Reprinted with permission,
Courtesy, Asbury Park Press, a Gannett Co. newspaper.
BY
SHANNON MULLEN
ASBURY PARK PRESS STAFF WRITER
|
- Are
C-sections moving from Plan B to Plan A?
It's a question many health professionals in the baby delivery
business are wrestling with these days as the rate of Caesarean
deliveries continues to climb.
Nationwide, C-sections accounted for 29.1 percent of deliveries
in 2004, the highest rate ever reported, according to the federal
Centers for Disease Control. The trend represents a sea change
in the course of a generation: In 1970, the Caesarean rate was
5.5 percent.
New Jersey's rate, which perennially leads the nation, was more
than one out of every three deliveries. In 2004, the C-section
rate among hospitals in Ocean and Monmouth counties ranged from
17.8 percent to 42.7 percent, according to the New Jersey Department
of Health and Senior Services.
Because of the legal, economic and societal forces driving the
C-section trend, few expect the rates to level off anytime soon.
"We could see a 50 percent Caesarean rate in our lifetime," predicted
Dr. Eric Lehnes, chairman of the OB-GYN department at Kimball
Medical Center in Lakewood. The hospital's 2004 C-section rate
was 17.8 percent, the lowest in the state, in part because of
the strong cultural preference for vaginal births among Orthodox
Jewish families in Lakewood.
Health experts cite two major reasons for the upswing in C-sections.
The first is doctors' fears of being sued for a problematic
delivery — a particular concern in a litigious state like
New Jersey, where many obstetricians pay $100,000 or more per
year for malpractice insurance.
"The standard you're held to is 100 percent perfection," said
Dr. Robert Graebe, chairman of the OB-GYN department at Monmouth
Medical Center in Long Branch, whose 2004 C-section rate was
28.8 percent, the lowest in Monmouth County. Graebe's medical
group recently instituted a 24-hour rotation of doctors who take
turns serving in the hospital as an on-site "laborist," a strategy
aimed at reducing the incidence of avoidable Caesarean sections,
he said.
A second reason for the rising rates is a growing preference
for C-sections among expectant mothers. Some busy women elect
to have a C-section not for any medical reasons but rather because
they want the convenience and predictability of a scheduled delivery.
Others are willing to endure weeks of recovery from a C-section
surgery, which involves cutting through several layers of abdominal
tissue, rather than subject themselves to the rigors of labor
and the physical toll of a vaginal delivery.
A related factor, health experts say, is that more women today
are well into their 30s by the time they deliver their first
child. These older moms are more prone to such complications
as high blood pressure that can trigger an emergency C-section.
In addition, some older women who have to go to great lengths
to get pregnant in the first place view a scheduled C-section
as a way to reduce the odds of something going wrong during delivery.
Yet some health experts see the rising number of C-sections
as a worrisome trend.
"It's major surgery," said Lehnes of Kimball Medical Center.
Compared to vaginal births, C-sections carry a greater risk
of infection, blood clots, stroke and damage to the bowel or
bladder. Scarring from one or more C-sections also can result
in uterine rupture later on and can complicate future deliveries.
The risk of maternal death also is greater with C-sections, according
to a report in 2003 by the American College of Obstetricians
and Gynecologists.
C-sections also cost more than standard deliveries: $11,524
for a C-section with no complications compared to $6,239 for
a vaginal birth with no complications, according to 2003 hospital
data from the U.S. Agency for Healthcare Research and Quality.
For her part, Dr. Debra Gussman, an obstetrician on the faculty
of Jersey Shore University Medical Center in Neptune, isn't convinced
that the prevalance of C-sections is a cause for concern.
Though a C-section may pose more risks, doctors have become
highly proficient in the procedure, and the overall outcomes
for mothers and babies are excellent, Gussman said. As for the
C-section rates themselves, she doesn't believe consumers are
much interested in where a certain hospital falls in the rankings.
Jersey Shore's C-section rate in 2004 was 35.6 percent, above
the state average.
"People don't choose a hospital, they choose a doctor," Gussman
said. "I don't think these numbers are very helpful at all."
By the time she was a young woman, Chrisie Stankowitz had listened
to enough nightmarish stories of terrible labor experiences to
convince her that a Caesarean section was the way to go.
As she got older, though, she realized these were worst-case
scenarios, so that when she got pregnant with her first child,
her preference had switched to a vaginal birth.
In the end, Stankowitz didn't have a choice. Because her baby
was breeched and also because she fell down steps near the end
of her term, her doctor performed an emergency C-section. Her
son, Mattingly, was delivered in perfect health two months ago
at Monmouth Medical Center.
"The outcome was great and it was quick," said Stankowitz, 32,
of Tinton Falls.
Stankowitz said she recently attended a baby shower where Caesarean
sections became a major topic of conversation. She can see the
advantages of both means of delivery.
"I think women should have a choice," she said.
"Old-fashioned" deliveries common at Kimball Medical Center.
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