The practice of “defensive” medicine, heightened by rising malpractice premiums, has created a climate of fear which not only affects the care providers, but also the clients they serve. There is an overall lack of support for normal physiological birth evidenced by the declining number of women who labor without the assistance of induction or augmentation. A rising number of women are being pushed into the operating room after failed inductions and fetal distress following augmentation (12).Cesareans save lives when performed as an emergency intervention. Many cesareans are the clear result of medical necessity. Others occur in circumstances where there are options available including many which are medically appropriate. A great majority of C-sections are performed as a result of a labor that has gone on too long or at the first deviation from the norm, such as a “non-reassuring” fetal heart rate on a monitor.
The relative safety of the cesarean section leads women to think it is as safe as vaginal birth. It is not. The escalating C-section rate in the U.S. should be a major public health concern. It represents a complex and difficult problem whose solution demands strategies that are multifaceted and comprehensive. Although doctors, hospitals, and insurance companies (who often represent warring interests), do contribute to the high rate of cesareans, it is not only with them that blame should be placed. These facts point to a failure in the United States’ system of maternity care and an insufficiency of consumer awareness and advocacy.
NIH Consensus Development Conference:
State-of-the-science statement on Vaginal Birth After Cesarean intended to provide health care providers, patients, and the general public with a responsible assessment of currently available data on vaginal birth after cesarean (VBAC).