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An independent panel convened by the National Institutes of Health concluded Wednesday that the scientific evidence is insufficient to compare the risks and benefits of vaginal deliveries vs. C-sections that are performed purely because the mother wants one.
The rate of C-sections in the USA reached an all-time high in 2004 of 29.1% of live births. Data for 2005 are not yet available, but most observers believe the rate has continued to climb.
"Limited evidence suggests that (cesareans performed at the mother's request) is increasing, but it is unclear why," the panelists wrote in a statement released after a 2 1/2-day meeting on the NIH campus in Bethesda, Md.
Estimates of "cesarean delivery on maternal request" range from 4% to 18% of all C-sections, according to the panel statement.
"Fear of labor and its potential complications, as well as desire for control" are driving some women to ask for C-sections when they have no medical reason for doing so, the panelists wrote.
Fear of labor pain is unwarranted, thanks to improved pain management, panelist David Birnbach, chief of women's anesthesia at Jackson Memorial Hospital in Miami, said at a press briefing. "No woman who wants pain relief should be made to suffer the pain of childbirth today," Birnbach said.
The panel recommended that one group -- women who know they want to have "several" children -- to not get a C-section solely because they want one. That's because the risk of placenta complications rises with each C-section.
Other women interested in scheduling a C-section should discuss the pros and cons with their physician throughout their pregnancy, the panel wrote.
"We don't believe it should be discouraged or encouraged," says panel chair Mary D'Alton, adding that doctors should not raise the possibility of scheduling a C-section if it is not medically necessary. D'Alton chairs the obstetrics and gynecology department at Columbia University.
The panel emphasized that C-sections should not be scheduled before the 39th week of pregnancy unless tests show the fetus's lungs are mature.
A pregnancy is considered full-term between weeks 37 and 41, but estimated due dates can be two or three weeks off, the panel wrote. So a C-section scheduled at 38 weeks might actually deliver a premature baby whose gestational age is only 35 or 36 weeks.
Deanne Williams, executive director of the American College of Nurse-Midwives, says she's "scared to death" that the panel's statement may spur increasing numbers of women to ask for C-sections. "People are not going to read the whole study, and they're not going to get the message that we don't know enough yet," Williams said.
But if patients and doctors read the entire statement, posted at consensus.nih.gov, they'll see that "clearly, this (C-section on demand) is not for every woman," says Catherine Spong, chief of the Pregnancy and Perinatology Branch at the National Institute of Child Health and Human Development, which co-sponsored the "state of the science" conference.
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