Birth On Demand: Elective cesareans are a growing trend

Waking at 3 am with painful contractions, endless hours of labor, decisions about pain control- these aspects of childbirth are now avoidable through a cooperating Obstetrician near you.

Victoria Beckham did it. So did Britney Spears, Elizabeth Hurley, Claudia Schiffer, Madonna, and many other celebrity mothers. These women gave birth via elective cesareans, enhancing a trend recently dubbed “too posh to push,” and the popularity is spreading among the not so rich and famous.

Cesarean rates have skyrocketed in recent years. The rapidly increasing statistics can partially be attributed to doctors who now deliver babies via c-section without any medical necessity. The World Health Organization (WHO) states that cesarean rates above 10-15% negatively impact maternal and fetal outcomes. The last cesarean section rates from the Center for Disease Control (CDC) from 2006 show the cesarean rate for the US was 31.3% (new numbers due at the end of November). The statistics are not clear on how many of the procedures are performed at the request of the mother, but it is estimated that 14% of the c-section births in the US are not medically necessary.

Facts and opinions both for and against this procedure have created a complicated situation and a question of ethics for some doctors.

One cause of the increasing rates is the controversy over VBACs, or vaginal birth after cesarean, deliveries. There are risks associated with VBAC deliveries, however, research has shown that the risks are minimal in most cases and do not justify mandatory c-sections for future deliveries. In fact, WHO has determined that multiple c-sections increase the risk of complications for mother and baby well beyond the likelihood of a uterine rupture in a VBAC.

Another concern is that it is not always clear who it is that is doing the “electing.” The trend is also on the rise of doctors encouraging moms to have cesarean deliveries. ChildbirthConenction.org’s national “Listening to Mother’s Survey” (March 2006) concluded that "Despite some professional and mass media discourse about 'maternal request' or 'patient demand' Caesarean … just one woman (0.08 percent) among 1,315 survey participants who might have initiated a planned primary cesarean … did so." In other words, it is more often the case that elective c-sections are more often than not done at the request and convenience of the doctor.

In March 2006, the National Institutes of Health held a conference entitled "Caesarean Delivery on Maternal Request" to address the rapidly increasing C-section rates. Studies discussed were not able to conclusively relate the rising rates on mothers, nor were they able to come to any recommendations either against or in support of elective cesarean deliveries.
So what is the problem with this birth on demand? Experts say that not only do c-section moms have a longer hospital stay, and a much longer recovery time, but up to a third of mothers who deliver by c-section have abdominal pain for about two months and 1 in 5 continue to have pain issues for six months. Also, mothers who have had c-sections are at increased risk for placenta previa in the future, making vaginal delivery impossible, or uterine rupture during vaginal delivery which can be deadly to both mother and child. Not to mention the risks associated with any major surgery including problems with anesthesia, blood clots, scar tissue and infections.

In contrast, planned c-sections are convenient and allow the mother control over childbirth. The risks of incontinence and hemorrhage that go along with vaginal birth are eliminated. Some experts claim that there is also a reduced risk of stillbirth, tears or trauma to the mother, or fetal injury during birth.

There is also debate over the timing of a planned cesarean. The Hollywood trend involves delivering the baby up to a month early, to avoid the time of the most abdominal stretching, reducing the chance of stretch marks, and making it easier for the mother to get back in shape after the pregnancy. The American College of Obstetrics and Gynecology says that births should not be forced prior to 39 weeks unless there is a valid medical reason, and to do so takes away critical time the baby needs to develop and prepare for birth.

Mikayla Dressing had an elective c-section with the birth of her third child. When asked what led her to this decision, she stated “I asked my doctor if he would take the baby through a planned c-section because I was scared of what would happen if I went into labor naturally.” Mikayla lives over an hour from the hospital, and has two other children whom she often cares for alone while her husband works. She tried to convince her doctor to do the procedure by expressing her fear that she would go into labor while home alone with her kids, and not have the support or time to make it to the hospital. Her doctor refused, since the operation was not medically necessary, so she sought out a different doctor who was willing to do the procedure. Mikayla claims, “It was so easy! Get a sitter, go to the hospital, and have the baby. No more fear of the unknown.”

Jennifer Sutliffe had her second child in September. She had an emergency c-section to deliver her daughter as a result of fetal distress. Jennifer wanted to have a VBAC delivery with her second child, but when she told her doctor her wish, he immediately listed off to her all of the risks that come with having a VBAC. He also told her that her hospital does not allow VBAC deliveries due to the potential complications and the liability involved. Jennifer was intimidated by the risks because she was not told that although the complications are possible, their occurrence is vary rare. Jennifer now feels she requested to have this child delivered by scheduled c-section because she was not fully informed.

In short, there is not yet any solid evidence to support or discourage the use of c-sections without medical necessity. The National Institute of Health states that it is important that mothers be informed of the risks associated with both methods of childbirth, and be warned of the increased risks of multiple cesarean deliveries to mother and child. It is still the case that individual hospital policies, and doctors, vary greatly in their position on the matter.