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Some doctors see problems in trend toward more C-sections

By Heather Warlick Published: September 10, 2007
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The baby talk around the kitchen table was scary for Susan Schmidt of Oklahoma City.

"Your mind kind of gets carried away,” she said.

"A couple of my friends had just had really bad inductions. They also had 9-pound babies. So, I was kind of starting to freak out about it.”

Like many couples today, Schmidt, 38, and her husband decided their baby should be delivered by Caesarean section. The procedure was scheduled so the Schmidt family could be at the Oklahoma City hospital when 7-pound, 6-ounce Jacob arrived Jan. 18.

"The C-section experience, for me, it was a cakewalk.”

A record 30.2 percent of all births in 2005 were Caesarean deliveries in the United States, and some experts estimate about half of those are done for the convenience of doctors and patients rather than because they were medically necessary.

C-sections are the most common hospital procedure performed in the U.S., according to the Agency for Healthcare Research and Quality. Dr. Dana Stone, an obstetrician-gynecologist at Lakeside Women's Hospital, said she worries about the yearly increase in C-sections performed.

"Nationally, the trend is more common, but it will probably move to Oklahoma,” she said.

Though she has only performed a "handful” of elective C-sections in her career, Stone said she has had many patients ask about them. When a patient seems to want an elective C-section, Stone said she asks why.

"Is it because you're afraid of pain? Is it because you're afraid you won't be the same afterwards?” Stone said. "If it's a pain issue, epidurals are great. Some people are claiming that the risk of weakened bladder control and things like that are related to natural childbirth and so they make the assumption that they can prevent it by doing a C-section, but there's not good data to support that.”

There are many medical reasons a physician may recommend a C-section, and the procedure can often save the lives of both baby and mother. Prolonged labor, fetal distress, pre-enclampsia, infections and active viruses are just a few problems that could lead to an emergency C-section. However, the rise in C-sections outpaces increases of these circumstances.

"Just a couple years ago, it was not considered even maybe ethical to do a primary C-section without a medical reason,” Stone said. But The American College of Obstetricians and Gynecologists has recently decided that as long as a woman knows the risks associated with an elective C-section, it is ethical for a doctor to perform them at their patient's request.

The rate of women dying during or shortly after childbirth — 13 deaths per 100,000 — is higher now than it has been since 1977. The overall level of maternal mortality is relatively low — fewer than 600 each year, according to the National Center for Health Statistics.

Experts blame the rise in C-sections and maternal obesity for the rising death rate. The death rate among infants is also higher at 679 per 100,000 in 2004.

"I think both of those probably have some bearing on it,” said Dr. Amanda Levine, a private practice obstetrician-gynecologist in Edmond. "But also you have to think about the fact that you've got a lot of women going through assisted reproduction, women who are much older are having kids, compared to younger women in their 20s.

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