Safe Childbirth Choices

Almost one in three live births is delivered through cesarean section, with women's choices trending more frequently toward this surgery every year. The national Healthy People 2010 goal is to reduce the rate of first-time cesarean sections to 15 percent of live births.

A cesarean section, or c-section, to deliver a baby is considered major surgery and carries all the usual risks of surgery. Elective c-sections are on the rise in the South and across the United States, confirmed obstetrician/gynecologist Dr. Gabriella Pridjian, chair of the Tulane Department of Obstetrics and Gynecology.

“Elective cesarean sections are scheduled so both the patient and physician can control delivery,” observed Pridjian, who said she and her colleagues at Tulane do not encourage elective cesareans. She added that fear of the effects of delivery on the birth canal is another factor driving the trend.

Induced births are also increasing, according to Pridjian. Labor can be induced medically if it has not occurred naturally by the 39th week of pregnancy. Induction of labor may increase the possibility that a woman will have a c-section delivery.

“The responsibility of the medical community is to make sure that whatever women choose for childbirth is safe,” said Dr. Ben Sachs, an obstetrician/gynecologist who is senior vice president of Tulane University and dean of the School of Medicine. Before entering the administrative world, Sachs practiced maternal fetal medicine and attended a great number of high-risk births.

“You can tell a woman what the risk is to her and to the baby, but each woman evaluates those risks from their own perspective,” said Sachs. “And this is not an exact science. This issue is very complex. For example, should a woman be offered a cesarean delivery for a 1 to 5 percent risk of serious injury to the baby? In my experience, many, if not most, women faced with this question opt to have a cesarean, thus assuming the risk for themselves rather than for their baby.”

The choice to have a c-section carries future risks in addition to those associated with the current surgery. For example, once a woman has a c-section, she will most likely have one for future births. That fact may limit the size of her family because each c-section is more technically complicated to perform than the last, said Pridjian.

The Healthy People consortium is an alliance of national and government agencies that has developed national health objectives, including the goal to reduce the rate of cesarean-section childbirth.

Madeline Vann is a freelance writer who holds a master of public health degree from Tulane.