There is a strange contrast that exists in the American College of Obstetricians and Gynecologists in which they support the right of women to choose an unnecessary Cesarean section–in the name of patients’ choice, patient autonomy, and informed consent; but are not allowed to have a vaginal birth after Cesarean (VBAC), or to give birth to their breech babies vaginally–despite what the patient wants, regardless of the same rules of patient autonomy, and in defiance of the practice and doctrine of informed consent. Here is a very interesting article from the Annals of Family Medicine, May 2006, entitled Patient Choice Vaginal Delivery?, which explores this dichotomy.

The introductory paragraph of the article is as follows:

Patient-choice cesarean delivery, a primary elective cesarean delivery performed without a medical indication, is increasing among pregnant women. The American College of Obstetricians and Gynecologists (ACOG) has released a formal opinion supporting obstetricians who perform elective primary cesarean delivery, citing the ethical premise of patient autonomy and informed consent. As physicians who advocate for women’s right to choose among a variety of medical options, we are pleased at the emphasis on preserving women’s medical choices. We are, however, perplexed at the narrowness of the choice. In recent years we have seen a decline in women’s choices for vaginal birth as vaginal birth after cesarean (VBAC) becomes less available and vaginal breech birth is rarely performed. The question of patient-choice cesarean delivery asks only whether a woman should have the right to choose a cesarean delivery in the absence of a medical indication. A woman’s right to choose a vaginal delivery is not addressed.

It is tempting to just quote the entire article, because there are so many good points it brings out, but I will refrain and just encourage you to read this article for yourself, and perhaps discuss it with your doctor. The authors cite many sources in the above paragraph and throughout the article, supporting their statements with published studies. They discuss the risks of C-section to the mother (both in the immediate post-partum, as well as its implications for future pregnancies), vaginal breech births and VBACs, their risks and benefits, what studies have said about them, what ACOG’s official recommendations are, and how these same births are handled in other countries.

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