Dr. Darney explains why many women are giving birth by Casaerean section (C-section) and discusses a currently controversial gynecological topic.
I think in obstetrics and gynecology, one of the most controversial issues is the rising rate of casearean delivery. Most women can deliver their babies safely vaginally and I think most women want to accomplish that. Many of us obstetricians are concerned that the casearean delivery rate is higher than it needs to be.
A variety of explanations, one of them is that we are increasingly concerned, we obstetricians, and I think overly concerned about the safety of having a vaginal delivery after a previous casearean delivery, is it safe to do that?
The evidence supports the idea that it is safe but many hospitals no longer permit what we call VBAC, Vaginal Birth After Casearean. So once you’ve had a caesarian delivery then you may continue to have subsequent casearean deliveries and that alone increases the rate.
Another is real caution, in some situations overly cautious reaction to the methods we obstetricians use to monitor the wellbeing of the baby during labor and before labor, fetal heart rate tracing, for example. Not really good evidence that it’s all that useful in predicting bad outcomes, but obstetricians often feel compelled, for legal and other reasons, to intervene sometimes before it’s necessary, and that intervention is usually casearean delivery.
About Dr. Darney, M.D., M.Sc.:
Dr. Philip Darney, M.D., M.Sc., is a Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco (UCSF) and Chief of Obstetrics and Gynecology at San Francisco General Hospital. He received his undergraduate degree in experimental psychology at the University of California, Berkeley, his medical degree at UCSF, and his Master of Science at The London School of Hygiene and Tropical Medicine.