Caesareans Up

Delivering babies surgically

"It was easy," said Joanne Lutz, a Bridgeport, Conn., housewife, after giving birth to her first child three years ago. "A few pushes and there he was." Her second delivery was not so simple. Mrs. Lutz had been in labor less than an hour, when monitors detected an irregular infant heartbeat and other signs of fetal distress. A difficult natural birth might have produced a brain-damaged or even stillborn baby. So her doctor promptly performed a caesarean section, safely lifting out a 6-lb. girl. Says Mrs. Lutz: "A scar is a small price to pay for a healthy baby."

A decade ago, just one out of 20 babies born in the U.S. was, in Shakespeare's phrase, "from his mother's womb untimely ripp'd." Doctors performed caesareans only in cases in which normal delivery was impossible, or the patient refused to endure vaginal delivery. Now, there has been a sharp upswing in the number of caesareans. Last year at least one out of every ten babies in the U.S. was delivered surgically. At major medical centers, which tend to handle more problem pregnancies, the share is even higher. The University Hospitals of Cleveland at present deliver 12% of all babies by C-section (as a caesarean is called in hospital corridors). At the New York Hospital-Cornell Medical Center, the figure is 22%.

Doctors explain that, compared with a difficult forceps delivery, in which the baby's soft skull may be squeezed and the brain damaged, a caesarean is far more likely to produce healthy youngsters. Improved monitoring techniques also favor surgery. Because machines can reveal almost instantly if the baby's heartbeat or position in the womb is abnormal, many doctors now automatically take the caesarean route when difficulties are encountered. As a result, risky breech births--in which the baby's head is not pointing downward and must be manipulated with instruments--are easily avoided.

There is also a benefit for the physician. A doctor who does a caesarean to avoid a difficult birth can rarely be faulted legally; on the other hand, a physician who performs a forceps delivery may find himself facing a malpractice suit if the infant turns out impaired. New York Hospital's executive associate director, Melville Platt, a former practicing obstetrician, notes that such "defensive" medicine makes good economic sense. In 1969 a New York City obstetrician had to pay $3,000 a year for malpractice protection. Today the same coverage costs $14,000.

Many women, as well as some doctors, fear that caesareans may be unnecessarily traumatizing for both mother and baby. Nor, they add, is the surgery without other hazards. For the mother, there is the chance of infection, bleeding and damage to the bladder; for the child, the possibility of premature delivery, which can lead to fatal lung problems. Yet the dangers are admittedly small. The death rate from caesareans is only a fraction of what it was a few decades ago. In fact, doctors often use only local anesthesia, letting the mother see the newborn baby almost immediately. In addition, the incision is so cleverly placed--just above the pubic hairline in a so-called bikini cut--that the woman can usually appear on the beach without her scar showing. Finally, even though intravenous feeding and pain relievers are required for a time, the new mother is usually out of the hospital in six days.

Perhaps most important of all, the surgery produces healthy babies. As Platt puts it: "Everyone wants a normally functioning happy child. Caesareans help them get what they want."

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