Your Health


This is MORNING EDITION, from NPR News. I'm Steve Inskeep.


And I'm Renee Montagne. In personal health, some women want more control over their birthing process, and they are increasingly choosing Cesarean deliveries. That option was once considered appropriate only out of medical necessity. Now it allows women to schedule a delivery date and prevent a long labor.

NPR's Allison Aubrey has more.


31-year-old mother, Jamie Seward, doesn't have a pang of regret about the way she brought Teddy, her nine-month old son into the world. Leery of a long labor, she approached her doctor early on about a C-section. After discussing the pros and cons, her doctor encouraged her.

Ms. JAMIE SEWARD: I thought that that was great, that women could have the opportunity to choose their birth experience, versus having an experience kind of forced upon them.

AUBREY: Accustomed to choice, Seward, who works as an attorney, liked the idea of controlling the timing of her child's birth. She says after she convinced her husband it was the right choice, she approached her delivery date anxiety-free.

Ms. SEWARD: There wasn't the rush to the hospital and the craziness. I didn't have to push for 20 hours. So, scheduling a C-section for me was just a preference, and I was happy with my decision.

AUBREY: Seward says just before she got pregnant, one of her long-time running pals had delivered a baby the traditional way, and was having bladder problems. She said a big part of her decision to opt for the abdominal surgery was the knowledge that it may help prevent post-labor incontinence.

Ms. SEWARD: I was able to start running again at five weeks, which was great, and I did not have any bladder control issues, which is also great. And I felt that the recovery was pretty easy.

AUBREY: Cesarean deliveries are on the rise. In the last decade, the rates jumped almost 50 percent to about three in every 10 U.S. births. Obstetricians make the decision most of the time. They almost always deliver breach babies, those are babies that are upside down in the womb, by C-section, and they often choose C's for high-risk pregnancies.

Add the new influence of mother's choice, which accounts for about three percent of the procedures, and it's clear the pendulum has swung, creating quite a controversy.

Dr. MICHAEL KLEIN: (Family Physician): Women are learning that they can prevent a whole range of bowel, bladder, and sexual issues. They pick it up in women's magazines, and they see the pop stars who are ordering cesarean sections like ordering out for pizza, and they ask themselves, you know, what about me?

AUBREY: Family physician, Michael Klein, of the University of British Columbia, does not approve of the trend. He says women may be hearing more about the presumed benefits of cesarean deliveries than about the risks.

Dr. KLEIN: For every 153 cesarean sections roughly, one woman will be readmitted with a complication.

AUBREY: Meaning a small number of women will end up back in the hospital with a surgical infection or bleeding, which can be serious. As for the newborns, Klein sites studies that show C-section babies are at a greater risk of breathing problems, and more often require oxygen therapy at birth.

Dr. KLEIN: We are not improving outcomes for babies, but we are damaging mothers.

AUBREY: The way Klein sees it, vaginal childbirth is safer for most women. But this is far from the medical consensus. The National Institutes of Health just wrapped up a conference on elective C-sections, and at the end of the day, many of the obstetricians, midwives and family doc's who attended agreed to disagree. Some speakers presented that shows cesarean deliveries do cut the risk of fetal injury and brain damage in babies, but physician James Nicholson says the conclusion of the conference panel was that there's simply not enough evidence to suggest that one method of delivery is safer than the other.

Dr. KLEIN: Again and again and again the speakers are saying we don't have evidence to speak to this important question.

AUBREY: The panel did make a few clear recommendations. Women who planned to have more than two children should not choose C-sections, because of the risk of complication increases with multiple C's. And to obstetricians, the panel says don't be an advocate. Discuss the process of elective cesareans only after a woman initiates the conversation.

Allison Aubrey, NPR News, Washington.

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