Moms who planned C-sections report high satisfaction, study says
Dawn Cofiell was adamantly opposed to delivering her son Donovan by cesarean section three years ago, but a complication made it unavoidable.

The experience was so smooth, pain-free and convenient that she surprised her doctor with requests to plan the major abdominal surgery for her next two children, Brayden and Kaitlyn.

"At first I was bummed about the fact that I had to have a C-section," said the Parkville mother, who delivered her children at Greater Baltimore Medical Center in Towson. "But I had such a good recovery and experience that I decided to go with what worked for the second and third."

Cofiell's experience has become relatively common, helping to accelerate the number of the C-sections nationwide — they've increased 53 percent from 1996 to 2008, the most recent data available. That trend has alarmed many doctors and public health officials, who are concerned about the surgery's risks. But it's also a sign that new mothers' satisfaction is now a real consideration in birthing decisions.

Doctors at GBMC and Johns Hopkins Bayview Medical Center who studied the issue say emotional well-being is important because a negative birth experience has been linked to postpartum depression, which afflicts one in 10 women, government data shows.

The doctors found that women who planned C-sections were much more satisfied with their experiences than those who planned vaginal births — partly because more than a quarter of the latter group ended up with unplanned cesareans.

"There is not enough evidence that we should offer everyone a C-section; we're not at that point," said Dr. Joan Blomquist, an obstetrician-gynecologist at GBMC, which has the fourth-busiest maternity department in Maryland.

"But for the right patient, it might be the right decision," said Blomquist, who was Cofiell's doctor. "At least we need to make sure they understand all the possibilities, that they don't have unrealistic goals."

The findings, reported in a recent issue of the American Journal of Perinatology, were surprising in that C-sections have been linked to higher rates of postpartum depression in past studies and vaginal births have been found to be more satisfying for mothers.

The research by Blomquist and Dr. Victoria Handa, an obstetrician-gynecologist at Johns Hopkins Bayview Medical Center, grew out of a conference at the National Institutes of Health about the growing number of C-section requests. The officials wanted to know what women were expecting from cesareans, and they funded the doctors' investigation.

The study polled 160 women planning vaginal delivery and 44 planning C-sections. The women were asked eight weeks after delivery about their fulfillment, distress and difficulty. They rated their satisfaction with the childbirth experience on a scale from one to 100 and how they felt right after birth using descriptors such as "disappointed," "enthusiastic" and "cheated."

Those planning C-sections reported higher satisfaction, higher fulfillment and lower distress and difficulty, and a more favorable overall experience than those planning vaginal birth.

The federal Centers for Disease Control and Prevention reported that about one-third of U.S. women giving birth had C-sections in 2008, the latest data available. The number crossed all races and ages.

Most of the busiest baby hospitals in Maryland were near the national average. GBMC had the highest rate at 45 percent, a number officials there attributed to women such as Cofiell who chose C-sections for subsequent deliveries, a higher number of high-risk pregnancies and requests for tubal ligations after delivery. Bayview had the lowest rate of cesareans among the busy baby hospitals with 18.5 percent.

Doctors say mothers are demanding more frequently to have labor induced, which makes them twice as likely to have a C-section. Doctors who fear malpractice lawsuits also may turn to cesareans more. A higher number of twins and triplets might be a factor, and obese mothers who are often hypertensive or diabetic.

In recent years, there has been a push by many hospitals, physician associations and government agencies to slow the use of C-sections for nonmedical reasons. Doctors say the surgery can lead to complications that include hemorrhaging and infections, and it takes the mothers longer to recover.

The National Institutes of Health said last year that it is safe for women to have a vaginal birth after C-section, known as VBAC, and should be encouraged. But some hospitals still do not regularly perform them. GBMC, for example, has started offering free classes on the subject, and Cofiell said she was counseled about VBAC but declined.

The demand for C-sections shows how times have changed, said Dr. Nada Stotland, a Chicago psychiatrist and former president of the American Psychiatric Association. Fifty to 60 years ago, women were much more upset about the procedure because they knew they had a major complication or felt they had failed in some way, she said. Even after a resurgence of support for natural childbirth, a C-section carries no stigma today.

Although the change in attitude is good news for women who need C-sections, Stotland said, it encourages others to undergo potentially risky surgery for nonmedical reasons such as convenience or fear of pain. Women who requested a C-section because they were overwhelmed by their fear of labor pain remain afraid, even though modern medicine means no one has to endure pain, she said.