“Patient Choice” Cesareans Almost Non-Existent

For Immediate Release
March 29, 2006

Contact: Susan Hodges, President
Citizens for Midwifery
1-800-CfM-4880 or 706-549-7023

Athens, GA – Although NIH has just completed a conference on “Cesarean Sections by Maternal Request,” recently-released results of a new “Listening to Mothers” survey from Childbirth Connection http://childbirthconnection.com/article.asp?ClickedLink=334&ck=10068&area=27 indicate that it is extremely rare for a woman to ask for a cesarean section. Only one (0.08%) out of 1300 women who could have asked for a primary (first) cesarean section actually requested it.

“In other words, ‘patient choice’ cesarean section is a myth,” pointed out Citizens for Midwifery Board Member Nasima Pfaffl. “Until recently, no one actually asked women if they were requesting cesareans, it was just assumed that cesarean sections for no medical reason equaled ‘patient choice’ cesareans. Today we know this assumption is wrong; birth certificates and hospital discharge data do not include any information about women’s intentions or decision-making.”

Most significantly, results of the Childbirth Connection survey (of births in 2005) http://www.childbirthconnection.org/article.asp?ck=10372 show that there is a serious discrepancy between what women understand as the reason for their cesareans and what the birth certificate data says. Birth certificate and hospital discharge data show that cesarean sections performed for no medical reason have been increasing, amounting to about 2% of all births in 2001. In contrast, of the women surveyed, 99.2% of those who had primary cesarean sections believed that there was, in fact, a medical reason, presumably based on what their doctors told them.

Most obstetricians sincerely care about their patients and do their best to provide what they believe is the best care. However, non-medical issues, such as physicians’ personal beliefs (not facts) about safety, liability insurance coverage, liability fears, hospital economics, efficiency and convenience, and reimbursement rates, may influence physicians to try to perform more cesarean sections.  Nearly 10% of the women in the survey reported “feeling pressured by a health care professional to have a cesarean delivery.”

“When an obstetrician “suggests” an elective cesarean section, the woman may assume her doctor – the expert she trusts – is recommending the procedure, that she “needs” the procedure, and that by acquiescing she is merely following expert medical advice that she believes must be in the best interests of her own and her baby’s health and well-being,” says Susan Hodges, President of Citizens for Midwifery.  “While the birth certificate may indicate an “elective” cesarean section, from the mother’s point of view it was not at her request or even by her choice.”

Citizens for Midwifery suggests that NIH recommend research to find out what is driving the wasteful and unconscionable increase in cesarean sections for no medical reason, and why women are being given misunderstood, incomplete or inaccurate medical justifications for them.

References available on request.

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Citizens for Midwifery is a national, consumer-based non-profit organization that promotes the Midwives Model of Care, provides information about midwifery and childbirth issues, and speaks up for consumer interests regarding midwifery and maternity care.  The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes. The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma and cesarean section.  Find more information about Citizens for Midwifery at www.cfmidwifery.org.