C-Section: 145;C146; is for choice

The findings are at variance with decades of medical advice aimed at trying to reduce the number of Caesareans, which for years were seen as unnecessary, costly and potentially risky. Overall, the panel found that current scientific evidence is insufficient to recommend performing or not performing Caesareans on demand, saying the available studies suggest both risks and benefits. Elective Caesareans should not be done until the baby8217;s lungs have developed sufficiently or on women planning to have more than two or three children.

But the experts said the procedure is an acceptable option for women8212;especially those in their forties8212;who are planning to have only one or two children. Mary E D8217;Alton of Columbia University Medical Center in New York, who chaired the panel, said: 8220;It should be discussed with the woman, and her decision should be honored.8221;

The report was praised by advocates of giving women more of a choice, and denounced by opponents who say Caesareans are dangerous and overused. Both sides said they think the report will prompt more women to request the procedure, more doctors to perform it and more insurance companies to pay for it.

More than 1 million of the 4 million babies born each year in the US are delivered by Caesarean section. As the number of Caesareans increased through the 1970s8212;in part because of rising malpractice suits associated with vaginal births8212;medical groups began campaigns that reversed the trend. Many medical authorities viewed the procedure as unnecessarily expensive and risky, and advocates of 8220;natural childbirth8221; saw it as turning a natural experience into a 8220;medicalized8221; one. But the number of Caesareans began to increase again in 1996, reaching an all-time high of 29.1 per cent in 2004.

The trend was fuelled by such factors as doctors8217; concerns about the safety of attempting a vaginal delivery after a previous Caesarean, women8217;s fear of pain and physical trauma of traditional labor and the convenience of being able to schedule deliveries. The rapid increase prompted the NIH to convene the panel to make the first new assessment of the procedures since 1980.

The panel concluded that Caesareans increase the risk for some serious, potentially life-threatening complications, particularly devastating uterine ruptures during subsequent vaginal deliveries. But there was also evidence that the surgical deliveries reduced risks such as bleeding by the mother and possibly brain damage to the baby.

Rob Stein