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Caesarean sections on the rise



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Driven by changing beliefs, soaring malpractice rates and fear of labor, scheduled Caesarean deliveries are on the upswing.

Nationally, Caesarean sections have increased since 1996, when they hit a low of 20.7 percent. In 2002, they made up 26.1 percent of all births in the United States.

For years, doctors and other health officials tried to decrease the number of scheduled Caesarean births.

Randall Morgan, a Wichita, Kan., obstetrician-gynecologist, said high Caesarean section rates started coming down as insurance companies demanded cost containment and as studies showed the surgical deliveries didn't improve the health of babies or mothers.

In addition, pregnant women tried to avoid Caesarean sections, even if they'd already had one with an earlier baby.

Nationally, health officials sought to get the Caesarean rate to about 15 percent by the year 2000.

For a while, the efforts worked. Caesarean section rates dropped steadily in the first part of the 1990s, though they never went as low as 15 percent.

Physicians say the increase of the past few years is driven by a number of factors:

-Vaginal deliveries by women who've had a previous Caesarean aren't considered as safe as they once were. "Uterine ruptures are rare, but they're potentially life-threatening to the mother and to the baby," said Victoria Kindel, a Wichita obstetrician-gynecologist.

VBAC - vaginal birth after Caesarean - rates were at a high in the mid- to late-1990s, when the Caesarean rate was low, and have been dropping since then.

-Vaginal deliveries of babies in the breech position no longer are attempted, as they sometimes were.

-Some women and doctors are concerned about potential long-term effects of vaginal deliveries, such as pelvic floor injuries that can result in problems with bowel and bladder control. Studies are continuing to determine whether elective Caesarean sections make a difference, Morgan said.

-"Some people are nervous about the pain of labor," Kindel said, and request Caesarean sections. An article in the Sept. 1 Ob-Gyn News points out that young women may never have seen labor and vaginal delivery but "have only heard horror stories. On the other hand, almost all of them know someone" who has had a Caesarean section.

-A public more willing to sue and rising malpractice rates make doctors reluctant to try vaginal births in some circumstances. "You're going to look at your options and say, well, I can do a VBAC and get sued, or I can do a breech and get sued, or I can do a C-section and probably not get sued," said Wichita obstetrician Travis Stembridge.

The Wichita physicians said they haven't had patients ask for a Caesarean section solely for convenience, so they could schedule the delivery of their baby.

Stembridge said he hasn't had any women request a Caesarean section but is doing four or five more a year than he used to, because of medical considerations.

Kindel said maybe 1 percent of her patients will ask for a Caesarean delivery. She asks them to check with their insurance company and discusses with them the risks. "Any time you have surgery, there's risks, with anesthesia, infection, bleeding ... even death," she said.

Morgan said Caesareans are safer now than they were in the 1960s and '70s, but they can cause problems down the road. Once women have scar tissue on their uterus, from a Caesarean section or other surgery, "they have increased risk for the next pregnancy that they wouldn't have had if they'd delivered vaginally."

He predicts Caesarean section rates will continue to rise as women who've had a Caesarean section have more children.

In other parts of the world, Caesarean sections are even more common. The Ob-Gyn News article noted that 40 percent to 50 percent of Latin American births are by Caesarean section, with the rate at 80 percent to 90 percent in private hospitals, where the wealthiest patients are served. And a 2001 survey found 69 percent of British doctors would agree to perform a Caesarean.

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(c) 2004, The Wichita Eagle (Wichita, Kan.). Distributed by Knight Ridder/Tribune News Service.

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