The percentage of women who deliver their babies surgically by Cesarean section is climbing steadily, here and around the world, and local health-care experts cite several reasons for the trend.


Spokane-area hospitals say that up to 33 percent of their births have been by C-section so far this year, which is up sharply from 20 years ago. Globally, many developed countriesincluding the U.S. and Francehave seen a sharp rise in the number of C-sections performed, says the American College of Obstetricians and Gynecologists. In some countries, that percentage now is quite highreportedly over 80 percent in Brazil, for example.


The reasons for that trend include parents desire to ensure a better health outcome for their baby during delivery and the ability of the expectant mother to choose when her child will be born and to avoid the pain associated with a vaginal birth.


Dr. Robert Sigman, director of Deaconess Medical Centers perinatal services unit, deals almost exclusively with women who have pregnancy complications requiring a higher-than-normal rate of C-sections. He asserts unequivocally that the percentage of healthy newborn babies is higher with C-section deliveries than with vaginal deliveries.


Vaginal birth is more dangerous to the infant, he says.


Heidi Wilson-Seger, Holy Family Hospitals family maternity coordinator, says a baby experiences far more trauma during vaginal birth than during a C-section.


Also contributing to the trend are C-sections on demand, or pregnant women asking for C-sections without having a compelling medical reason for the procedure, says Wilson-Seger. She says the current legal environment is such that obstetricians are more likely to agree to such a request than in past years. The doctor will advise the mother of the risks and benefits of the two options, but mother and doctor must decide jointly whether a birth will be vaginal or by C-section.


Sigman says, You dont get sued for C-sections, but you do get sued for vaginal deliveries.


Wilson-Seger says C-sections also are up because of documented risks associated with delivering a baby vaginally after a woman had a C-section previously.


Health-care experts emphasize, though, that a Cesarean delivery is a major abdominal surgery, and add that expectant women and their physicians should consider carefully the potential surgical complications and the risk of death when choosing that method of delivery.


A study published by Brooklyn, N.Y.-based Obstetrics & Gynecology magazine found the postpartum maternal death rate following C-sections is three times higher than following vaginal deliveries.


C-section pregnancies also cost more and regularly require an additional day in the hospital for mothers to recover, says Dr. David Compton, of Coeur dAlene Obgyn PA. He says the average cost of a pregnancy that culminates with a vaginal birth is less than $10,000, while the cost of a pregnancy that culminates with a C-section delivery is $15,000 or more.


At Holy Family, C-section deliveries now account for about 22 percent of all births, up from 10 percent 20 years ago, but still well below the national average of 29 percent, Wilson-Seger says.


At Deaconess, which has a perinatal center where C-sections are more common, C-sections accounted for 33 percent of the more than 3,400 deliveries recorded since January 2005. Sacred Heart, which also offers perinatal care and performed 4,450 deliveries over the same span, recorded about a 32 percent rate of C-sections. At Kootenai Medical Center, which doesnt offer perinatal care, the C-section delivery percentage, although up to 24 percent this month, is typically about 20 percent, says Karen Pearl, KMC spokeswoman. The rate at Valley Hospital & Medical Center is about 17 percent.


Even with the trend toward more C-section deliveries, obstetricians here sometimes disagree on when a C-section is the best option for delivering a baby.


Compton says he works individually with expectant mothers to determine the best method of delivery, but all things being equal, usually will recommend a vaginal birth.


Many moms want to deliver their child vaginally regardless of the risk, he says. I believe in supporting the autonomy of the patient, but theres the growing issue as to whether a woman should be able to ask for (and get) a C-section without labor.


Compton says certain health factors will prompt him to recommend a C-section delivery. If the mother is a diabetic, suffers from hypertension, or has heart disease, for example, maybe labor is not a good idea, he says. Defects in the unborn child revealed during pregnancy also can trigger the need for a C-section, he says.


Wilson-Seger says about the only pre-existing condition that would prompt a Holy Family doctor to recommend a C-section earlier than six weeks before a scheduled birth date would be if the woman earlier had sustained a pelvic injury that would preclude vaginal birth. Otherwise, she says, the obstetrician and patient would work closely to determine all pertinent factors leading up to the birth, including the size of the baby compared with the size of the mother, before making that decision.


Every pregnancy, baby, and birth canal is different, she says.


Compton says many hospitals dont allow vaginal second births if the mothers first child was delivered by C-section, because the uterus will be scarred from the earlier surgical procedure.


At the present time, there are significant risks to delivering a baby vaginally after a C-section, he says. Although the risks have decreased markedly over the past 20 to 30 years, delivering a baby vaginally after a C-section can increase bleeding, infection, and cause other organ damage.


Vaginal births after Cesareans, known as VBACs, are performed regularly here only at Holy Family, says Wilson-Seger. She says Holy Family adheres to guidelines developed by the Washington, D.C.-based American College of Obstetricians & Gynecologists. Among those guidelines is a recommendation that the attending physician be present throughout the labor process, she says. Thats because VBAC failures can be catastrophic, says Sigman, sometimes endangering the lives of both infant and mother.


Wilson-Seger says 25 percent of all mothers who had C-sections earlier end up having vaginal births, and she adds that attending physicians there can deliver a baby by C-section in as little as six minutes if a planned VBAC fails.


If the mother wants multiple births, she should deliver them vaginally, she says, thus avoiding the scarring of the uterus that can add risk to later births. If a mother has two C-sections, theres no chance our doctors at Holy Family would prescribe a VBAC. She adds, Ive seen as many as five C-sections for one woman, but the risks are way up there.


Sigman says about 85 percent of women who deliver babies, whether vaginally or by C-section, request pain relief. Those medications can include spinal injections that numb the patient from the rib cage down for either a vaginal or C-section delivery, or an epidural injection made into an area near the spine for vaginal deliveries. Epidural injections stop pain from the rib cage down.


For C-section deliveries, the abdomen is prepped and surrounded by sterile drapes, Sigman says. The incision, which normally is up to five inches in length, is made just above the pelvic bone and exposes the uterus. The wall of the uterus is cut open, and the infant is removed from the uterus and placed on the mothers abdomen, and the umbilical cord is cut. The incisions in the uterus and the abdomen both are closed by stitching.


Sigman says about 60 percent of all women who deliver babies experience some degree of stretch marks on the abdomen, but they have nothing to do with the method of delivery.


Like Sigman, Compton says the liability climate surrounding birth deliveries is tough, especially regarding VBACs, which many obstetricians, for legal reasons, shy away from.


Women often are asked to sign forms confirming that theyve been informed about risks associated with C-sections or VBACs, but neither Sigman nor Compton believe that formality protects them from possible legal repercussions.


The consent form does nothing for me, says Sigman. Theres no way I can inform the patient in 30 minutes what its taken me years to learn. Her final decision is that she is relying on me.


Contact Rocky Wilson at (509) 344-1264 or via e-mail at rockyw@spokanejournal.com.