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    Tuesday, November 04, 2003

    Pro-Choice? The American College of Obstetrics and Gynecology says that it's OK to let a woman choose a Cesarean delivery over a vaginal one, although they stop short of promoting it:

    Where medical evidence is still limited, ACOG says there is no one answer on the right ethical response by a physician considering a patient request for surgery. Thus the decision on whether to perform an elective cesarean delivery (also known as 'patient choice cesarean' or 'cesarean on demand') will come down to a number of ethical factors including the patient's concerns and the physician's understanding of the procedure's risks and benefits.

    In the case of an elective cesarean delivery, if the physician believes that cesarean delivery promotes the overall health and welfare of the woman and her fetus more than does vaginal birth, then he or she is ethically justified in performing a cesarean delivery. Similarly, if the physician believes that performing a cesarean would be detrimental to the overall health and welfare of the woman and her fetus, he or she is ethically obliged to refrain from performing the surgery. In this case, a referral to another health care provider would be appropriate if physician and patient cannot agree on a method of delivery.

    This is a sticky situation for obstetricians. Having a baby is one of the few medical conditions in which the patient has the leisure to shop around for the kind of care she wants (unless she lives in a remote rural area.) The conventional wisdom holds that Cesarean deliveries are fraught with more complications and dangers both for the baby and for the mother. That surgical delivery should only be resorted to when the risks of a vaginal delivery are greater than the risks of surgery. But there's little data to back the conventional wisdom:

    ....ACOG cautions that "both sides to this debate" must recognize that evidence to support the benefit of elective cesarean is still incomplete and that there are not yet extensive morbidity and mortality data to compare elective cesarean delivery with vaginal birth in healthy women. With better data, there may be a shift in clinical practice.

    Sometimes, though, the conventional wisdom is right even though it hasn't been extensively studied. When things go right, vaginal delivery is less invasive and has a quicker recovery time. That means less chance for infections and other complications. And when things don't go right, well, that's the place for Cesareans.

    posted by Sydney on 11/04/2003 08:00:00 AM 0 comments


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