Elective Cesarean
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Should a Woman Be Able to Choose an Elective Cesarean?


Transcript from Good Morning America on ABC
Air date June 23, 2000
PAM SAWYER: There is a great debate beginning to emerge in the medical community. Each year, one in every five babies in America today comes into the world through a cesarean section, the country's most common surgery. It's also fast becoming the country's most controversial procedure because the conventional wisdom that women should avoid cesarean section may in fact be shifting and some obstetricians are now calling the cesarean section preferable to vaginal births. And they believe that women should at the very least have the option to choose between the two and that insurance companies should basically pay for the same equally and treat them equally. Well joining us now, Dr. W. Benson Harer, the president of the American College of Obstetricians and Gynecologists, who is in favor of giving women the choice to have c/sections. And with an opposing view, Dr. Marsden Wagner, former director of Women's & Children's Health at the World Health Organization. Good to have you both here, it's like weighing in on each side here. And I want to say Dr. Harer that you are not speaking for the American College of Obstetricians and Gynecologists....
Dr. W. BENSON HARER: Thank you. It's my personal views.
SAWYER: ...you are speaking for yourself. One in five now have cesarean sections but you say cesareans are safer and in fact better, and that in the future, women should be able to choose and in fact that maybe they should be routine.
HARER: That's not quite exactly it, but what I say is that women should be given the facts and then given the choice.
SAWYER: But you said that there are 3 to 4 times more problems...
SAWYER: ...a higher rate of problems, with vaginal birth than with cesarean section.
HARER: For the baby, the risks are far higher for vaginal delivery than for an elective cesarean section at term. For the mother, the immediate risks for a cesarean section are a little higher, but the longer term risks of pelvic dysfunction, urinary incontinence, anal incontinence, pelvic dysfunction--those risks are higher for vaginal birth and over the long time I think that the risk balance out that there really is no big difference.
SAWYER: What about this, Dr. Wagner, if it's better for the baby, if over the long term, it balances out to better for the mother, why shouldn't women at least be able to choose it?
Dr. MARSDEN WAGNER: Because in fact if you really study the scientific literature carefully, there can be no doubt, that to say that cesarean section is perfectly safe for the baby has to be labeled a lie. It is absolutely not true.
SAWYER: Why? What is the risk?
WAGNER: Well, let me give you the risk. First of all, when the surgeon picks up the scalpel and cuts open the woman's belly, in 2 to 6 percent of cases, he also cuts into the baby. There's a risk. Secondly of all, there's good scientific data that if the baby is born by cesarean there is a much greater risk of something called Respiratory Distress Syndrome, which is a big killer of babies, and....
SAWYER: It's because when the baby comes vaginally it presses the lungs and forces...
WAGNER: There you go.
SAWYER: ...the mucous out of the lungs.
WAGNER: There you go.
SAWYER: [to Harer] What about this?
HARER: The difference is with most of the statistics for cesarean come out of emergency cesareans where there is a problem with the mother. What I'm talking about is an elective cesarean section at term with a healthy baby where she's had good prenatal care and we know that the baby's condition is good. In that case this condition is extremely rare.
SAWYER: But why change...
WAGNER: All of what I am saying about risk for the woman and baby I am using elective cesarean not emergency cesarean. The cutting of the baby happens, the Respiratory Distress Syndrome does happen more often with cesarean than with vaginal birth and so does prematurity which is another big killer of babies.
SAWYER: I don't know whether we can solve these statistics here although we'll look into them and try. [to Wagner:] But I want to ask you this--you think the motive is a little suspicious. You think that doctors want surgeons present at every birth. You think that at the end of the day that it's less litigation for the doctor. Right?
WAGNER: Anybody who thinks that those obstetricians that promote cesarean are promoting it because they suddenly discovered women's rights, well, I'm ready to sell some swampland in Florida to those people because that's extremely naive. Because there are compelling reasons why obstetricians prefer more cesarean. First of all, it means....excuse me.
SAWYER: I was just going to let Dr. Harer answer you to these charges.
WAGNER: First of all, it means that there is convenience. You see, an obstetrician--the average birth is 12 hours, a cesarean is 20 minutes!
SAWYER: Dr. Harer, what about this, is this for your convenience?
HARER: No, not at all, I really believe that physicians are motivated to do what's best for their patients and I believe that the average patient can make her own decision about what's best for her.
SAWYER: Don't you worry that something has worked well for, well, 50,000 known years at least in the species, has a reason?
HARER: Until this last century, 1 out of every 100 women who got pregnant died and its still that way today in Nigeria, or in Gambia, and the third world nations.
SAWYER: And you have also said that today babies are bigger and that that is increasing.
HARER: That's true. The weight of babies has been going up and as the babies get bigger the risk of damage to the mother is very high. Six percent will have fecal or urinary incontinence after deliveries today.
WAGNER: There is no scientific evidence that doing over 10 percent of births with a cesarean improves the outcome for the woman or improves the outcome for the baby. There's data from all over the world, including the US and Germany and France...
SAWYER: Here's my promise to our viewers out there since we have, as I say, these irreconcilable positing of the facts here. We're gonna see if we can reconcile them and we'll come back to you later on and let you know what we conclude. But we appreciate you setting up this debate for us. 'Cause it's not gonna end, it's just beginning.


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