European Stars And Stripes (Newspaper) - August 15, 1989, Darmstadt, Hesse                                To your health at some hospitals in the United states caesarean account tar As Many As 40 or 50 percent of deliveries Here a red Cross Volunteer cuddles e new arrival. Needless caesarean by Jane e. Brody new York times he soaring rate of caesarean deliveries in the United Stales is coming under increasing scrutiny. American researchers report that perhaps half these procedures needlessly risk the Mother s Lile or health without Benefit to the baby. Studies have found that babies fare just As Well in areas where the caesarean rate is under 20 percent As they do in areas where the rate is Over 40 percent. In fact in some medical centers in Western Europe where the caesarean rate is much lower than it is in the United states the death rate for infants around the time of delivery is lower than in comparable centers in the United states. A comparison of births at Parkland memorial Hospital in Dallas and the National maternity Hospital in Dublin published last year indicated that the same Low perinatal mortality rate could be achieved with one third the num Benof caesarean that were done in Dallas three decades ago Only one baby in 20 in the United Stales was delivered by caesarean in which the baby is taken from the womb through an abdominal incision Fine name is actually from the latin word for to Cut while an ancient Story holds that the name refers to Julius Caesar and the method of his birth experts say he could not have been Cut from his Mother s womb today the caesarean rate in the United states averages one in four births and at some hospitals caesarean account for As Many As 40 or 50 percent of deliveries. Curiously the Rise in caesarean which has been most rapid in the last 15 years parallels efforts to make of Slelics More natural and humane. More mothers today Are awake throughout childbirth More fathers participate in labor and delivery and More babies share Hospital rooms with their mothers. For mothers who have caesarean deliveries the birth experience May be marred by disappointment dulled by painkillers and sometimes scarred by complications. This is not to say that All or even most caesarean Are unnecessary indeed my twin sons might never have been born alive and healthy if not for surgical intervention. My Pelvis was too narrow for Normal delivery of seven Pound babies they were rescued after 12 hours of labor. Twenty years ago caesarean were done when doctors had Good reason to believe that the Mother or the baby would not survive a vaginal birth without undue harm. Today the emphasis is different As physicians strive for perfect babies and an easier labor and delivery for mothers an analysis published in 1987 in the journal obstetrics and gyn ecology revealed that 36 percent of caesarean Are now done because the woman had a previous caesarean As Many As 95 percent of the women who have had a caesarean and Are having another child have a second caesarean. Despite studies that have shown at least half could safely deliver vaginally. In 1980, the american College of obstetrics and gyn ecology advised doctors to give most such women a trial of labor rather than automatically scheduling a caesarean for subsequent births. The second most common reason for surgical deliveries accounting for about 27 percent of caesarean is failure of labor to Progress. This is often a judgment Call based in part on what the physician or the patient considers too Long a labor. The problem May be exacerbated by the widespread use of epidural injections to ease pain. These can have the unfortunate Side effect of slowing labor. In other industrialized countries where the caesarean rate is half ours physicians Are far More aggressive in their use of the drug oxytocin to stimulate labor. But when labor fails to Progress because the birth canal is too narrow for the size or position of the baby american physicians often prefer to operate rather than to try to turn the baby manually or to do a forceps delivery. A forceps delivery occasionally results in brain damage. An alternative to surgery in some cases is a suction technique that pulls the baby out without compressing the head. In nearly 9 percent of caesarean the physician operates because the baby is lying in the Breech feet or buttocks first position. The birth canal is sometimes too tight for the shoulders to come through easily and the babies May be deprived of oxygen in the difficult delivery. In another 9 percent of caesarean the baby is removed surgically because the physician believes it is in distress and in danger of suffering brain damage or dying if labor is allowed to proceed longer. The diagnosis of fetal distress has become much More common with the expanded use of fetal heart monitors during labor. Critics say fetal distress is Over diagnosed leading to caesarean deliveries of Many babies who would have been unharmed by a vaginal birth. They urge physicians to confirm suspicions of fetal distress by assessing the acid Content of blood taken from the baby s Scalp. Miscellaneous other medical reasons account for the remaining 19 percent of Caes ieans. They include serious chronic illness or Active herpes infection in the Mother a pregnancy that has gone beyond 42 weeks premature rupture of the amniotic membranes which greatly increases the risk of infection and blockage of the birth canal by a Mal positioned Placenta. All of this however obscures a Well recognized fact among practising obstetricians Many caesarean Are done because doctors in the United states fear malpractice suits for failing to operate when there was some hint that All was not wed. Defensive surgery has become a fact of life for american obstetricians 60 percent of whom Are sued at least once. Rarely if Ever Are doctors sued for operating when a vaginal delivery would have sufficed. Suits for failing to operate however May be filed even years later when a child delivered vaginally is discovered to have learning disabilities. Another common accusation is that greed is responsible for the rising rate of caesarean. Doctors usually earn 20 to 40 percent More and hospitals May double their Revenue with a caesarean birth. This is difficult to prove of course but critics note that the caesarean rate is highest in private hospitals and lowest in municipal hospitals. They also note that resident physicians who Are salaried Are much less Likely to operate than private obstetricians who receive a fee for services. Though a caesarean is one of the safest operations it is still major surgery that places the Mother at two to four times the risk of dying in childbirth than if she delivered vaginally. That risk of course is still Low one death in 2,500 caesarean deliveries. More Likely complications include infection which occurs after 40 to 70 percent of Caesarea Haemorrhage blood dots and injury to the bladder or intestines. I developed an infection after my caesarean resulting in a 1 May Hospital stay and week Tong separation from my babies. It left me debilitated and undernourished when i most needed stamina to care for two infants. The baby can also be endangered by a caesarean especially those scheduled in Advance of labor. Mistakes Are commonly made about a woman s due Date. Such errors can result in the inadvertent delivery of a premature baby. The risk can be reduced if gestational age is assessed by an ultrasound exam near the end of the first trimester and if before delivery the baby s lung maturity is assessed by analysing a Sample of the amniotic fluid. Preliminary studies also suggest that babies delivered by elective caesarean May miss the action of certain hormones and other substances released during labor that help prepare them Lor life outside the womb Page 16 the stars and stripes tuesday August 15,1989