When it comes to delivering babies, “once a caesarean, always a caesarean” has been the rule among doctors, hospitals and insurers for decades. But the conventional wisdom may be about to change, thanks to new guidelines issued by the American College of Obstetrics and Gynecology. And with the government expanding its role in the health care business, the timing couldn’t be better.
One out of every three babies born in this country is surgically delivered, which is not only extremely costly — a C-section is more than double the cost of a vaginal delivery — but less safe than previously thought. A study last year by the Eunice Kennedy Shriver National Institute of Child and Human Development found that accompanying a 50 percent rise in C-sections from 1998 to 2005 was a roughly 30 percent increase in incidents including serious breathing difficulties, shock, kidney failure, blood clots and blood transfusions.
C-sections also pose obstacles for moms who want to start bonding and nursing with their babies immediately after birth, as anesthesia affects both them and their newborns.
While there is some risk of uterine rupture with a vaginal delivery once a woman has delivered via caesarian, it is slight — 0.7 percent to 0.9 percent; and only slightly higher than the 0.4 percent to 0.5 percent risk for women who have previously delivered vaginally. But this risk — along with the accompanying fear of lawsuits — has helped fuel the rise in C-sections: With the specter of million-dollar awards, doctors, hospitals and insurers all want to practice defensive medicine.
But statistics indicate that in 60 percent to 80 percent of cases where women with prior C-sections are allowed to attempt a traditional delivery, they are successful. Thus the new guidelines issued this week, indicating that vaginal deliveries are safe for most prior C-sections — even for women having twins or those who’ve had two prior C-sections — are welcome. Indeed, they’re probably long overdue.