New York, NY (July 26, 2004) -- Throughout the history of obstetrics, obstetricians have viewed Cesarean section as a delivery mode that is either medically indicated or not.

Times have certainly changed: According to new research from New York-Presbyterian Hospital/Weill Cornell Medical Center, nearly 1 in 5 women who had a Cesarean delivery after being in labor either requested or were offered a Cesarean delivery at some point during labor without a classic medical indication.

The topic of elective or patient choice Cesarean delivery before the onset of labor has received much attention. However, this research -- published in a recent issue of Obstetrics and Gynecology -- is the first to address "an even more important dimension of patient choice Cesarean delivery -- intrapartum elective Cesarean delivery."

"We found that about 20% of our patients who had a C-section after being in labor were either offered or requested a C-section, without a clear-cut medical indication, at some point during labor," said lead study researcher Dr. Robin Kalish, Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian/Weill Cornell.

According to Dr. Kalish, rates of Cesarean section -- whether elective or medically indicated -- continue to rise in the United States and globally.

"It's become more and more commonplace throughout the United States and globally, so it is especially important that we accurately identify why Cesarean deliveries are being done and that we not confuse medical and patient choice issues," she said.

To find out, they had obstetricians at one busy New York City hospital fill out questionnaires between May and November 2002 on 422 consecutive deliveries performed on women who had been in labor prior to the C-section.

The result? "C-section was offered by doctors in 13% of cases prior to a clear medical indication, and patients requested it in almost 9% of cases," Dr. Kalish said.

The researchers then tried to tease out what factors prompted the decision to opt for Cesarean rather than vaginal birth.

Surprisingly, factors specific to the delivery process itself -- such as duration of labor, use of epidural anesthesia, or gestational age of the fetus -- did not appear to play strong roles in C-section decisions. Neither did patient-centered factors such as a woman's age or number of previous deliveries.

In fact, the real "surprise" is that "we didn't see a difference in patient characteristics, but we did find differences in physician characteristics," according to Dr. Kalish. Doctors who were older, specialists in maternal-fetal medicine, or full-time faculty members at the hospital/medical school were more likely to offer women C-section during labor than were younger doctors or non-specialists.

Dr. Kalish stressed that Cesarean delivery remains riskier than vaginal delivery, and the decision to opt for C-section should never be taken lightly.

"C-section does carry higher rates of complications in current and especially future pregnancies, higher blood loss than vaginal delivery, and there may be higher costs for the hospital and the public, since there's a longer recovery time," she said.

Dr. Kalish asserts, "This study documents the clinical importance of intrapartum elective Cesarean delivery and points the way towards much needed research concerning patient choice and physician counseling during labor."

Collaborating on the research were Dr. Frank Chervenak (Chairman of the Department of Obstetrics and Gynecology), Dr. Laurence McCullough, and Meruka Gupta -- all of the Division of Maternal-Fetal Medicine in the Department of Obstetrics and Gynecology at New York-Presbyterian-Weill Cornell; and Dr. Howard T. Thaler, of Memorial Sloan-Kettering Cancer Center, New York City.

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