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Childbirth
may be perfectly natural, but it's not harmless. Around
the world, some 500,000
women die from
pregnancy complications each year. Though maternal death
is rare in developed countries, vaginal delivery has its
complications,
such as hemorrhoids, months of back pain and higher risk
of incontinence down the road. Natural birth holds risks
for babies,
too — especially those born to older women.
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May 16, 2005
These
are just some of the reasons for the steep increase in cesarean
sections. Fifty
years ago, fewer than one American
baby in 50 was delivered surgically. The proportion now exceeds
one in four, and cesarean rates have risen in most other developed
countries. Critics say the trend toward high-tech delivery
wastes money and makes childbirth less safe. Yet some women
now demand C-sections, and doctors are ever quicker to perform
them. Is all this surgery warranted? What's a prospective mother
to do?
It's not a simple question. Surgical delivery does spare
a woman from labor and its after-effects, and it gives her
some flexibility in scheduling delivery at her convenience
instead of the baby's. But it also slows recovery. Women who
have C-sections can't drive or lift anything heavier than a
baby for a few weeks afterward. They require more rest than
those who deliver vaginally, and most receive pain medications
that can compound their tiredness. The safety issues are even
murkier. Surgery can improve birth outcomes in complicated
pregnancies, but no one has fully evaluated the impact of elective
C-sections. Does surgery raise or lower the risk of complications
in women who could safely de-liver vaginally? Because elective
C-section is such a recent phenomenon, we still don't know.
The vast majority of cesareans are still ordered by physicians,
and the increase stems mainly from changing medical needs.
As women give birth at later ages — and as fertility treatments
yield more twins and triplets — babies are more likely to arrive
early, when they're too small to risk vaginal delivery. Some
studies suggest that women receiving epidural anesthesia or
labor-inducing drugs are more likely to require a C-section.
And improved fetal monitoring has made it easier to tell when
a fetus is not reacting well to labor. Even in women with similar
risk factors, the rate of C-section varies widely depending
on the doctor and the setting. A woman attending a small community
hospital is usually seen by one physician who knows her well.
This personal care has an obvious upside, but women in these
settings often end up having their labor induced, just to guarantee
that the familiar physician performs the delivery.
Wherever
you live, the first step to a good birth is to speak up about
your preferences. Many physicians are willing to perform an
elective C-section once the mother understands the risks and
benefits. But if you've had one cesarean, don't assume you're
destined for another. For women without other risk factors
(obesity, advanced age, an extended pregnancy, a very large
baby, more than one previous C-section), vaginal birth is only
slightly riskier than a second surgery — as long as it's done
in a hospital where emergency services are always available.
In the end, what happens during labor is also up to your baby.
If the child foils your plans, take heart. It won't be the
last time.
Frigoletto is the Charles and Robert Montraville Green Professor
of Obstetrics and Gynecology at Harvard Medical School and
chief of obstetrics at Massachusetts General Hospital. JUNGE
is an editor at Harvard Health Publications. For more information
go to health.harvard.edu/NEWSWEEK.
© 2005 Newsweek, Inc.
© 2005 MSNBC.com
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