Dr. Philip Darney explains why many women are giving birth by Caesarean section and discusses a currently controversial gynecological topic.
I think in obstetrics and gynecology, one of the most controversial issues is the rising rate of caesarean delivery. Most women can deliver their babies safely vaginally and I think most women want to accomplish that. Many of us obstetricians are concerned that the caesarean delivery rate is higher than it needs to be. A variety of explanations, one of them is that we are increasingly concerned, we obstetricians, and I think overly concerned about the safety of having a vaginal delivery after a previous caesarean delivery, is it safe to do that? The evidence supports the idea that it is safe but many hospitals no longer permit what we call VBAC, Vaginal Birth After Caesarean. So once you’ve had a caesarian delivery then you may continue to have subsequent caesarean deliveries and that alone increases the rate. Another is real caution, in some situations overly cautious reaction to the methods we obstetricians use to monitor the wellbeing of the baby during labor and before labor, fetal heart rate tracing, for example. Not really good evidence that it’s all that useful in predicting bad outcomes, but obstetricians often feel compelled, for legal and other reasons, to intervene sometimes before it’s necessary, and that intervention is usually caesarean delivery.