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NARRATION
The medical community is divided about the advisability of C-sections.
Maureen Rayson, a midwife in Manhattan, would prefer traditional techniques of natural birth such as breathing exercises and massage. She worries that these natural methods have been replaced with anesthesia, and abdominal surgery.
RAYSON
"Women feel a lot more empowered when they're able to deliver vaginally, as opposed to going in, getting an epidural, having the doctor do things for you, you feel like you're not doing anything much to get your baby here."
NARRATION
C-section can be a lifesaving intervention for complications during labor such as breech birth, when the baby is not being in the optimal head-down position for delivery. But it's also a major abdominal surgery that carries a greater risk of womb infection, blood loss, and longer recovery time.
Yet many doctors are endorsing them…
MORITZ
"There's an expression in obstetrics that says 'no one ever regrets doing a C-section.'"
NARRATION
Obstetrician Jacques Moritz of St Luke's Roosevelt Hospital says doctors are afraid of lawsuits. That's why many of them decide to perform C-sections.
MORITZ
"Basically, everybody wants the perfect baby and when that does not happen in our society the only remedy // is basically suing somebody."
NARRATION
Maria Barroso from the International Cesarean Awareness Network says there's another, positive incentive for doctors.
BARROSO
"The money. // Obviously for a C-section they're gonna be there for an hour, and they're gonna get paid three times the amount of money as they would in a vaginal birth, which they have to sit there for 20 hours and wait for the mom to give birth."
NARRATION
The increasing use of fertility treatments is also a factor. The treatments lead to multiple pregnancies - twins and triplets - which are riskier pregnancies and often result in C-section births.
Many doctors also consider it risky for a woman to have a vaginal birth after cesarean delivery of a previous child. They say there's a chance that the uterine scar from the previous C-section will tear.
Doctor Moritz says obstetricians still follow the old rule "once a C-section, always a C-section," even though he thinks it's a minor risk.
MORITZ
"It happens 1% of the time.// But we're actually practicing for the 1% and we're applying it to the 99%. Welcome to America."
NARRATION
In addition to C-sections promoted by doctors, some mothers are choosing cesareans because they want to maintain their vaginal tone intact for intercourse or to avoid urinary incontinence later in life.
Rayson says midwives know how to address these considerations.
RAYSON
"We have exercises that are designed // to protect from getting damage to the pelvic floor muscle. Not a problem at all."
NARRATION
Another looming factor in the steady rise of C-section is obesity. Because Americans are getting heavier, so are the babies. And bigger babies means that sometimes women can't push them out.
As the C-section rate continues to mount, health authorities are taking measures to counter the trend. The Department of Health and Human Services has set a goal of cutting the C-section rate in half by 2010. Meanwhile, health activists are working to educate doctors about the issue, lobby congress to hold hearings, and collect testimonies from women who have had C-sections.
Tamara Rosenberg, Columbia Radio News.