Cesarean Sections: The Easy Way Out?

Of course, after the first c-section, it is likely another will be performed, as it is currently viewed as the safest way to deliver after a previous c-section. There are, however, mothers who opt for VBAC, or Vaginal Birth After Cesarean. For many mothers, this has been a very safe and successful method after a c-section (60-80% of mothers who attempt it are successful), yet many doctors and hospitals refuse to allow this method of childbirth to be attempted. Why? It can of course be quite risky, especially in cases of mothers who had placental problems in past pregnancies, women with high vertical incisions, and the risk of uterine rupture is real (though rare). So why are doctors and hospitals opting to not even take it on? For the hospitals equipped to perform an emergency cesarean and choosing not to allow VBAC, what message does this send to pregnant women?

For the doctors, the risk of a malpractice lawsuit is very real. While the U.S. continues to debate the current laws of negligent torts (malpractice lawsuits), the truth is that some physicians are practicing what is known as defensive medicine. By performing procedures having little or no medical benefit to a patient, but keep them safe from a lawsuit, one can imagine the increase in patient's insurance costs, but also something even more serious for the practicing physician. Loss of confidence and self-respect. One would think that a doctor who is too scared of a malpractice suit would be more inclined to perform a procedure purely at a patient's request, rather than for medically necessary reasons.

Regardless of the reason, are patient requested cesarean sections truly a danger to woman and infant? A recent conference of the ACOG decided to address the rising c-section rates and the controversy surrounding what they are calling "cesarean delivery upon maternal request" (CDMR). The worry is that some mothers are scheduling a c-section for the ease of knowing when they will deliver, having a sitter ready for other children at home, ready to walk into the hospital. Opinions aside, is this a safe way to go?

According to Dr. Mary D'Alton, director of obstetrics and gynecology at Columbia University Medical Center, the data is well, inconclusive. "There just isn't sufficient evidence at this time to fully evaluate the benefits and risks of cesarean delivery based on maternal request compared to normal vaginal delivery. "There was consensus, says Dr. D'Alton, that CDMR is not recommended for women who are planning on having several children since the risks of placenta previa and placenta accrete increase with each cesarean delivery."