Lamaze International’s President, Dr. Pam Spry, discussed cesarean section with Medscape recently. Here is a small excerpt:
Medscape: Are rates of surgical delivery being driven up by women or clinicians? Is this the age of Blackberry birth — scheduling everything ahead of time?[16]
Dr. Spry: Actually, there are 2 parts to this question. One is, what has driven up the rate of repeat cesareans, and that answer is easy: there has been a big decrease in the availability of choosing to labor and deliver vaginally (VBAC) after having 1 or 2 previous cesarean births, causing a huge increase in the rate of surgical delivery [for repeat cesareans]. Compared with the early 1990s when VBACs were encouraged and acceptable, many hospitals, insurance companies, and clinicians now refuse to allow women to try laboring after a previous c-section because of perceived medical and legal risks.
The second part of the question is whether women or clinicians are responsible for the increase in the primary c-section rate, and I think that’s more difficult to answer. In a study of more than 1500 women, we tried to determine just that. The research results indicated that only 1 woman in the study actually reported that she requested a cesarean, which leaves the decision for the vast majority of cesarean deliveries up to clinicians. So understanding when cesareans are medically necessary, as well as the risks involved, is important in achieving a safe and healthy birth.
There are definitely some interesting discussions. If you’ve been around the block, they aren’t new, but it’s nice to see them laid out so nicely for the average person. Read it and let us know if you agree with Dr. Spry’s conclusions about how and when change will occur.