Most Women Would Not Choose C-Section
Excerpt By Suzanne Rostler, Reuters Health

NEW YORK (Reuters Health) - Extremely high rates of Cesarean section delivery in Brazil may reflect doctors' misperceptions and not women's preferences, according to researchers.

Their study found that 72% of women with private medical insurance and 31% of women whose delivery was paid for by national health insurance underwent C-sections.

However, interviews with more than 1,100 women at two points in their pregnancy revealed that 70% to 80% in both healthcare sectors hoped to deliver vaginally. About one quarter of women in Brazil deliver their babies in the private sector, the report notes.

Although vaginal deliveries have fewer complications, a quicker recovery time and are less expensive than Cesarean deliveries, obstetricians may believe that wealthier women would prefer a C-section in order to avoid the pain of labor and preserve sexual function, according to the report in the November 17th issue of the British Medical Journal.

``I know it sounds crazy, but there is a widespread understanding or belief among doctors that better-off women prefer Cesareans,'' the study's lead author, Dr. Joseph E. Potter from the University of Texas in Austin, told Reuters Health.

Alternatively, doctors may believe that a C-section is safer for the newborn and more comfortable for the mother.

Although many Cesarean deliveries are necessary to save the lives of the mother and newborn, many of the women in the study who gave birth surgically never actually went into labor. Cesarean deliveries had been planned for nearly two thirds of women in the private sector (64%) and nearly one quarter of women in the public sector (25%).

``While we do not have evidence to support any of these interpretations, we are concerned that the rates of Cesarean section in the private sector are above any accepted standard and are inconsistent with women's preferences,'' Potter and colleagues conclude.

In other findings, 73% of women in the private sector who underwent unwanted C-sections had talked to their doctor about their delivery preferences, compared with only 37% of women in the public sector.

``The point here is that although private patients have some opportunity to discuss type of delivery well in advance of delivery, the doctors do not seem to push for or insist on a Cesarean until just a few days before the woman is due to deliver,'' Potter said.

In the public sector, women rarely have the opportunity to discuss the type of delivery they would prefer during their pregnancy and may not even meet the doctor who will deliver their baby until they enter the hospital for delivery, he said in an interview.

Dr. Richard Johanson and Mary Newburn of North Staffordshire Hospital Trust in Stoke on Trent, UK, suggest that obstetricians look to midwifery units and areas in which interventions such as Cesarean section are low.

``Expectations and attitudes of the community as well as those of pregnant women and their carers are important,'' they write in an accompanying editorial.

In the US, nearly 23% of babies were delivered via C-section in 2000, according to the US Centers for Disease Control and Prevention.

SOURCE: British Medical Journal 2001;323:1155-1158, 1142-1143.

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