, a Plymouth, Pa., woman who wanted a vaginal delivery during her 2004 pregnancy even though tests showed her infant would likely weigh in at more than 13 pounds.
Concerned that Marlowe's choice could endanger her safety, hospital officials filed to become the legal guardians of her unborn baby and won a court order to perform a "medically necessary" C-section if Marlowe returned to their facility.
Marlowe had an 11-pound baby girl through a successful vaginal delivery at another hospital, but stories like hers are becoming more common. To date, hospitals in 12 states have obtained court orders mandating that patients with high-risk pregnancies undergo C-sections in their care.
The fiercest battles are being fought over vaginal birth after Caesarean (VBAC), which carries a minor risk of uterine rupture, in which prior C-section incisions (which are usually made horizontally) reopen during delivery.
"Women who want VBACs have the right to make informed refusal of care," says Tonya Jamois, president of the International Cesarean Awareness Network, Inc., based in Redondo Beach, Calif. "But doctors are ignoring women's refusal to have C-sections and carting them off to the operating room under protest."
According to the awareness network, more than 300 hospitals nationwide have sought to ban vaginal births after Caesarean. The incidence of such births has plummeted 63 percent since 1996, according to the Atlanta-based Centers for Disease Control and Prevention.
Addressing the Trend
As the C-section rate continues to mount, health authorities are taking measures to counter the trend.
At the Washington-based American College of Obstetricians and Gynecologists, members of the Task Force on Cesarean and Delivery Rates are working to educate doctors about when C-sections are necessary.
At the Washington-based Department of Health and Human Services, administrators have set a goal of cutting the C-section rate in half and tripling the vaginal birth after Cesarean rate by 2010.
At the American College of Nurse-Midwives in Silver Spring, Md., administrators have launched a campaign to reduce unnecessary C-sections and are lobbying Congress to hold hearings on the issue.
At the International Cesarean Awareness Network and the New York-based National Advocates for Pregnant Women, activists are collecting testimony from women who have had forced C-sections and providing them with legal referrals.
Meanwhile, women like Jennifer Reid--who is scrambling to find a doctor who will offer her vaginal birth after Caesarean--are continuing to fight for the care that they seek.
"Within the next month, I'm going to have this baby one way or another," says Reid. "My only hope is that I can have the type of delivery that I believe is the healthiest."
Molly M. Ginty is a freelance writer based in New York City.
For more information:
American College of Nurse-Midwives:The REDUCE Campaign: Research and Education to Decrease Unnecessary Cesarean Sections:http://www.acnm.org/news.cfm?id=234
International Cesarean Awareness Network:http://www.ican-online.org
More Women Choosing C-Sections, Despite Risks:http://womensenews.org/article.cfm/dyn/aid/1266/