|Elective C-Sections: Doctors Debate Risks Versus Planning|
Eleven years ago this July, two doctors in Italy described a new "phenomenon" in a letter to American Journal of Obstetrics & Gynecology. A recent law allowed pregnant women "the choice of the route of delivery"—and a small number were actually opting for C-section. The journal called it "a new ethical and clinical dilemma."
"There is no direct evidence comparing cesarean delivery on maternal request to planned vaginal delivery," says the National Institutes of Health's 2006 consensus statement. After all these years, doctors are left with "more research is needed." The NIH statement does recommend that certain women not get elective C-sections, including those "desiring several children" (because of an increased risk for placental complications with future C-sections) and those less than 39 weeks pregnant "or without verification of lung maturity." But it also says, "After thorough discussion and review, cesarean delivery on maternal request may be a reasonable alternative ...."
We live in a democratic country where freedom of speech, religion and choice are important. With that said, why doesn't the mother have the autonomy to decide her own medical treatment? With the use of modern technology we have reached the point where the cesarean delivery is equally as safe for the mother and baby, if not safer, than a vaginal delivery.
Cesarean delivery by maternal request (CDMR) occurs for multiple reasons. They include the fear of experiencing a vaginal birth, uncertainty of the timing of delivery, being successful with the endeavor, safety to the baby, fear of the unknown or loss of control of one's body in labor. Another strong argument is prevention of pelvic floor damage, which may cause stress urinary-incontinence, pelvic-organ prolapse and anal incontinence.
Finally, a potentially more persuasive argument is based on the fear of injury to the baby. There's a higher risk with complicated vaginal delivery and unplanned cesarean section than with cesarean delivery by maternal request for things including intrapartum death, cerebral palsy, birth injuries, neonatal infection and stillbirth at term before the onset of labor. In light of these uncommon but devastating outcomes, CDMR are not necessarily riskier than vaginal deliveries.
Elective cesarean delivery is becoming increasingly popular. Use of CDMR by celebrities has certainly increased its notoriety. CDMR allows women to choose the birth date as well as avoid the uncertainty of labor and delivery, so why not just give women the choice? I believe the potential risks of this particular elective surgery preclude us from offering it to all women.
Despite one goal of Healthy People 2010 being a 15 percent primary cesarean rate, cesarean delivery in the U.S. reached its highest level yet in 2006, of 31.1 percent. Cesarean deliveries have been associated with higher risks of maternal hemorrhage, infection, and even death. Additionally, neonates delivered via cesarean appear to experience higher rates of respiratory complications and possibly death. Further, there are risks from a cesarean delivery for both maternal and neonatal outcomes in future pregnancies, including intrauterine fetal demise, uterine rupture, and placenta previa and accreta.
to offer an elective procedure that may lead to increased maternal and neonatal mortality in current and future pregnancies with unclear benefits is medically and ethically questionable.
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written by Sherah , October 03, 2011
In the US a women is given the right to choose whether or not she would like to have a child, or have an abortion. But when a women choose the Right to Life option, she loses her right to choose her medical options as to surgery. If a C-section can be performed in an emergency, one should medically be safe to be performed electively. All these statements regarding infection and deaths to the mother were all based on C sections performed, not just electively but also Emergency C Sections, correct? So if a women is scared she may have to have a C Section after being subjected through hours and hours of vaginal labor, why not allow her the right to choose the C Section in the first place. She has the right to refuse medical care, so she should also have the right to CHOOSE what care she receives.