C-sections: Are they the better choice?

By KATHERINE SNOW SMITH

© St. Petersburg Times, published October 1, 2000

If you're planning to have a baby, there's a growing chance that you could deliver by a Caesarean section. C-sections are on the rise nationwide and are expected to increase at St. Petersburg hospitals as well.

The federal government recently released numbers showing C-sections accounted for 22 percent of births across the country. The C-section rate has risen three years in a row with a 4 percent increase last year.

For years we've heard talk about the benefits of vaginal childbirth over Caesarean, but it seems doctors are rethinking that.

Locally, Caesareans account for 24 percent of the babies born at Bayfront Hospital, which gets most of the high-risk pregnancies in the county. St. Petersburg General's quarterly C-section rate the past year is between 8.5 percent and 19 percent. Neither hospital has seen an increase, but doctors expect local hospitals will start following the national trend.

"For the last few years the impetus has been on decreasing the C-section rate. Now the question is "What's the big deal?' " said Dr. Romeo Acosta, head of the obstetrics department at St. Petersburg General. "In today's society, with anesthesia being available 24 hours around the clock, the risk of C-section complications is very, very small. . . . If we can give a better outcome for the baby and create less trauma for the patients" C-sections are the better choice.

In the late '80s and early '90s, there was a lot of enthusiasm in the obstetrics field for vaginal births after C-sections, abbreviated as "vbacs." For years, women who had one C-section were told all subsequent babies must be delivered the same way. But then doctors and mothers started proving that women with healed incisions in their uterus could deliver babies vaginally.

While less than 1 percent of vbacs result in problems, those problems are very serious.

"With a ruptured uterus, even if the doctors are all there, when things go bad they go bad very quickly," said David Gesper, chair of obstetrics for Bayfront-St. Anthony's health care.

"In my own practice, we have had no bad outcomes from vbacs. But you have to look at the scarred uterus in a labored patient as a potentially troublesome problem."

And if anything does go wrong, in today's society lawsuits often follow. That's another reason the C-section rate is up. Doctors are taking the safer route.

"Even if you did nothing wrong. Even if ultimately you were found not guilty of any medical malpractice you have spent many countless hours fighting that," Gesper said. "In other parts of the world the C-section rate is much lower because you don't have the same kind of legal issues."

Other reasons for the recent increase in Caesareans include women having children at older ages. Also, obesity plagues the nation and obese women have less success with vaginal births.

The most common, long-standing reasons for C-sections are breech babies, when the fetus is positioned feet first, and pregnancies when the baby is very big and the mother is small. And if a baby goes into distress there is often an emergency C-section.

Doctors and patients want to avoid C-sections because the recovery is longer, there is the chance for infection and any type of surgery presents risks of hemorrhaging or blood clots. Since Gesper came to Bayfront in 1981, he said, five or six women have died from C-sections.

But at a recent New Orleans convention of obstetrics professions, some doctors from large medical institutions were predicting women may soon choose to have C-sections now instead of other surgery later in life. Acosta said some estimate 60 percent of women will have C-sections in the not too distant future.

Women are living longer and facing problems such as urinary incontinence and a weakening of the vaginal floor, which allows for the uterus to slip out. "A very large amount of women will have to wear some type of diaper in the last 10 years of life," Acosta said.

These problems are often caused by trauma at the time of delivery, multiple births or large babies, he said.

"I really anticipate the C-section rate is going to skyrocket like never before," Acosta said. "I think it will improve the outcome as far as the health care of the women in the long run."

Gesper, at Bayfront, said he thinks a 60 percent C-section rate is a bit of a stretch. "You really have to factor the fact that women have bladder control problems for reasons other than childbirth," he said.

Acosta agreed that his colleagues in the St. Petersburg area were shocked to hear predictions for such a sharp increase.

"We still have the mentality of trying to reduce the C-section rate," he said. "If you look at it from the common sense viewpoint, it would seem women were meant to deliver vaginally. That's the natural way of having babies. "We need to assist our patients in having their baby the best way possible."

At St. Petersburg General, 40 percent of women who have had previous C-sections have subsequent vaginal births. Nationwide 23 percent of women who have had previous C-sections had vaginal births later.

"I think we have a group of physicians and midwives that are very supportive of women having vaginal births after C-sections or laboring patients longer," said Lisa Bozarth, a midwife at St. Petersburg General. "They're all such experts that they think women can go a little extra time and still have a safe vaginal birth."

Doctors also make every effort to turn a breech baby about three weeks before the due date so a C-section won't be necessary. And they stress the importance of good nutrition. A healthier mother without weight issues isn't as likely to need a C-section.

"Our health care professionals certainly share with women that there are two ways to have a baby -- vaginally or surgically," Bozarth said. "When there is a C-section, (mothers) don't feel let down or disappointed, because they are well-informed of the possibility."

For those babies who are delivered by a Caesarean section, they are in prominent company. The surgery is named after Julius Caesar, who supposedly was born the same way.

- You can reach Katherine Snow Smith by e-mail at Oliviachar@aol.com; or write Rookie Mom, St. Petersburg Times, PO Box 1121, St. Petersburg, FL 33731.

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