When Greenwich resident Janet Delos first found out she was pregnant with twins, her doctor told her straight away that the best option for birth would be a cesarean section. “I might have been able to do it vaginally; I just didn’t want to risk having a vaginal delivery and then having something go wrong and having an emergency C-section,” Delos said this week. “I felt more comfortable knowing it would be a planned C-section, and that I had more control then over the process.” Cesarean sections – a surgical procedure during which doctors make an incision through a woman’s abdomen and uterus to deliver a baby – have been increasing in frequency across the nation for years. In 1989, 22.8 percent of all American births were done using C-sections, according to the National Center for Health Statistics; by 2011, the figure increased to 32.8 percent births – about one in three. And Connecticut is among the states that use the procedure most frequently. In 2011, 35.8 percent of the state’s deliveries were done through Cesarean section.
It’s a multifaceted movement, according to Dr. Steven Laifer, chief of obstetrics at Bridgeport Hospital. Laifer said the increase in C-sections is linked to multiple births like Delos’s experience, as well as an increase in women having children later in life, when more complications can occur during pregnancy and delivery. Here in Fairfield County, older moms is incredibly common: The Bridgeport-Stamford Metropolitan Statistical Area has the second highest percentage of 35- to 50-year old mothers in the nation, with more than one in three women giving birth in a typical year falling into that age bracket, compared to about one in five nationally. Reducing the risk for complications is a huge motivator for opting for the surgery instead of a more natural childbirth, not just for the health of the baby and the mother, but for the protection of the doctor. “One factor that clearly is pushing the cesarean section rate higher is the liability environment we live in,” said Laifer. “I think the way I would describe it is we have certain general reasons why we do a cesarean section: The labor doesn’t progress properly; The baby is thought to be too large and there might be birth injuries that could be incurred during the process; We detect some signs or concerns where the baby might not be tolerating labor, so the oxygen is diminished, sometimes in a dangerous way,” he explained. “And I think in the last 10 to 15 years, the threshold at which we intervene has come down, and I think that’s a direct influence of the medical-legal environment. There is no room to make an error.” For instance, a Norwalk couple was awarded more than $58 million in a 2011 medial malpractice suit, stemming from a delivery in which the obstetrician was accused of waiting too long during the woman’s labor before deciding an emergency C-section was needed, resulting in brain damage to the baby. “I think physicians are very much influenced by trying to avoid getting involved with something like that, which can be a very, very damaging thing,” Laifer said. On the other side, some new mothers say they feel the push for cesarean sections sometimes stems from a financial concern in other ways. Ana Kostovic, a Greenwich woman who gave birth to twins two years ago at Greenwich Hospital said she had to go the C-section route, after the first twin was found to have turned itself upside down and got intertwined with the second baby. As a result, she and her doctors decided on a scheduled Cesarean to ensure the delivery went off without a hitch. But she also noted that while she controlled the situation in her case, she’s heard talk that other women don’t always have that kind of power. Kostovic summed up the common perception that’s repeated in Mom circles: “A lot of (obstetricians), they make more money doing C-sections, and that’s why they promote it,” she said. “Just for business.” One mother, who asked to remain anonymous, noted that she felt her labor was treated like a “hurry this up” process. During a “drawn-out” labor process, she said she was offered C-sections twice, with pressure mounting as she said she was told she “would be discharged because the insurance did not want to pay for me to ‘just sit in a room.’” She had to be assertive to continue along with her original plan to have her daughter through a vaginal delivery. “I have had many people tell me they feel like it is a factory approach to birthing,” she added. But some women embrace the idea of a C-section, which can make it easier to plan out a pregnancy and increase the predictability in the process. “There’s the convenience factor, and some women may want to avoid labor,” said Laifer. “The patients that I’ve seen are ones that … are very scared of labor and don’t want to do it. They’ve heard horror stories and don’t want to experience it.” In Laifer’s experience, many of the patients who choose a cesarean section for convenience or out of fear of significant pain or damage to the pelvic tissue are much more likely to be affluent. “The upper 1 percent – I don’t know whether the experience of labor is as appealing to them as it is to more down-to-earth women,” he said. It’s a theory that may shed some light on the fact that Laifer said local rates of cesarean sections run roughly in line with the state data, which shows 35.8 percent of women opt for C-sections for one reason or another. But at the end of the day, Laifer said a sky-rocketing rate of Cesarean sections is not necessarily something to be concerned about. “Our ability to identify a potentially compromised fetus to prevent a fetal death, I think is clearly much better than it was 20 to 40 years ago, and that has clearly contributed to this rate, because babies who would have died in utero are now delivered early and can survive,” he said. firstname.lastname@example.org; 203-964-2229; http://Twitter.com/MagEGordon; http://facebook.com/TrendingWithMaggieGordon