Jury Still Out on C-Sections on Demand

For some women, the idea of planning a Caesarean section may sound like an appealing and convenient option -- they can schedule their babies' birthdays in advance.

Past media reports indicate that women increasingly request scheduled C-sections, although the surgery was originally intended for emergency circumstances to avoid harm to the mother or baby.

Today a group of researchers warns that little is known about whether it's safe to do C-sections regularly. Nor is it known how many women actually request C-sections in advance because many hospitals do not record such data.

"There is insufficient evidence to fully evaluate the benefits and risks of CDMR [Cesarean delivery on maternal request] as compared to planned vaginal delivery, and more research is needed," stated a draft released by a conference of scientists convened by the National Institutes of Health. "Until quality evidence becomes available, any decision to perform a CDMR should be carefully individualized and consistent with ethical principles."

The panel, which has been meeting all week, noted that women planning large families especially need to be informed of the risks of CDMR, because with every C-section the risk of scar tissue causing problems in future deliveries increases.

The panel also recommended that surveys be conducted to help clarify how many women request C-sections in advance, and that studies be done to better determine what risks C-sections pose when compared with vaginal deliveries.

As it stands right now, several doctors said they believe the ultimate choice should be left up to the woman herself, after she's been informed of the known risks and benefits.

"From my take on the conference, the majority of the data indicate we really cannot say one is better than the other," said Dr. W. Benson Harer, a past president of the American College of Obstetricians and Gynecologists. "Therefore, I promote choice."

This sentiment was echoed by Dr. Victor Hugo Gonzalez-Quintero, an associate professor at the University of Miami's maternal-fetal medicine division. He said not very woman in his practice requests C-sections.

C-Section on the Increase

"Elective C-section has both short-term and long-term complications. ... If after discussion of all these factors, the woman elects for C-section, then her choice should be respected," he said.

In general, unplanned C-sections have become more common. In 2004, 29.1 percent of all births were through C-section. A small percentage of these C-sections were thought to arise from the mother's request.

Several reasons account for the increase in C-sections. Women in general are giving birth later in life, which increases the risk of complications. And more women are obese, which makes delivery more difficult. And women who have had one C-section generally are far more likely to deliver again through C-section.

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