The Washington Times on Wednesday examined factors contributing to the rise in the number of elective caesarean sections in the U.S. According to data released in March by the Centers for Disease Control and Prevention's National Center for Health Statistics, the rate of c-sections in the U.S. is at an all-time high of 31.8% of births, compared with around 20% in 1996. However, changing attitudes toward c-sections, doctors and insurance companies' concerns about malpractice lawsuits, and some women's perception that scheduled births are more convenient have led to the increase in c-sections, which carry risks of complications from anesthesia and longer hospital stays and recoveries than vaginal births.

Bruce Flamm -- an obstetrician with Kaiser Permanente and spokesperson for the American College of Obstetricians and Gynecologists -- said a shift in thinking about repeat c-sections is the main reason for the higher number of elective c-sections. Ten years ago, women who previously had c-sections were encouraged to attempt vaginal births in subsequent pregnancies to avoid surgery's high cost and risks of complication. However, current ACOG guidelines stipulate that an ob-gyn, an anesthesiologist and an operating room all must be available in case of emergency to perform a VBAC, Flamm said, adding that many hospitals "feel they cannot comply" with the guidelines. Flamm said that "[m]edical-legal issues" also have contributed to the rise in scheduled c-sections because doctors are worried about being sued if there are problems during labor. However, data on complications in c-sections show that a large portion occurs during emergency procedures and that the risk of complications is relatively the same for scheduled c-sections as for vaginal births, according to Flamm.

Cost and insurance coverage also are factors. According to ACOG, a c-section typically costs about $10,000 to $15,000, almost twice as much as a vaginal birth. Gretchen Humphries, advocacy director for International Caesarian Awareness Network -- an advocacy network that aims to increase awareness and reduce the number of unnecessary surgical deliveries -- said that insurance companies in the 1990s typically wanted women to attempt labor and vaginal delivery. She said that after "a few spectacular disasters, the insurance companies were on the hook as well." Consequently, insurance companies today "are not going to tell women they can't have a c-section," according to Humphries (Goldberg Goff, Washington Times, 4/15).

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