Elective Surgery: Nose Job. Breast Augmentation. Cesarean????

True story: I had the misfortune of bad timing the other day in the bathroom at the UWS Loews Theater, overhearing a brief conversation between two very pregnant women. The conversation went something like this:

“When are you due?”
“March 20th, but I’m having my c-section on the 18th.”
“I’m having a c-section on the 23rd. Why are you having a c-section?”
“Well, at 37 weeks, the baby was already 7 pounds 13 ounces and my doctor said ‘I wouldn’t put you through labor with a baby that big’.”

I left after that. Shocked by what I heard, I headed back to the theater and proclaimed to my husband, “I know what my next blog entry will be about.”

Sometimes I get the sense that my students feel I am anti-medical establishment. Actually, I am not. I am very thankful that modern medicine and technology exist for true emergencies and for the prevention of disease and illness. (Pregnancy and labor do not often, thankfully, fall into the latter category.) I am, however, not a fan of doctors offering to give elective cesareans for cases of presumed large babies and other erroneous reasons.

I have three major problems with this.

How big is baby really? Many doctors rely on the ultrasound data to determine the weight of the baby. Yet, in a study at the Department of Gynaecology, Obstetrics and Neonatology, University of Medical Science of Bari, Bari, Italy, it was determined “Twenty-nine formulas provided an overall mean absolute percentage error less than or equal to 10%, with overall predictions within ±10% and ±15% of the actual birth weight (69.2% and 86.5%, respectively). So how could the doctor be so sure that the mother was carrying a 7 pound 13 ounce child?

Big babies do not automatically require a cesarean. Even if a child’s weight is on the higher side, who says that the mother’s body is not capable of birthing her own child? (I personally witnessed a petite mother push out a 10 pound 3 ounce baby, totally naturally!)

I also think that the risks of cesarean births tend to be overlooked. Yes, they are safer than in years past, but there are still many complications and risks to consider when deciding to birth in this manner. The Maternity Center Association released data from a study concluding “Review of more than 300 research studies shows cesarean section increases chances of infection, pain, re-hospitalization, and breastfeeding problems in the mother, and increases the likelihood of serious problems for mothers and babies in future pregnancies, including infertility, placenta problems and fetal death.”

In a very interesting study reported by Science Daily, published by the British Medical Journal, researchers found “Women having a non-emergency caesarean birth have double the risk of illness or even death compared to a vaginal birth”. The article makes a clear distinction between cesareans performed as a result of medical necessity and those which are elected based on other criteria. The neonatal death statistics were also alarming: “The authors also found that the risk of neonatal death was also significantly increased (more than 70% higher) up to hospital discharge for babies who were born head first from both an elective and a clinician chosen caesarean delivery, compared to a vaginal delivery.

So why are doctors performing so many cesareans? There are many factors I’m sure, but the threat of litigation is one of them. Joel M. Evans, MD, OB/GYN, assistant clinical professor at Albert Einstein College of Medicine in Bronx, N.Y., says, “Unfortunately, we’re in an environment in which more cesarean sections are performed than are necessary. One of the reasons for this is the practice of defensive medicine. Doctors are making decisions to perform cesarean sections sooner than they did in the past to avoid lawsuits. What I mean by this is that some cesareans are clear medical necessities, but others lie in a gray area, where there are other possible medically appropriate options. Now, more and more physicians find it easier to follow the growing trend of just go ahead and do it, avoid a lawsuit.”

Also along these same lines, another unfortunate effect of undergoing a cesarean birth is that it forever categorizes the woman as ‘had cesarean’. Should she choose to have another child, she will have to seek out a doctor who specifically supports VBACs (Vaginal Births After Cesarean). Many doctors will not, for fear of a law suit in the event of something going wrong.

Let me be clear: How one births is a personal choice. Furthermore, I am not anti-cesarean, and I am certainly not anti-medicine. I just want to bring to the attention of those women having elective cesareans the fact that there are a number of considerations to be made. The choice is yours, but so is the responsibility to carefully weigh both the risks and the benefits of your decision.

5 comments March 17th, 2008