In 1989, a medical study done in Houston, Texas, concluded that epidural analgesia is associated with significant increases in the incidence of cesarean section for dystocia in women having their first labor.
Cesarean sections are sometimes performed for other than maternal or fetal well-being, such as avoidance of patient pain, patient or provider convenience, provider legal concerns or provider financial incentives.
Although rare, there have been reports of court-ordered cesareans performed on women against their will. One such case was appealed, supported by 118 US organizations, claiming that the decision was unconstitutional and raises complex legal, moral and religious issues. The appeal judge issued a forceful decision asserting that "in virtually all cases the question of what is to be done is to be decided by the patient -the pregnant woman- on behalf of herself and her fetus."
In March 1990, an ACOG survey of 2,213 obstetricians documented the changing attitude about VBAC in the US. The survey reported that women under the care of younger physicians and physicians in practice for fewer years were more likely to accept the option of VBAC than women under the care of older physicians and those in practice the longest.
Of 11,814 women admitted for labor and delivery and attended by midwives to 84 free standing birth centers in the US, 15.8% were transferred to the hospital and 4.4% had a cesarean section. Although the women were lower than average risk of a poor pregnancy outcome, their cesarean rate is one-fifth of the national average.
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The International Cesarean Awareness Network, Inc. (formerly Cesarean Prevention Movement), is an international, nonprofit organization that was founded by concerned parents and professionals in June 1982 led by Esther Booth Zorn. Governed by an elected Board of Directors, ICAN has grown rapidly with members in every state of the U.S., as well as many foreign countries. Over 80 chapters provide information and support on a one-to-one basis. Since ICAN's inception the vaginal birth after cesarean rate has doubled, yet there remains much to be done to prevent initial cesareans, as well as promote VBAC.
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Reprinted with permission from The International Cesarean Awareness Network