But allowing women to just opt out of VB without explaining the benefits of natural birth
. CS is major surgery.
Abstracts from journals indicating safety of VB over elective (I have had to resort to abstracts as not at work with access to most journal articles through the academic institute I work for):
Ann Acad Med Singapore. 2003 Sep;32(5):577-81.
Should doctors perform an elective caesarean section on request?
Devendra K, Arulkumaran S.
Source
Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, London, UK.
Abstract
The incidence of caesarean sections performed on request without medical indications is rising. The reasons for this are not only for perceived medical benefit, but are also due to social, cultural and psychological factors. Despite dramatic improvements in the safety of anaesthesia and surgery, mortality and morbidity are greater for elective caesarean sections compared to vaginal deliveries. An association exists between pelvic floor damage and childbirth, but this cannot be attributed entirely to vaginal deliveries and does occur even after a caesarean birth. The incidence of late intrauterine deaths is unlikely to be reduced by a policy of universal elective caesarean section, as these procedures carry a risk of iatrogenic fetal morbidity and mortality. The legal and ethical issues of request caesarean sections are complex. The validity of informed consent for non-indicated surgery is unclear. An individual has his/her rights and so does society. When society's rights are judged to have priority, the individual's right becomes a privilege. Based on this principle, maternal request caesarean sections must not compromise the provision of care to women requiring medically-indicated caesarean sections or should not dent the resources of public healthcare. In dealing with requests for caesarean sections, obstetricians should establish the reasons for the request and provide clear, unbiased information based on the best available evidence. Individualized modifications to the management of labour may allow some women to have vaginal deliveries. A second opinion from a colleague may help the patient to reconsider the request and make a more informed choice.
J Obstet Gynecol Neonatal Nurs. 2007 Nov-Dec;36(6):605-15.
A review of issues surrounding medically elective cesarean delivery.
Miesnik SR, Reale BJ.
Source
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, PA 19104, USA. [email protected]
Abstract
The rate of cesarean delivery has increased dramatically over the past decade. Medically elective cesareans are a major factor contributing to this rise. This article discusses the most recent evidence on the perinatal risks of cesarean delivery versus vaginal birth, the economic impact of elective cesarean delivery, and ethical principles related to cesareans performed without medical indication. Physicians' rationales and responses to the issues are reviewed and the recommendations and guidelines of professional organizations are summarized. Available evidence does not lend support to a current shift in clinical practice. Research is needed to adequately compare outcomes of planned cesarean delivery and planned vaginal birth. Until evidence supports medically elective cesarean as a birth option that optimizes outcomes for low-risk mothers and their infants, obstetric care providers should continue to support evidenced-based decision making that includes advocacy for vaginal delivery as the optimal mode of birth.
J Perinat Neonatal Nurs. 2001 Dec;15(3):23-38; quiz 89.
The case against elective cesarean section.
Goer H.
Abstract
Prominent American and British obstetricians have been advocating for performing more Cesareans. They argue that Cesarean section is as safe or nearly as safe as vaginal birth, eliminates pelvic floor damage and the consequent symptoms caused by vaginal birth, is safer for the infant, and is desired by many women; however, abundant evidence in the medical literature refutes the validity of those claims.