The American College of Nurse-Midwives (ACNM), the nation's oldest women's healthcare association, is increasingly concerned about the dramatic rise in cesarean sections in the United States and the alarming call from some physicians that women should be given the opportunity to make a choice between a vaginal birth and a cesarean section.

"We are on the verge of surgically removing a baby just for convenience," warns ACNM President Joyce Roberts, CNM, PhD, who has extensively studied the progress of normal labor. "When the overwhelming majority of women enter pregnancy with no medical complications, women have every reason to be skeptical about any recommendation that promotes surgical intervention during childbirth."

Dr. Roberts' views are consistent with a recent article in the May 10, 2000, issue of The Journal of the American Medical Association, which reviewed method of delivery and risk of maternal postpartum rehospitalization. It found that women who had cesarean deliveries were almost twice as likely to be rehospitalized than women who had vaginal deliveries.

Based on the scientific evidence, ACNM believes that cesarean section and induction of labor should be performed only when medically indicated. Women who request an elective cesarean section should be educated about the lack of evidence to support purported benefits of surgical over vaginal delivery as well as the possible negative effects of this procedure on them and their babies.

"A review of the history of childbirth in the U.S. provides evidence that recommendations for elective cesarean sections are part of a worrisome pattern," said Roberts. "For years women were told that cutting the vagina (an episiotomy) during child birth would prevent problems for women in their later years. Then, they were told that once a woman had a c-section she should always have a c-section. Both of these approaches have now been shown to be bad practice."

ACNM Executive Director Deanne Williams, CNM, MS, adds, "We have reached a crisis situation in some parts of the country where over 50% of women are having cesarean sections. Some women are being encouraged to endure so many cuts to their belly that I wouldn't be surprised to hear of someone sewing in a zipper."

Proponents of cesarean section maintain that this major abdominal surgical procedure will prevent problems for women in their later years. However, Williams said, "With no solid evidence to demonstrate that a cesarean section will protect older women from problems, like incontinence or uterine prolapse, this is clearly the wrong approach."

In addition to the position that cesarean section and induction of labor should be performed only when medically indicated, ACNM also believes that any woman who has a cesarean section should know that she was given every opportunity to deliver vaginally, including: the continuous presence of a support person during labor, encouragement to walk and assume a comfortable position, access to hydrotherapy and other alternative methods of pain relief, no imposition of artificial limitations on the time she is allowed to labor, no unnecessary interventions and access to care from a certified nurse-midwife (CNM) or certified midwife (CM).

As an organization dedicated to evidence-based practice and whose members are responsible for nine percent of the nation's vaginal births, ACNM has prepared a bibliography and list of other references on the pros and cons of cesarean sections. This and other information is available on the ACNM Web site at www.midwife.org.

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