The American College of Obstetricians and Gynecologists' ethics committee's statement saying that it is ethical for physicians to provide non-medically indicated caesarean sections "downplays the risks" of the procedure for women and their fetuses, according to a statement released on Wednesday by the American College of Nurse-Midwives, Doulas of North America, the Coalition for Improving Maternity Services, Lamaze International and the Association of Nurse Advocates for Childbirth Solutions (ACNM release, 11/19). ACOG's ethics committee earlier this month released a statement saying that the risks associated with c-section relative to the risks of vaginal delivery are unclear, and the lack of data indicates that it is not "ethically necessary to initiate discussion regarding the relative risks and benefits of elective (caesarean) birth versus vaginal delivery with every pregnant patient." The committee warned against "actively advocating" non-medically necessary c-sections. However, the committee concluded that "if the physician believes that (caesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. "The burden of proof should fall on those who are advocates for ... the replacement of a natural process with a major surgical procedure," the committee wrote (Kaiser Daily Reproductive Health Report, 11/3). ACNM said, "Regrettably, the opinion issued by the ACOG Committee on Ethics may lead to an increasing level of distrust between health care professionals and the women who seek our services," adding, "The purported benefits of caesarean section on demand are unproven and the known risks place the woman's life and reproductive future on the line. This is the message women must receive." According to the release, research indicates that the risk of maternal death following a c-section is five to seven times higher than the risk of maternal death following a vaginal delivery.

High U.S. C-Section Rate
According to the release, the World Health Organization recommends a c-section rate of no higher than 15%, but the U.S. c-section rate is greater than 26%. Rae Davis, executive director of CIMS, said, "With a million women having caesarean sections every year, this means that 400,000 to 500,000 may be unnecessary." Lamaze, ACNM, DONA, CIMS and ANACS -- which represent approximately 15,000 childbirth professionals -- said in the statement that they believe that "all caregivers should respect the birth process and not intervene without compelling medical indication" (ACNM release, 11/19).