TMC conference ignites C-section debate

When organizers from the UMKC and Truman Medical Center (TMC) departments of obstetrics and gynecology decided on seminar titles for their Update 2000 conference, held at the downtown Marriott April 13 and 14, they wanted to spark interest and debate among the members of the national medical community who would attend the conference.

Titles such as "Strategies to Optimize a Caesarean Delivery Rate," "Caesarean Section: Is it Time to Change the Tune?," and "Elective Caesarean Section at Term (38 weeks) as a Cost Control Measure" were listed on a press release distributed by the hospital's marketing and public relations department. The course director for the conference, Dr. Eugene Pearce, weighed in -- perhaps not considering that his audience would extend beyond medical professionals -- with an equally provocative quote: "Considering the changing status of women, coupled with the emphasis on patient choice and damage to the female pelvic floor during vaginal births, it may turn out in the future that women will prefer to have Caesarean sections," the physician stated in the press release.

The desired effect spilled over into the public arena. Conference organizers were subjected to a letter-writing and e-mail campaign, telephone calls, and a small protest outside the conference site from groups opposed to elective Caesarean sections.

"It should be noted that the titles of the topics related to Caesarean section are purposely provocative and controversial in an effort to attract attention and to have a successful registration. Evidently, this has succeeded in attracting attention in a manner that was not anticipated," wrote Dr. James P. Youngblood, professor and chairman of the UMKC department of obstetrics and gynecology, in his e-mail response to the dozens of protest letters he received about the conference.

"We just found it appalling that they would discuss the benefits of making elective, unnecessary C-sections an acceptable option," says Anita Woods, president of the local chapter of the International Cesarean Awareness Network (ICAN). Woods was alerted to the conference by a TMC employee.

ICAN, a nonprofit organization, seeks to support and inform parents recovering from or wanting to prevent a Caesarean section or traumatic birth. Vaginal births after Caesarean (VBAC) have gained popularity in the past 20 years as an acceptable alternative for most women who had a Caesarean section during their first labor. Previously, scarring from a C-section would most likely rupture during a vaginal labor in subsequent pregnancies, endangering the mother's and child's lives. Modern incisions are low and horizontal, making the risk of rupture considerably lower.

Pearce, head of the section of gynecology at Truman Medical Center and associate professor of gynecology at UMKC, said in a telephone interview before the conference that the goal was to give medical professionals, the conference's primary audience, information. "We weren't proposing to increase C-section rates, nor were we proposing to give the patient the option of having elective Caesarean sections. Our goal was to illuminate and give ideas.

"I don't have a problem at all with these groups who have sent us letters. I have the highest respect for people who assist in safe, natural childbirth -- especially midwives and doulas. I just believe that these people saw the titles to the sessions and jumped to conclusions."

Pearce, who began practicing medicine in the 1950s, became interested in the C-section procedure after learning that his mother was born by Caesarean in 1901. Whatever the choice of birth, Pearce says, the woman should receive the best in medical care; that care may not, particularly in his approach, call for much invasiveness in the birth experience. "I have a long experience in private practice," Pearce says, "and have always practiced minimalist obstetrics and believe that we have overdone technology."

He adds that the real issue the medical community must confront is: When it is safe for a woman to have a VBAC birth? "Twenty years ago, the C-section rate was at 20 percent in this country. When the World Health Organization said that figure was too high, VBAC was considered a safe method for the majority of women to lower the C-section rate. But now we are seeing that about one out of 1,000 VBAC births end in catastrophe by tearing the vaginal wall, putting mother and child at risk. We are simply trying to devise better methods of evaluating and assessing who is at risk with VBAC."

Pearce says a physician's ability to predict risk factors is not perfect and that sometimes problems occur that doctors did not expect. "Great Britain and Brazil already offer Caesarean section as an elective option. The Caesarean rate in Brazil is at 42 percent right now, higher in certain groups. One-third of women gynecologists in Great Britain who responded to a survey which asked if given the choice, would they have an elective C-section said they would. Our goal is to debate this issue and discuss ideas so that if our audience is exposed to this later, they would be informed."