Pros and Cons of C-Section on Demand in Low Risk Patients

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Professor Richard Paul: "My name is Richard Paul, and I am from the University of Southern California in Los Angeles."

Professor Sabaratnam Arulkumaran: "And I'm Arulkumaran, Arul for short, from the University of Nottingham in the U.K."

Professor Richard Paul: "This afternoon, we would like to discuss the topic of cesarean section today, some of the trends that we see, and ask the question - have we gone too far in our demands to reduce the cesarean section rate which is seemingly a great demand put upon the obstetrician/gynecologist by organizations?"

Professor Sabaratnam Arulkumaran: "I think the problem was mainly put on the physicians because it was perceived that in the private sector the cesarean sections were done for monetary reasons. Currently, the issue is becoming a broader one because the women themselves want a cesarean section on request. There is debate about whether it's a woman's right to request a cesarean section. Discussions surround what is a woman's right as opposed to a privilege, and what is society's right. One of the concerns is the limited budget to provide health care services. The C-section that is done on request might consume more money and may even block up the theaters necessary to do emergency procedures. Many organizations like to consider C-section on request as a privilege and to monitor the situation to see how it develops."

Professor Richard Paul: "My view is that an informed woman certainly has the right to request a cesarean section. I think there's current debate relating on whether or not cost effectiveness may not be about equal for a cesarean birth, at least in the United States. Clearly in my opinion, the baby has a less traumatic exit from the mother by cesarean birth. It's generally accepted that the cesarean is associated with more morbidity for the mother. But isn't the question then - can the mother accept increased morbidity if she believes this is best for her baby as it's being born, and perhaps as we now understand, better for her later in life as it relates to late complications - less pelvic floor disorders, stress incontinence, and that type of issue. So we are going to see this debate occur, and I think we will see the demand for cesarean increase, and that will occur quite rapidly."

Professor Sabaratnam Arulkumaran: "In one of the surveys which they conducted in the U.K., they looked at whether the decision to do a cesarean section is made mainly by the physician or in participation with the woman. Increasingly the obstetrician is willing to discuss the issue and a joint decision is made. I think that is a right direction in which things should move in terms of clinical practice. The advantages and disadvantages of any procedure should be explained to the woman. She should be allowed to have an informed choice in the matter. I do not know how it works in the United States."

Professor Richard Paul:: "I think that the public is becoming more and more aware of the safety of cesarean sections - it's a safe operation. Particularly more and more women are requesting an elective cesarean as opposed to one trial of labor after prior section; the whole arena is changing. With women beginning to predominate as the providers, I think many of them, in fact, also tend to feel that cesarean is the preferable method of giving birth. This will no doubt have a major impact over the next few years, regarding the availability of that service, and the willingness of the obstetrician to go ahead and do a cesarean at the patient's request. I think one of the things that we believe medically is that there's more risk with cesarean. But when you look at the safety of the operation - it's an incredibly safe operation today. In my opinion, much of what has happened to drive this demand to decrease the cesarean rate is driven on an economic basis. It has been promoted by lobbies from insurance companies and by the Federal Government in order to limit the cost as opposed to really what's medically correct."

Part 2 - "Vaginal Delivery Following Previous C-Sections"