Women's Health

Nearly one in four American babies is exposed to its first light in an operating room, with masked doctors and nurses peering into its mother’s womb as a surgeon cuts open the uterus to remove the baby.
Although often lifesaving for both mother and child, surgical delivery – also called a cesarean section or C-section – has become a multi-billion-dollar business for both doctors and hospitals. The fee is higher for surgery than for a vaginal birth. Hospital bills are higher too: the mother stays longer and requires more services and drugs.
Public Citizen’s’ Health Research Group, consumer advocates in Washington, D.C., analyzed the cesarean situation. Since 1970, they report, C-sections have surged from 6 percent to almost 25 percent of all births. The group found 56 hospitals nationwide with more than 40 percent C-sections; some hospitals exceeded 50 percent. The Abrom Kaplan Memorial Hospital in Kaplan, Louisiana, topped the list, with a cesarean rate of 57 percent. The Health Insurance Association of America says the average cost for a cesarean in this nation in 1991 was 7,826 dollars, compared to 4,720 dollars for a vaginal delivery. More than 7 billion dollars was spent in the United States on nearly a million cesareans. Public Citizen’s Health Research Group estimates that half of these surgeries were unnecessary.
There is a rising clamor within and outside the medical community for doctors and hospitals to reject surgery as the first answer to birth problems.
In an interview shortly before he died, Dr. Mortimer Rosen, chief of obstetrics at Columbia-Presbyterian Medical Center in New York City, called the cesarean explosion a dangerous national scandal. He was a leader in the effort to reduce birth surgeries. “Cesareans are costly, dangerous, and painful,” Dr. Rosen told me. “This is not a neat, simple procedure. It is big-time, major surgery. The floor of the operating room is covered with blood and fluids. A woman loses two units of blood, undergoes anesthesia. She is scarred internally and externally.”
A C-section can be a lifesaver, however. Liz Baldwin, 41, of Miami, says she is sure surgery saved the life of her firstborn son, David. Labor contractions were lowering David’s blood supply in the womb by pushing against his defective birth cord. A cesarean was performed, and David was saved. Still, Mrs. Baldwin recalls the aftereffects: “For 2 to 3 weeks, I had the most horrible pain.” She was determined that her next baby would have a vaginal birth. But her first doctor said that a vaginal birth after a cesarean would endanger the baby’s life and hers also.
Many obstetricians maintain that a surgically scarred uterus can rupture under the pressure of labor contractions. However, Dr. Bruce Flamm, of Kaiser Permanente Medical Center in Riverside, California, says the risk of rupture is less than 1 percent. Dr. Flamm led the research for a 5-year study on the risk of uterine rupture after C-section. The study, involving 5,733 women, ended in 1988.
Mrs. Baldwin found another doctor and, 4 years later, had Billy by vaginal birth. “It was the most wonderful experience,” she says. “I wept tears of joy for 3 months, just thinking of it.”
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WOMEN’S HEALTH