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Medical Edge Newspaper Column from Mayo Clinic
THE PROS AND CONS OF ELECTIVE CAESAREAN BIRTH
DEAR MAYO CLINIC: It seems like doctors push for vaginal birth
at any cost. I was in labor for more than three days and begged for a
Caesarean delivery. Instead, I got a forceps delivery and have had medical
problems (urine leaking, etc.) ever since. Is there such a thing as an
elective C-section? Do you recommend it?
ANSWER: There is only one reason physicians attempt to achieve
vaginal delivery — the benefit of the patient. For health-care providers,
Caesarean births are faster, can reduce medical-legal risk and can mean
higher reimbursements. So, in your situation, it is very likely your care
provider was attempting to provide the best care for you and your baby.
There’s no proven benefit to choosing a Caesarean delivery as the preferred
way to give birth. A Caesarean delivery — delivery of a baby by means
of an incision in the abdomen — is very low risk. But the risk to the
mother is slightly higher than with a vaginal delivery.
The risk of Caesarean birth increases as you have more children. The risk
of uterine rupture, placental abnormalities and other complications increases
with repeat Caesarean deliveries. Some of these complications are life threatening to mother and baby. In general, if you are having a fourth
Caesarean delivery, you are much more likely to have a complicated birth
than a woman having her fourth vaginal delivery.
Elective Caesarean deliveries could offer advantages. They can be scheduled.
The hard work and discomfort of labor and delivery is exchanged for post-operative
pain that is well managed today. There’s some thought that Caesarean deliveries
may prevent weakening of the pelvic floor leading to a falling uterus
or a leaky bladder. However, the evidence for this is very weak.
Given what we know, I don’t recommend elective Caesarean births. They
greatly increase the cost of medical care, and there’s no proven health
benefit to mother or baby.
— Roger Harms, M.D., editor-in-chief, Mayo Clinic Guide to a Healthy
Pregnancy,
Rochester, Minn.
Additional Resources:
Obstetrics
Appointment
Information for Obstetrics
Information
on C-Sections
READERS: Is osteopenia in your personal health vocabulary?
It should be, especially if you’re a woman past menopause.
Osteopenia is a degree of bone loss that’s between healthy, normal bones,
and osteoporosis, which causes weak and brittle bones and increases the
risk of bone fracture. A diagnosis of osteopenia is a call to action to
stop further bone loss.
Your bone health is determined in part by a bone mineral density measure,
which compares your bone density with the peak bone density of a young,
healthy person. Every postmenopausal woman should have the screening by
age 65. Depending on risk factors, your doctor could recommend the test
earlier.
If the BMD indicates osteopenia, you’ll want to talk to your doctor about
ways to halt bone loss before it progresses to osteoporosis. Ways for
people to keep bones healthy include:
— Consume 1,200 to 1,500 milligrams of elemental calcium and 400 to 600
international units of vitamin D every day.
— If you smoke, quit.
—If you’re sedentary, get moving. Daily weight-bearing exercises and strength
training help build bones.
— Talk to your doctor about other medication options, especially if you’re
at increased risk of osteoporosis. Risk factors include menopause before
age 40, family history of osteoporosis, smoking, white or Asian heritage,
oral steroid use and several other clinical factors.
Additional Resources:
Osteopenia
More
Information on Osteopenia
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2005 TRIBUNE MEDIA SERVICES, INC.
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