Caesareans are Ethical?

THE APPPAH REPORT by Michael Trout

The ethics committee of the American College of Obstetricians and Gynecologists issued a report in October last year, signalling its members that they were ethically sanctioned to perform caesarean sections with or without medical necessity. This appears to be a reversal for ACOG which, for years campaigned to reduce the number of surgical deliveries.

On the face of it, this action appears to be a response to consumer pressure for elective caesareans, whether for convenience, fear of the pain of childbirth, or parental concerns about complications from the physical “trauma” of labour and delivery. Whatever the reason, this is not an innocuous shift in childbirth practices in the USA.

What does it mean for babies, for parents, and for our culture if we officially sanction birth as a surgical procedure? The National Vital Statistics Report states that c-sections are already at an all-time high of 26.1% in the USA with a high of 44.7% in Puerto Rico and a low of 19.1% in Utah and New Mexico. If the ACOG ruling, as some have suggested, is likely to increase the number of caesareans, so what? Does it matter to women? Does it matter to babies? Does it matter to men? Mary Axness, APPPAH member from California, wonders “. . . if women would see c-sections as the ‘neat and clean, easy way out’ if. . . we called it what it is: childbirth by major abdominal surgery. . . I do think something in many women is indeed either dead or deeply asleep, lulled into anesthetized torpor by the din of the hyper-technological status quo, and into ignorance by books like Just Take It Out!, which unapologetically touts caesareans as optimum.”

In an era in which, unquestionably, we—as a culture—are turning toward technology more and more, what is the responsibility of the physician to inform parents of the risks associated with caesarean delivery? What is the responsibility of both the physician and the “consumer” to regulate their own use of technology? What is the responsibility of the culture to attend to the impact of our automatic “yes” to any method that is new and more convenient? We protested medical practices in the 60s and 70s that limited parents' control of their own births. Now many parents protest that they want the medical world to take the control back, often making demands for as much medication as possible, as little pain as possible, and as much predictability as possible. APPPAH member Joann O'Leary from Minnesota reports that a recent announcement at the World Congress on Women's Mental Health (March 2004 in Washington, D.C.) that women should have a right to ask for caesarean birth evoked a huge positive response from the clapping audience!

Is there a responsibility to the baby (whom Jane English, author of Different Doorway: Adventures of a Caesarean Born, says is most assuredly affected) to acquire informed consent before such an elective surgical procedure is begun?

Where do you stand on this issue? Let me know at: mtrout@infant-parent.com.