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To C or not to C: OB-GYNs told to relax already during labor

The story may be apocryphal, but it makes a point. Years ago, when the medical community began to advocate "natural" childbirth, a comedienne quipped that she would rather have "natural" tooth extraction. Perhaps it was an Ohio woman who said that all the breathing exercises expectant mothers learned were not to manage their own pain but to manage the nurses' pain -- if these mothers-to-be were breathing and not screaming, an OB nurse's day was a whole lot easier.

Managing childbirth is a subject that has been hotly debated for decades. Should the mother be conscious? Should the mother have pain medication? Should the mother be squatting or lying down? Should the mother be at home or in the hospital? When should doctors intervene in the process?

The debate has turned more and more to the prevalence of deliveries by cesarean section. When you look at the statistics, there does seem to be good reason for questioning the use of C-sections: About 1 in 3 women in this country gives birth by C-section.

The question is, how many of those surgeries were medically necessary? The surgery sounds simple but carries distinct risks, as all surgeries do, but in this case for both mother and child. Research has also shown that one cesarean begets another: A woman who delivers by C-section is much more likely to deliver her next child by C-section.

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have published new guidelines to help doctors determine -- or better determine -- when a C-section is appropriate. The overall message the authors want doctors to take away from the guidelines is simple: Be patient.

We'll explain more in our next post.

Source: WTVM-9, "Guidelines to reduce C-section births urge waiting," Lauran Neergaard (Associated Press), Feb. 19, 2014

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