C-section controversy

The NIH says there's "insufficient evidence" to recommend for or against elective cesareans. Unsurprisingly, the debate intensifies.

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Earlier this week, the National Institutes of Health convened a conference to discuss the risks and benefits for moms who give birth via elective C-section. The symposium was a response to the skyrocketing rate of cesarean surgeries in the U.S.; according to the Associated Press, 29.1 percent of births in 2004 (the most recent year for which data are available) were C-sections, a 40 percent increase since 1996. Physicians say the boom is at least partly attributable to the increasing number of mothers who request the surgery.

The NIH panel hoped to be able to assess the risks and benefits and recommend for or against what they call “maternal request” cesarean deliveries. Unfortunately, the panel found “insufficient evidence” to do so; there are lots of pros and cons on each side, and the panelists could not offer a “recommendation in either direction.” The elective surgery’s benefits include “decreased risk of hemorrhaging for the mother, and a reduced risk of certain birth injuries for the baby;” there are also downsides, like “an increased risk of respiratory problems for the baby and a longer maternal hospital stay.”

Vaginal births may offer lower risk of infection, while C-section may leave fewer new mothers suffering from incontinence, the panelists determined. The panel also said women who want large families should avoid elective C-sections because the procedure can increase complications for future pregnancies, and warned that women shouldn’t opt for C-sections out of fear that the facility where they give birth won’t have enough drugs to help them manage the pain of vaginal delivery. (The panelists advised hospitals to ensure that their pain-management arsenals are well stocked.) But as for whether elective C-section is more or less risky or advantageous than vaginal delivery, the upshot was: “More research is needed.”

The panel got extensive media coverage, some of which may have been a little slanted. Here’s what the Washington Post reported on Thursday, in a piece titled “NIH Panel Finds No Extra Risk in Caesarean Section”: “Caesarean sections are not necessarily riskier than vaginal deliveries and may be safer in some ways for the mother and baby in many cases, an expert panel concluded yesterday.” Technically, that’s not inconsistent with the panel’s findings, but the Post’s “C-sections aren’t worse, and may even be better” report doesn’t strike quite the same tone as the NIH’s “there are risks and benefits on both sides” conclusion.

And the American College of Nurse-Midwives is annoyed. “Inaccurate or misleading headlines and reporting about the recent NIH panel on cesarean delivery for maternal request will exacerbate the harm unnecessary surgery causes women,” the college said in a press release on Thursday. “Coverage of the event by several major media organizations — including The Washington Post, NBC’s Today and Nightly News programs, and others — presented women with a distorted view of the National Institute[s] of Health’s State of the Science findings.”

The ACNM also noted that most news stories failed to mention the fact that “members of the panel stated repeatedly that because the evidence on the risks and benefits is so weak, doctors should not be asking women if they want this surgery.” That’s important, the college said, because a recent Listening to Mothers survey found that “nearly 10 percent of survey respondents reported feeling pressure from health professionals to have a cesarean delivery.”

It’s worth noting that as healthcare professionals who don’t perform surgery and who generally lean away from a medicalized approach to birth, the ANCM’s skepticism is not necessarily surprising. And certainly many women have positive experiences with elective cesarean birth. But that doesn’t change the fact that it’s irresponsible to give women the impression that elective C-sections are safer than vaginal deliveries when medical consensus on the question remains elusive. Mothers deserve the most complete and unbiased information possible so they can make informed decisions based on their individual circumstances, and not on the idea that there’s a right way to give birth.

Page Rockwell is Salon's editorial project manager.

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