A Cesarean Section On A Lucky Day?
16 Apr 2004
Should pregnant women have the right to demand a Cesarean section even if there’s no bone-fide reason for the operation? Or be allowed to have the C-section on a lucky day? Today more women are asking for this right. But is this request utter madness?
Years ago it would have been sheer folly to perform a C-section unless there was a serious emergency. Women would have died from either uncontrollable bleeding or infection. Now it’s a different story with improved surgical techniques and antibiotics.
The International Federation of Gynecology and Obstetrics claims that since there’s no evidence that a patient choice Cesarean has no benefits it’s not ethically justified.
The World Health Organization adds that a Cesarean section rate above 15 per cent is questionable. This figure automatically condemns both Brazil where the rate is 32 per cent and Hong Kong’s rate of 27 per cent. And in some private Brazilian clinics the rate is 75 per cent!
Natural birth organizations such as Lemaze International label the proponents of Cesarean on demand as orchestrating a campaign of misinformation.
So what is the risk of a C-section? Dr. Mary Hannah of the University of Toronto reports that of 100,000 women having an elective Cesarean 5.9 will die compared to 2.1 women who have a vaginal delivery.
Babies delivered by Ccesarean also require more oxygen therapy at birth. There’s also increased risk of bleeding in subsequent pregnancies. In addition, wounds can become infected and there’s an increased risk of blood clot forming in the legs.
But a planned C-section is not without its merits. A huge benefit is future freedom from urinary incontinence often associated with coughing or sneezing. Or as sometimes happens a loss of urine without stress. In one study 26 per cent of women suffered this annoyance six months after a normal delivery. And if you’re one of the four per cent who have fecal incontinence that’s other matter.
Patients who have these complications often require surgery later in life when they’re usually less healthy. And if you take 100,000 of these operations some women are going to die.
A planned C-section also decreases the risk to the baby. There’s less likelihood of stillbirth, fetal heart abnormalities and prolapse of the cord cutting off oxygen supply to the baby.
So who is right? You need the wisdom of Solomon to answer this question. Certainly no surgeon is going to amputate an arm simply at the request of a patient. But a "patient choice Cesarean" is not a black and white issue. So I believe this request is reasonable in 2004.
My crystal ball says that there will be more patient choice Cesareans in the future. But like any procedure it’s vital that the risks and benefits be fully explained to those who request it. Moreover, if a decision is made for an elective cesarean and a complication occurs patients should not run to a lawyer. Most complications are an act of god.
Today too many couples expect a perfect child when we know that about four per cent of babies will have an abnormality.
Some readers may wonder, "What would I do If I was a woman?" The risk statistics I’ve used are so similar that this would not be a part of my decision.
You must also realize I’m a trifle biased due to personal experience. I’ve spent many hours in surgery trying to relieve women of urinary and fecal incontinence due to natural childbirth. I knew that some of the operations would fail. I’d also know that patients with incontinence are much more aware of this distress than the surgeon who performed the operation.
In all probability I’d request a patient choice cesarean and accept any consequences from it. But there’s one thing I’d never do. In Bangkok, Thailand, some women are asking for a C-section on a lucky day such as the birthday’s of their revered king and queen or on Valentine’s Day. And in China some women, for the same reason, are requesting birth at Chinese New year. That’s a dangerous game to play. The lucky day could be the wrong day.
