Too Posh To Push?

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    Officially, the American College of Obstetricians and Gynecologists (ACOG) agrees. Last November, an ACOG ethics committee issued its opinion on the debate, finding it ethical for doctors to perform elective C-sections so long as the procedure doesn't imperil the health of the mother or child. But the committee fell short of offering guidelines, citing lack of evidence. Dr. Laura Riley, of Boston's Massachusetts General Hospital and the current chair of the ACOG obstetrics practice committee, says studies haven't fully explored the issues many women fear most: pelvic-floor damage and incontinence. "The studies are still out," says Riley, but in reference to her personal practice, she adds, "My thought is, a vaginal delivery is safer for the mother."

    A Gallup poll published in February suggests that female obstetricians are sharply divided on the issue. Thirty-six percent say they would not perform a caesarean at a woman's request if it wasn't medically necessary, 32% say they would, and 28% say it would depend on the circumstances. Tellingly, 27% of the polled doctors who had been pregnant had had at least one C-section themselves, and 22% of those procedures were elective.

    A case in point is Dr. Kim Warner, 36, chair of the obstetrics and gynecology department at St. Joseph Hospital in Denver. When her first child was due last year, she scheduled her own C-section. Warner had spent the past five years surgically reconstructing pelvic-floor muscles and repairing leaky bladders in women who had experienced difficult natural deliveries. She didn't want to risk a hard labor herself.

    On Aug. 22, 2003, Warner and her husband arrived at St. Joseph, where about 15 of their closest friends and family members were waiting. Within half an hour, Warner was in recovery holding a baby girl named Kiah; the next day mother and child were home. "Everything was just smooth as silk," says Warner. "I wouldn't think twice about having another C-section." But, she adds, "I'd think twice about having another baby. It's hard work."

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