Health Law

C-Sections All The Rage

Ten years ago about 1 in 5 pregnant women had a C-section; in 2006 that number was nearly 1 in 3.  C-section supporters point to eliminating rare but frightening complications of vaginal delivery.  Others point to the increased recuperation time, risks of uterine rupture and other problems during subsequent surgeries.

Another possible explanation for the increase in  surgeries is the cost of malpractice insurance.  In some states that cost may be upward of $100,000 and it could jump drastically if anything goes wrong during labor and delivery.  So doctors can avoid lawsuits by avoiding labor.  It also means that doctors and patients can organize their days much better by scheduling surgeries.

Many women seem to prefer surgical delivery.  Some do so because they either don't have time for childbirth classes or they want to schedule early enough before due date to avoid stretch marks and saggy skin.  Others may simply want to avoid the pain of labor.

So, why not C-sections?  Experts say that C-sections mean a longer hospital stay and recuperation.  Gene Declercq of the Boston University School of Public Health, in a survey of 1600 new mothers, found that more than 75 percent of them complained of pain over the next  two months and 1 in 5 was still having discomfort after 6 months..

More worrisome is the higher likelihood during future pregnancies of having placenta previa, in which the placenta blocks the cervix and detaches during labor (potentially cutting off the baby's oxygen supply), or a ruptured uterus, increasing the possibility of hysterectomy and fetal death in utero. The surgery also carries a slightly elevated risk of death for the mother because of complications from anesthesia, infections and blood clots. And scar tissue that forms at the incision site can lead to bowel obstructions years or decades later.

Another major concern is for the health of the baby.  Researchers reported in the British Medical Journal that, compared to babies delivered vaginally or by emergency c-section, babies delivered electively 3 weeks before due date had four times the risk of breathing complications and five times the risk of lung problems because of immature lung development.

There's no question that some women need C-sections, such as those with placenta previa. But the World Health Organization recommends a cap of 15 percent of deliveries -- the U.S. rate in 1978 -- based on evidence showing that higher levels don't benefit either mother or baby. Though the drama-free planned C-section certainly has its appeal, Declercq stresses that women and doctors need to "stop seeing it as just another surgery."

Full post as published by Cerebral Palsy Law Blog on June 02, 2008 (boomark / email).