Are Your Patients Requesting Cesarean Deliveries or Inductions?

A recent video segment on ABC News (see embedded video) addresses the growing rate of placenta accreta. The accompanying article with the jarring headline, "Placenta Accreta: Multiple C-Sections Can Kill Mother," reports that doctors are attributing the rise in this condition (from 1 in 30,000 pregnancies in the 1950s and 1960s to 1 in 2500 pregnancies in 2007, according to a report in AJOG) to the increased number of cesarean births. The article goes on to describe more reasons for the growing incidence of cesarean delivery, including diabetes, preeclampsia, and advanced maternal age, under the heading "More Women Demand Caesarians."

Not surprisingly, the article has readers in a tizzy over when, exactly, a cesarean delivery is needed . . . and has them pointing fingers regarding who is to blame for the increased rate of this surgery.

High Costs of Health Care

One commenter criticizes the increases in medical insurance from law suits directed at medical professionals and "related facilities." He states that "Doctors are not Gods, and as a result many times they perform procedures that lessen the probability of future legal ramifications from patients."

Another accuses hospitals and doctors of being greedy:

"There is an obvious reason that doctors are recommending c-sections more often today: they get more money for them! With the ludicrous cost of health care in America due to the fact that hospitals are businesses and therefore interested in maximum profit, the c-section is a much more lucrative option than natural childbirth. It IS a major surgery and the hospital gets a portion of all the costs that come from any major surgery. Since both the hospital and the OB personally get a bigger chunk of change, there is not much incentive to encourage natural births."

Moms and the "Elective C-Section"

Several commenters complained about the use of elective cesarean births, such as this reader:

"The problem is that too many [women] want the c-section so they can schedule the birth. They don't seem to understand it is a serious surgical procedure. If a woman had to have a c-section because of a problem, that's one thing. But scheduling the birth like a dentist appointment is naive. And dangerous, both now and in the future."

Study Finds Delivery Interventions Not Linked to Healthier Newborns

But ABC News isn't the only outlet calling attention to the high incidence of cesarean deliveries and other interventions. . .

"Whether a hospital had high or low labor induction rates or high or low C-section rates didn't seem to make any difference to the baby. If you don't improve the health of the baby by doing these things, why not try for a lower rate?" says Dr J. Christopher Glantz, MD, MPH, researcher of a new study published in the Journal of Maternal-Fetal and Neonatal Medicine that analyzed the rates of labor induction and cesarean births in low-risk pregnant women, and found that rates of intervention at delivery had no bearing on the health of new babies. The results of this study are making the rounds on several major health and science sites.

In an interview with WebMD, Dr Glantz associated the rise in labor induction and cesarean deliveries with overall public acceptance and demand for the procedures. "A lot of patients have become much more accepting of interventions and are asking to be induced or have a C-section. Socially there is a much stronger acceptance and demand for these procedures, and some is out of convenience on the doctor and patient side."

Dr Glantz remarked that some inductions or cesarean deliveries, when done for specific, established medical reasons, are necessary and lead to improved outcomes, but that patients should "be clear what the reason is if your obstetrician is suggesting an induction or cesarean section."

WebMD's article also quotes Dr John Weitzner, MD, who pointed out that "A vaginal delivery is preferable if everything is going well, but to say 'I'm not going to have a C-section' because of a study like this is an error in judgment." He noted some issues with the study design and conclusions, including the fact that the study doesn't look at still births, which may have skewed the results.

In an article posted to ScienceDaily, Glantz acknowledged that the optimal rate of any medical intervention is hard to define, and larger studies are needed to better understand the relationship between intervention and outcome.

What Do You Think?

Why the apparent increase in cesarean deliveries and inductions? Do you find, as Glantz noted, that more of your patients are requesting cesarean births or inductions? Share your thoughts in our comments section below.