Commentary : Medical Community Is Delivering a Disservice Through Unnecessary Cesareans

Like one out of every four women who gives birth each year in San Diego County, I gave birth to my first child by Cesarean section in 1983. Like virtually all of those women, I believed it was the best thing for me and my child.

And, like at least half of those women, I was wrong.

The dangers of vaginal birth that my reputable, trusted doctor so vividly detailed were unsupported in the medical literature.

The frightening statistics he quoted were false.

The Cesarean panacea he described was a fabrication.

A baby was born, but truth was aborted.

Many obstetricians, who find Cesarean delivery lucrative and convenient and who consider it the ultimate answer to the malpractice threat, find it persuasive to exaggerate the dangers of normal delivery and downplay the risks of surgical birth.

“Let’s face it. The only difference between vaginal birth and Cesarean birth is a couple days of discomfort,” Dr. Robert Resnik, chairman of the reproductive medicine department at UC San Diego School of Medicine, told the San Diego Birth Forum during a panel discussion of Cesarean birth.

Attitudes such as this are commonplace in obstetrics, and they help explain why the Cesarean rate in San Diego County is 25.3%, a record surpassed in Southern California by only one other county. (Nationwide, Cesarean sections have quintupled since 1970, reaching 24.1% of all births, without any corresponding reduction in infant death rates.)

At Scripps Memorial Hospital in La Jolla, roughly four out of 10 pregnant women who walk through the door are delivered by surgery, according to state figures. At Sharp Memorial Hospital, the number is three in 10. At a total of 13 county hospitals, the Cesarean rate exceeds 20%--twice what many authorities say is justifiable medically.

Doctors who decry these trends, who approach birth as a natural event rather than a medical episode, are suspect in San Diego’s conservative medical community. Some have left to practice elsewhere. Those who remain try to practice without notice.

They and parents who dare to question the Cesarean trend face the same taunt: If healthy babies are born, what difference does it make how they’re delivered? As Dr. Resnik would say, is anything more at stake than a couple days of discomfort?

Plenty.

The difference is medical. Nearly half of all women undergoing Cesarean section experience complications from the surgery. Some of these complications are minor ones, such as gastrointestinal distress. Others are major, such as hemorrhage. Cesarean birth is a major surgical procedure that carries with it major surgical risks that do not accompany vaginal birth.

The difference is ethical. Medical literature is unequivocal about the superior safety of vaginal delivery in general and of vaginal delivery for women who have previously had Cesarean deliveries in particular. Even the conservative American College of Obstetricians and Gynecologists advocates vaginal births after Cesarean sections. Doctors who continue to perform Cesarean sections on 20%, 30%, 40% or more of the first-time mothers they see and 90% or more of the prior Cesarean mothers are knowingly putting their patients in jeopardy without medical justification.

The difference is economical. Cesarean delivery costs more than twice what vaginal delivery costs. Ralph Nader’s Public Citizens Health Research Group has estimated that unnecessary Cesareans cost three quarters of a billion dollars annually. Unnecessary Cesareans affect more than parents and babies; they touch every individual or employer who pays an insurance premium.

The difference is practical. Cesarean recovery is slower, involves a longer hospital stay, entails more pain, requires more medication, necessitates more help back at home, results in longer maternity leaves.

The difference is emotional. Many women suffer feelings of anger, failure, disappointment, grief or violation as a result of their Cesarean births, and some have trouble bonding with their babies.

There is no question that Cesarean delivery can be a lifesaving procedure for mother and/or child. But it is also beyond reason that one out of four births would end badly if a surgeon did not intervene.

I was one of those women who got angry. Disappointed that I experienced birth strapped to an operating table, my body numb, the wound and delivery hidden from my view; upset that my baby’s birth date was determined by my doctor’s meeting schedule; outraged that my infant son, Gregory, was yanked into the world an estimated two weeks before he was ready, I began to study.

Having studied, I learned that my Cesarean was not medically necessary and, in fact--because it was scheduled and took place before labor began--put my son at risk for complications.

While I’m not one normally drawn to causes, what I learned galvanized me into action and I joined the San Diego chapter of the national Cesarean Prevention Movement. Begun in 1982 by Esther Zorn to combat the tide of unnecessary Cesareans and to give special support to mothers seeking a vaginal birth after Cesarean, CPM has 70 chapters in 31 states and members in six other countries.

The 2-year-old San Diego chapter is still small, but, as the parent group declares, “We are making a difference.”

We are identifying those local physicians who are enthusiastic about normal, vaginal birth, and helping women to find them, even if it means changing doctors very late in pregnancy.

We are lobbying hospitals to cease those practices that promote surgical birth and to implement policies that facilitate normal birth, and we have seen changes in their policies as a result.

We are providing literature, referrals, counsel and support to women from throughout the county who want nothing more than to bear children without medical interference.

And we are making a difference in individual lives. While fewer than than one in 10 Cesarean mothers nationwide deliver subsequent infants vaginally, more than nine in 10 of those who have been counseled by CPM of San Diego complete a vaginal delivery after a Cesarean.

Last month, when a watershed study reported a Chicago hospital’s successful effort to slash its Cesarean rate by doing little more than requiring outside second opinions in all non-emergency Cesareans and instituting rigorous peer review of all C-sections, we challenged local hospitals to do the same.

We as consumers are doing what we can to stem the Cesarean tide. Now it’s the medical community’s turn. If prospective parents were accurately informed about the differences between Cesarean and vaginal delivery, medical research has documented that fewer would consent to Cesarean delivery.

We think it’s time for doctors to start delivering truth as well as babies.