Cesarean on Demand

by Dr. Michele Brown, OB/GYN

Here's What You'll Find Below:   • A Case History
  • C-section Trends
  • Reasons Given for Elective C-sections
  • Are There Viable Disadvantages to an Elective C-section?
  •
What is the Answer?

twoMy mothers-to-be are astonishingly different from one another as they arrive ready to give birth in all possible shapes, sizes, and stages of delivery. Yet, in another way, they are mostly of one mind...determined to do anything medically necessary for the well-being of their baby.

Fortunately, the majority of births are pleasantly routine and everyone goes home a bit sore, but happy, healthy and determined to be a successful family. Once in a while, a delivery that may seem quite routine at first, can suddenly become complicated for any number of reasons. If the problems become overwhelming, the OB/GYN will strongly suggest that the parents give their consent for delivery via cesarian section, commonly known as a C-section.

This decision should not be suggested lightly because, after all, it's surgery! Only after the OB/GYN deems that the risks of a C-section are lower than the risks of a vaginal delivery should the C-Section option be chosen. Safety for the mother and baby always come first and only the physician is trained to know when this procedure is medically necessary. In rare cases, parents may be told ahead of labor that a C-section will be medically necessary, (i.e. if the child did not turn around in the womb). This is not considered elective because the need for surgery is decided in advance.

After delivering more than 3,000 babies, I thought I had heard it all! That is until quite recently when we OB/GYNs began hearing a more puzzling kind of medical request -- and began hearing it more and more often.

A Case History

B.P. is a 40-year-old professor of obstetrics from a major university hospital who is admitted to labor and delivery at term contracting every 5 minutes for the last hour. This is her first child -- having been conceived through in-vitro fertilization. She is a healthy woman with no medical problems, has had a completely uneventful pregnancy with all routine prenatal testing showing normal results, appropriate fetal growth, adequate amniotic fluid, baby in a perfect head down position, and a recent ultrasound estimating the baby to weigh approximately 7 pounds. On admission to the delivery floor she requests an elective cesarean section.

It has been established that an individual has the right to refuse medical procedures, but does it also follow that a person has the right to demand a medically unnecessary treatment?

C-section Trends

cesarean birthObstetrical care throughout the world is undergoing dramatic changes. Cesarean deliveries are increasing to the extent that in some countries, such as China and parts of Latin America it is well over 50%. There have always been certain traditional reasons for performing a cesarean section but recently "maternal request" has been added as a new indication. The rate of elective cesareans in the United States is now estimated to be between 4% and 18%.

Reasons for Elective C-sections

Fear of labor -- (tocophobia): Some women have a fear of pain, fear of an emergency and/or having to undergo a traumatic experience involving higher morbidity and mortality associated with complications.

Maternal convenience: Scheduling takes into account childcare, work concerns, support systems, choice of surgeon.