C-sections for everyone? New English rules stir debate

Pauline Hull, who runs a website about elective cesarean child birth, C-sections, poses for picture with her children in Farnham, England, in this photo dated Thursday, Nov. 3, 2011. Pregnant women in Britain, where the government provides free health care, may soon be able to get a cesarean section on demand thanks to a rule change. Hull has had two C-section births herself and says that doctors tend to over exaggerate the risks of C-sections. (AP Photo/Sang Tan) AP

C-sections, cesarean, NHS, pauline hull
Pauline Hull, who runs a website about elective C-sections, poses with her children in Farnham, England, in this photo dated Thursday, Nov. 3, 2011.
AP

(CBS/AP) Are free C-sections a good thing? Lots of British folks are asking, now that a new rule change may soon allow women to get a cesarean on the government's dime.

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Currently the National Health Service covers the cost of C-sections if there are health concerns for mom or baby. The new rules would require the NHS to pay for the procedure also for pregnant women "with no identifiable reason" for a cesarean, after talking it over with mental health experts.

The rule change has some in England saying paying for C-sections is simply indulging women who are "too posh to push."

"The idea of rendering the life-saving caesarean a 'lifestyle choice' ... seems to smack of yet one more form of cosmetic surgery," Louise Foxcroft, a medical historian, wrote in The Guardian. "It is then, at the very least, the height of absurd vanity and, at most, an example of the ever-present gynophobia that permeates our society."

Other women applaud the new rules.

"It's about time women who have no desire to view labor as a rite of passage into motherhood be able to choose how they want to have their baby," said Pauline Hull, site operator of Elective Cesarean, who has had two children by cesarean because of medical reasons. "The important thing to me was meeting my baby, not the experience of labor." Hull said midwives often overexaggerate C-section risks and underestimate those of vaginal births.

The organization behind the new rules, the National Institute for Health and Clinical Excellence, said it routinely updates guidance every few years and denied there was pressure to change its more restrictive C-section advice. But in recent years, advocates and some doctors have slammed the U.K. health system for not giving women a greater say in childbirth.

Twenty-five percent of women have C-sections in the U.K., versus about 30 percent in the U.S. In both countries, rates have doubled in recent years, though doctors say that's also due to health problems more pregnant women are facing like obesity and diabetes.

The World Health Organization has previously said wealthy countries should aim for a C-section rate of about 15 percent, though it also says there isn't enough evidence to know what the ideal rate is.

Some experts said there's no substitute for the natural way.

"As long as it's safe for both mother and baby, a vaginal birth is absolutely the best way for anyone to deliver," said obstetrician Dr. Daghni Rajasingham, spokeswoman for the Royal College of Obstetricians and Gynaecologists. She said the physical stress put on a baby's lungs during labor helps them adapt to breathing after being born.

What do U.S. experts have to say about C-sections?

The American College of Obstetricians and Gynecologists said in its most recent statement on the subject ,"ACOG continues to review all of the issues surrounding maternal-request cesarean, but at this time our position is that cesareans should be performed for medical reasons, "Dr. Stanley Zinberg, ACOG deputy executive vice president, said.

Zinberg said high-risk groups including women carrying multiple fetuses conceived through fertility treatments, older women becoming pregnant, and overweight and obese women, are high-risk for cesareans. Women who still want a C-section, he said, should be counseled on potential risks including a higher risk of infection, scar tissue, blood clots, complications from anesthesia, and the potential need for future cesareans, which entail additional risk.

In July of 2010, ACOG also updated its guidelines in attempt to to curb rising C-section rates, suggesting more women should opt for a vaginal birth, including most women who have had previous c-sections and those carrying twins, CBS News reported.

What do you think of C-sections for non-medical reasons?

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