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Delivery debate: Vaginal or C-section?

More women are selecting surgery without a medical reason

From Elizabeth Cohen
and Christy Feig

Clair Sassin said she decided a Caesarean section would be best for her and her daughter.
Clair Sassin said she decided a Caesarean section would be best for her and her daughter.

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DELIVERY DEBATE

Vaginal birth benefits

• Easier recovery for mother
• Helps babies breathe better
• Not major surgery

C-section benefits
• Reduced risk to pelvis floor
• Less chance of uterine rupture

Sources: Physicians/medical journals

(CNN) -- More women are choosing to have Caesarean sections instead of vaginal births, according to a report released Monday, and their decisions, together with doctors' cooperation, has become a contentious subject among obstetricians, politicians and feminists.

The report is the first of its kind by Health Grades Inc., a consultant and research group, which evaluated data from 2,000 hospitals in 18 states. The study found that 1.56 percent of deliveries in those states were "patient choice" C-sections in 1999. In 2001, 1.87 percent were elective procedures.

The trend has some doctors and ethicists fuming because they contend that C-sections are more dangerous for mothers and their babies.

"When people say, 'I'm going to do something that's more dangerous to my health, more dangerous to my baby's health,' it seems to me our values are getting out of whack completely about giving birth," said bioethicist Art Caplan.

Others said it's not a certainty that a scheduled C-section is more dangerous than vaginal birth and point to conflicting evidence about which type of delivery is safer.

"I think women have a right to chose their health care and be in control of their bodies," said Dr. Bruce Bonn, an obstetrician and gynecologist. "If they're making an informed decision, they should be allowed to do that."

Clair Sassin said the minute she found out that she was pregnant, she knew she would chose to have a C-section.

Sassin said she did not want to labor for hours and hours, and she wanted control and predictability.

"I knew it would be less stress on the baby, and I really knew it would be less stress on me," Sassin said. " ... I knew two months ahead of time when she was going to be born and that allowed me professionally and personally to plan and schedule and take care of things."

A few years ago, Sassin might have had a hard time finding a doctor to grant her request. But things have changed, and more doctors are agreeing to perform C-sections when there is not a medical reason for the surgery.

C-sections are major surgery, but a recent article in the New England Journal of Medicine reported that the rate for complications after surgical delivery is declining. And several studies show that while the instances of maternal death is low for both kinds of deliveries, the risk of maternal death is lower in elective C-sections than in vaginal deliveries.

Experts said there is another maternal benefit. The surgery alleviates damage to the pelvic floor that may cause incontinence in later years.

But Tonya Jamois of the International Cesarean Awareness Network said the procedure still has risks.

"All sorts of surgical mistakes can happen," she said, "anesthesia problems, nicks from the surgeon, and that's just in the surgery."


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