PUBLISHED: 5:09 PM on Wednesday, May 31, 2006
C-sections usually for medical reasons, but some may opt for the convenience
Morris News Service

There were no last-minute phone calls when Jami Britton and her husband, Brandon, left for the hospital to have their second baby. Childcare for their 2-year-old daughter, Riley, had been arranged. Brandon had already cleared his work schedule and the doctor was waiting for them to arrive at the hospital for the 1 p.m. Caesarean section delivery of their son, Noah.

"The main benefit was being able to plan ahead," Britton said. "And how fast delivery went with no labor was nice too."

Britton's surgery was for medical reasons, but many women are scheduling C-sections simply for the convenience. The emerging trend - known as elective C-sections - is sparking a national debate.

Nearly three in 10 U.S. mothers are giving birth by Caesarean. In 2004, the latest data available, 29.1 percent of the nation's 4 million births were by Caesarean, the highest rate ever recorded, a 40 percent rise since 1996.

No one knows exactly how many C-sections are purely elective. Some estimates suggest there could be tens of thousands annually, and critics say many of those women were pressured into surgery or didn't know the risks.

In March, the National Institutes of Health held a three-day meeting to determine how much is known about the risks and benefits of a planned Caesarean - and how to ensure that mothers-to-be get all the facts. The conclusion of the conference was that there is too little research to know for sure whether it is a good or bad idea to elect for surgical birth.

Caesarean section is a surgical birth process typically reserved for emergency situations that arise during labor and delivery. Planned C-sections, like the Britton's, are often scheduled for women who previously had C-sections or when doctors determine there are pre-existing conditions that would complicate a vaginal birth.

That was the case for the Brittons. In the weeks leading up to Jami's due date, her doctor discovered Noah was in the breech position, which means he would have left the vaginal canal bottom first. They decided to schedule his birth because of his position and his potential birth weight. He was born Friday, April 28 at 12:50 p.m. weighing in at 9 pounds and 1 ounce.

"Initially I was nervous and scared because major surgery is involved," Britton said. "But over time I got used to the idea." Although she was disappointed she wouldn't be delivering vaginally -- like she had done with Riley -- as the day grew near, she felt more confident about the C-section process. And she discovered there were some benefits to a Caesarean birth.

Dr. Calvin Siegers, a local gynecologist, attended the conference in Washington, D.C., to learn more about the elective surgeries.

"Patients are just beginning to bring the topic up to me, saying they've read about it in a parenting magazine or seen something about it on TV," Siegers said.

To date, he has not performed an elective C-section. He said he would not rule it out, but would only consider the procedure if it was patient driven and with informed consent.

"If we agreed all the questions had been answered and that the patient understands the risks, then I would consider it," he said.

Dr. Thomas VanWingen said he has seen elective C-sections happen a handful of times during his 20-year career.

"It's not a common request or occurrence in West Michigan," said VanWingen. He wouldn't say whether or not he would perform such a birth, but would say if he thought the patient was appropriately counseled and had valid reasons, he would consider it.

"Attitudes are widely different with respect to childbearing. That's where communication is important," he said. "Elective should really be the exception versus the rule." Good reasons for elective C-sections might be concern about potential damage to the pelvic floor as a result of a vaginal delivery. The damage could cause incontinence later in life. VanWingen said inappropriate reasons would be for the convenience, fear of labor or fear of delivery.

"Education can help overcome those fears," he said.

Both doctors said it was important to remember that a C-section is a major surgery with risks involved: infection, bleeding, injury to other organs such as the bladder and bowels. And, recovery following a C-section typically takes longer than a vaginal delivery.

Britton said it has definitely taken her longer to get back on her feet following her C-section.

As for the question of whether or not to choose a Caesarean over vaginal delivery, her advice for mothers-to-be is to only have a C-section for medical reasons.

"Even with the benefits, I wouldn't ever do if for the convenience of it," she said.

Park Township resident Kara Heck agrees. Heck had an emergency C-section on March 31. After her water broke, it became apparent that with her babies in a transverse position, she would not be able to deliver twins Justin and Jenna naturally.

"The doctor had warned us to be prepared for all different avenues of delivery," Heck said. "I had wanted to deliver naturally, but more importantly we wanted to do what was right for the children."

Heck's 18-month-old daughter, Kaitlynn, was born vaginally and Heck said that while she can see benefits and drawbacks to both methods of delivery, she would not choose one method over the other. For now, the jury is still out on whether or not elective C-sections are here to stay.

"Child birth is personal and can arouse a passionate response whenever methods are discussed," VanWingen said. "It's a controversial topic I think we'll be discussing for some time."