Monday, March 6, 2006
On the maternity ward at Sharp Mary Birch Hospital, a woman is determined to have a baby the old-fashioned way.
The woman's cervix is dilated about four centimeters. Nurses here think she has about seven or eight hours of labor to go before the baby is born...but not before the woman spends some tough moments pushing the baby out.
This is the way most women give birth.
But a growing number of pregnant women are choosing not to go through this age-old process. They're bypassing labor to voluntarily undergo a c-section.
Last year, 29-year-old Karina Dolan did just that.
Karina Dolan: "I thought it was a little funny, you know, it's almost like too posh to push, you know I'm just gonna go in and choose to have my c-section. And I really was against it, but then, I was almost being a hypocrite about it because then I found myself wanting to just have the c-section.
Dolan says she was afraid she'd have too big a baby to give birth the regular way.
Dolan: "Having to labor, you know, going through the epidural, I was fine with that. But it was the whole pushing for three hours, and then not being able to get a big baby through my pelvis, that is what I did not want."
As it turns out, Dolan's baby weighed in at seven pounds, ten ounces. So Dolan could have had a vaginal birth. But she says she has no regrets.
Between 2001 and 2003, the number of elective c-sections rose by 36 percent in the United States. A health care ratings service estimated at least two out every 100 pregnant women chose this option last year.
Obstetrician Jessica Kingston practices at UCSD Medical Center in Hillcrest. She says she certainly doesn't advertise the procedure.
Dr. Jessica Kingston: "It's not something I offer to all patients. If I have a patient who requests it or wants to discuss it, I certainly go through the process of discussing it with her. But we don't routinely offer it for patients who present for pre-natal care.
Kingston says studies comparing the risks of elective c-sections with normal delivery are inconclusive.
Even so, she says a c-section is major surgery that involves incisions into a woman's abdomen and her uterus. So Kingston likes to ask her patients a lot of questions.
Kingston: "The first thing that I like to determine is the reasons for wanting a c-section, and then from there how many children they plan to have in the future, because those all factor into their potential risks for future problems from a c-section. And I also just want to know her reasons for having it, to find out if they're valid concerns, how much they've thought about it.
Up until the end of World War Two, it wasn't that unusual for a woman to die from a c-section. But doctors say with the advent of blood banks and antibiotics, the procedure has become quite safe. In 2004, nearly 30 percent of all births were caesarian.
Still, some gynecologists think elective c-sections are a bad idea.
OBGYN David Priver has been in practice for 32 years.
Dr. David Priver: "There's three reasons why I oppose it. First would be the cost, second I don't think it's really in women's best interest, and thirdly I don't think it's in baby's best interests.
Dr. Priver says women who have a c-section rack up much higher hospital and doctor costs than women who have a vaginal birth.
Then there's the potential impact on a woman's health.
Priver: "You're talking about having a major operation, as opposed to not having a major operation. So, there's certainly a longer recovery time, there's more blood loss, the infection rate is higher, so you've got a variety of reasons why it's not in women's best interests."
Finally, Priver says vaginal birth is actually better for the baby. He says the contracting uterus compresses the baby's chest, and helps empty fluids out of the breathing passages. Priver says babies born by c-section tend to have more short-term breathing problems.
And what about the birth experience?
Hope Renn is a nurse-midwife at UCSD Medical Center.
Hope Renn: "For a lot of women, the experience of working through labor and having a vaginal birth is one of the hardest things that they've ever done in their life. And I've seen women truly transformed by the experience. They feel like they're capable of doing anything because they've moved through this experience. They thought they couldn't do it, and they did it, and it really transformed them and crossed over into other parts of their lives."
The American College of Obstetricians and Gynecologists says as long as patients understand the risks, their choice of how they want their baby to be born should be respected.
After all, no matter what the method of delivery, the vast majority of mothers and babies end up A-OK.
Kenny Goldberg, KPBS News.