Caesarean birth choice increases

WASHINGTON -- Doctors reassured Randi Rosenberg there was no reason to fear natural childbirth -- she was in fine shape. But she so wanted to skip labor with her first baby that she switched doctors to get an elective caesarean section.

It's still rare, and intensely controversial, but more expectant mothers seem to be choosing C-sections when there's no clear medical need.

So says a new study that, by counting insurance claims data, estimates about 80,000 women had planned, elective C-sections in 2002, up from an estimate of just under 63,000 the year before.

That's a fraction of the nation's 4 million births. But the numbers are stirring a major debate among obstetricians who for years have been urged, by the government and consumer groups, to lower the overall number of caesareans they perform. In 2002, C-sections accounted for 26.1 percent of all births, a record high.

Caesareans can be life-saving for many mothers and babies. Fetal distress, breech babies, twins or more, or diseases that make labor risky for the mother can all be important reasons to have one.

Still, it's major abdominal surgery that, though safer today than ever before, still carries some serious, occasionally life-threatening side effects: hemorrhage, infection, and blood clots. Possibly more important, one C-section brings more risks to future pregnancies.

So critics insist C-sections require a compelling medical reason.

Proponents of elective C-sections say the worst risks are rare, especially in a healthy, rested woman -- and that vaginal birth has its own problems, including a possible but unproven higher risk of incontinence from vaginal tears or use of forceps. They say fully informed women should be able to choose.

''Most doctors, when they are being honest . . . recognize there are cases to be made for both sides -- and also recognize that the question hasn't been studied in a way that permits anyone to know for certain what the best course is," said Dr. Jeffrey Ecker, a Massachusetts General Hospital high-risk obstetrician.

He cowrote recent ethics guidelines for the American College of Obstetricians and Gynecologists to help doctors determine how to weigh the pros and cons with interested patients.

''It felt like the right thing to do," said Rosenberg, 38, whose daughter, Alexandra Marais, was born June 8. Years ago, Rosenberg had surgery to remove a fibroid. Now she feared that pushing during natural childbirth could rupture her uterus. Doctors said the old scar wasn't a threat, but she wasn't convinced.

Women getting elective C-sections are usually over 35, more affluent, and planning only one child, said Dr. Samantha Collier of HealthGrades of Denver, a company that studies health care quality.