CESAREAN EPIDEMIC: State of the art or fleeting trend?
There is no doubt that we are witnessing an increasing rise in the number of cesarean deliveries performed throughout the developed world, with Greece being no exception. And even though indications may vary, it is mainly fetal disproportions and abnormal fetal heart rates (FHR) that goad professionals into employing this method. But are these truly the reasons or just the pretext for a fast and safe delivery? As a matter of fact, many question whether the aforementioned indications contain enough gravitas so as to justify the absolute need for a cesarean section, especially nowadays in the presence of advanced technological facilities and strict guidelines monitoring the delivery process. To clarify the uncertainty, maternal and prenatal outcome constitute the key factors to be taken under consideration. However, there is no evidence that a cesarean delivery greatly contributes to either of them. Another prominent interpretation of this epidemic derives from the attitude of the mother herself. An increasing number of women undergo a cesarean section at their own will or decide to do so under external influence. Hence the term CDMR or Cesarean Delivery by Maternal Request. The choice to have less than two children, the fear of fetal intrapartum hypoxia or trauma, the reluctance to undergo a vaginal delivery procedure, the anxiety of perineal lacerations, less sexual satisfaction and future incontinence, all form the motives which impel a woman to choose CDMR. Nevertheless, most women often underestimate and are not prepared for the effects of a cesarean section post delivery, some of which include post partum hemorrhage, future abnormal placentation and parity restrictions. A salient method of confronting the problems that arise from the widespread use of cesarean sections is the introduction of VBAC or Vaginal Birth after Cesarean. The Eunice Kennedy Shriver National Institute of Child, Health and Human Development (NICHD) the Society for Maternal Fetal Medicine and the American College of Obstetricians and Gynecologists 2013 Workshop greatly stress the efficiency of this practice. However, this action would not only require the enhancement of the methods used through adequate training and a more in depth mother consultation process, but it also gives rise to the possibility of legal drawbacks. Therefore, the question remains unanswered. Cesarean section: State of the art or a fleeting trend?