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APHA Scientific Session and Event Listing

Case against Elective Primary Cesarean Surgery

Henci Goer, BA, 970 Buckeye Drive, Sunnyvale, CA 94086, 931-964-2293, goersitemail@aol.com

Despite public health mandates to reduce the U.S. cesarean surgery rate to 15% as a measure to improve maternal-child health outcomes, a National Institutes of Health State-of-the-Science conference concluded, and a growing number of obstetricians argue, that there is equipoise between the potential harms of planned cesarean surgery and planned vaginal birth. The implication of this argument is that no action need be taken to reduce the cesarean rate. However, a review of the research leads to the conclusion that cesarean section significantly increases maternal short-term, long-term, and reproductive morbidity and perinatal morbidity in both the current and future pregnancies compared with vaginal birth. Planned cesarean surgery reduces the likelihood of some harms compared with unplanned surgery, but there still remain disparities compared with vaginal birth that are necessarily consequent to major surgery and the presence of a uterine scar and surgical adhesions. Furthermore, the chief advantage claimed for cesarean surgery is that it prevents pelvic floor dysfunction, a hazard supposedly intrinsic to vaginal birth. In fact, the research cited in support of this is problematic. Studies also show that pelvic floor dysfunction relates primarily to modifiable factors of obstetric management or to pregnancy itself. Moreover, cesarean surgery offers minimal protection against pelvic floor dysfunction in the short term and none at all in the long term.

Learning Objectives: Participants will be able to refute arguments that

Keywords: Access to Health Care, Barriers to Care

Presenting author's disclosure statement:

Any relevant financial relationships? No

Women's Choices in Childbirth: Access to Care

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA