Cut and run

An increasing number of American women are choosing C-sections. Is this trend a risky indulgence, or a sign of female empowerment?

By Dana Hudepohl

Jul 9, 2004 | Several months after Jennifer Feeney, 34, a veterinarian in New Jersey, found out that she was pregnant, she read an article in Time magazine about celebrities such as Madonna and Elizabeth Hurley choosing to have C-sections -- not because they needed them, but because they wanted them. "I thought, Wow! That's something I'd do," she says. At her next appointment, she joked with her doctor about scheduling a cesarean birth. When he was receptive to the idea (while at the same time warning her of the risks) Feeney decided that an elective C-section was the best option for her.

"I absolutely dread the entire thought of laboring and delivering," says Feeney. "I can't see myself sitting around moaning, panting, sweating and screaming while people poke and prod at my vagina. It just seems so unnecessary to me."

Although Feeney is determined to go through with her decision, she's learned to keep her plans to herself. Her husband and doctor are supportive, but other people tell her she's "copping out." "You'd think it was the worst thing in the world to do," she says. Some other expectant mothers she's met online are horrified and have accused her of being ignorant and selfish. One woman even told her that she's going to be a terrible mother because she's only thinking of herself rather than doing what's best for her baby. "I thoroughly researched all the possible complications of C-section versus vaginal delivery and there are possible complications with both," she says. "Believe me, if I had found any statistical evidence that a C-section was worse for my baby, I would not do it."

Feeney is just one of a growing number of women across the country who are asking their doctors to deliver their babies by C-section even when they have no medical indication not to have a vaginal delivery. A study released last week by HealthGrades, a Denver company that studies healthcare quality, found that approximately 88,000 women had elective C-sections in 2002, up from about 71,000 in 2000, an increase of nearly 25 percent. "I think it would be safe to say that this is probably an under-representation of what's actually going on," says Dr. Samantha Collier, vice president of medical affairs at HealthGrades, noting that doctors may not always specify in the paperwork when a C-section is truly elective. "I don't know that it's ever going to completely replace vaginal delivery but I think it will continue to be a growing trend."

For decades, not having unnecessary C-sections was the feminist cause célèbre; can it be that having them -- a decision, like abortion, that is increasingly couched as a woman's "choice" -- is the new feminist cause?

"What the women's movement did was push for women to be able to choose a less medicalized birth, with less risk of having an intervention imposed on them that they didn't need," says Amy Alena, program director of the National Women's Health Network, a group that opposes C-sections except when they are medically necessary. "And that's the real problem with the movement for the C-section option: If it's presented to a woman as, Here are two equal options, it's no surprise that women are going to choose it. But if it's presented in what we would be considered a more balanced way, we think fewer women would be likely to choose it, because there are greater risks [with a C-section]."

According to the latest data from the Centers for Disease Control and Prevention, the rate of C-section is at an all-time high, with more than one out of four American women giving birth by surgery. While the bulk of this number is still made up of C-sections that are performed for medical reasons -- like a baby in breech position or with a dropping heart rate -- more and more women are requesting surgery. Their reasons run the gamut: Everything from the convenience of scheduling a birth to fearing labor, hoping to avoid a marathon delivery with complications or wanting to prevent long-term bladder, bowel or sexual problems that sometimes result from vaginal delivery.

But the optional C-section trend is making some doctors fume. "The outrageous cesarean rate we now have in this country is a national medical disgrace," says Theodore M. Peck, M.D., a perinatologist at the Gundersen Lutheran Medical Center in La Crosse, Wis., and author of "Empowered Pregnancy." "A general principle that we as doctors go by is 'Above all, do no harm.' By offering some anxious women the 'easy way out,' we are in fact potentially doing harm to some of them."

Next Page: "It really does suck to be faced with no choice in how you give birth"

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