When Maternal-Request Cesarean May Indicate Fewer Choices For Women

Modern obstetrics has become infested with defensive-medicine driving much of our day-to-day practice. Not only has this made the specialty of ob/gyn less desireable amongst graduating medical students, but has undoubtedly raised the cost of doing medicine and ultimately the cost of managing what would otherwise be uncomplicated pregnancies.

In her essay, An Essay On The Factory Model of Childbirth, Obstetrician/gynecologist Lauren Plante addresses the contemporary phenomenon of the "perfect" pregancy outcome expectation and how this may have resulted in actually fewer childbirth choices for women who may have thought they were being liberated. She focuses on the larger scale issues of the healthcare industry and hospital-driven infrastructure/system changes that favor cesarean delivery, for instance.

Anectodally, I've observed some of the changes in management of obstetrical patients over the last several years. It is much more difficult to have a pregnancy vaginally and without intervention now-a-days. One last thing: in 1970, the cesearean rate was about 5%; in 2009 it is approaching 30%. Meanwhile, the rate of cerebral palsy, one of the most commonly cited complications we try to avoid by doing a cesarean, has not changed.