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Friday, November 16, 2007

Virtual Insanity

I've been working on a paper about maternal requested cesarean delivery and to my (somewhat) surprise have found that it is likely just media hype. I think you'd have to have your head in the sand to not be aware of this phenomenon; look at all the celebrities who have had cesareans just because.

One argument I have come across is that cesarean by maternal request is a woman's right. It's her body, her baby, so she can have a cesarean if she wants. I understand the feminist philosophy behind this, but is this angle being exploited by the obstetrical field to legitimize more cesarean births? The latest stats say that 30.2% of all births were by cesarean in 2005. That is roughly 1 in 3 babies born by surgery. And depending on the state and/or hospital you look at, those numbers can be higher.

There is an article in the November issue of Bioethics regarding this issue. The framework in which the author examines this "trend" is feminist, and argues against cesarean birth by choice. I do not have access to the full article, so I am just going off the abstract. But I lean in this direction.

Whenever this topic of cesareans comes up, there is always a backlash of "if it weren't for c-sections, we'd not have the great advances in maternity care today." I agree, to a point. Absolutely there have been numerous lives saved by the advances in cesarean birth. I certainly don't see them as an "all bad" procedure. But that doesn't mean there isn't risk. The World Health Organization states that there are no improvements in perinatal mortality with cesarean rates over 15%.

But getting back to my original point, this "trend" may just be all hype. Perhaps its just the media and the celebrities playing up these c-sections. I've also read that it may be related to the obstetrical perception of more women requesting c-sections without medical need, yet studies have shown that most obstetricians receive very few requests. So in other words, the obstetrical profession is out there saying the rise of c-sections is largely related to maternal request but there isn't data to support this belief.

Virtual insanity, indeed.


Sheridan said...

There is no way to measure this currently. There may be more moms having "elective cesareans" but how many of them were scared into them by their OBs? Big baby... low fluid, whatever the case may be. I know moms who have gone to their cesareans, crying because they wanted a vaginal birth. But statistically it is an elective cesarean.


Courtney said...

I've done a bit of research on this as well and I've found that "convenience" c-sections are indeed extremely rare. When a c-section is requested without medical necessity, it is often due to psychological necessity (PTSD, sexual abuse, etc). It's no wonder that women who have survived abuse are discreet about the reason they can't tolerate birth. It's not exactly something you want to share with acquaintances.

As far as the celebrity argument, from what I've found, there are very few (if any) documented cases of celebrities having convenience c-sections. This "trend" has been fueled by rumors just like all the other crazy celebrity stories we hear and believe. Think about it, has a celebrity come forward with information about their reason for having a c-section? Why would they? If the whole world cared about you and your birth, would you be knocking on doors to tell people you had to have a c-section due to an active herpes infection, for example?

I believe this is just hype that unfortunately gets used to bash women who either choose c-section for compelling reasons or women who decide to be discreet about the cause for their c-section.

Labor Nurse said...

Sheriden, I have come across that it is very difficult to measure the rate of maternal requested c/s because this info is not entered on birth certificates and for insurance purposes, billing and coding may be fudged (so MDs can be paid for the c/s)

Courtney, you make some good points about why celebrities are having c/s. There are some who have said they have had c/s because of their fear of pain. Others don't publicly announce why, but it does seem like a good majority of them have it. I was on a website (, I think) that has a list of celebrities who have had c/s for maternal request.

The argument has also been made that "elective" is very subjective. If a woman was offered a VBAC, but chose a c/s, is that considered elective without medical indication? Or if the woman requests the c/s for her hx of traumatic sexual abuse, etc, is that not a medical indication? There are a lot of gray areas...

Rinna said...

I'm an immigrant to the US but where I come from, a significant number of women would choose a C-section unless their doctor discourages them from it because they are afraid of labor pains.
It just does not make sense to me. I think that because of the rising incidence of C-sections, it becomes more of the norm. Some women tend to forget that giving birth to babies vaginally has been the norm since time immemorial. They also are not aware of the possible implications of a C-section and all the much more surprised when informed that it is actually major surgery.

Di said...

None of my friends or neighbors are celebs, but I have seen several request c-sections and have their OB happily comply. Reasons include, "Well, my Mom is flying in on Tuesday and I want her to be there and she'll be able to take care of my toddler so it would be REALLY convenient." to "I don't want to go through the pain of labor just to end up with a c-section anyway."