Legend has it that Julius Caesar was born through surgery, rather than vaginal delivery — hence the term “caesarean section.” Another view is that the operation gained that name because, as Roman dictator, Caesar decreed that pregnant women who were thought to be dying should have their babies delivered that way. Over time, as the operation became reasonably safe and routine, physicians recommended it for women whose health might be jeopardized by going into labor, or staying in labor too long.
Now there’s a widespread belief that some mothers and some doctors are scheduling caesarean sections as a convenience; there’s no painful waiting period or unpredictable demands on health care professionals. And it’s reimbursed by insurers at a higher level — raising concerns that the fee-for-service system may be influencing medical decisions, at least subconsciously.
When to opt for a caesarean section should always be a medical decision. Thus, a new series of guidelines nudges doctors to let first-time mothers stay in labor longer before ordering the surgery. The guidelines change the starting point of active labor from 4 centimeters of dilation to 6, and urge patience before resorting to a caesarean.
Many obstetric organizations have long been concerned over increased caesarean rates, which have nearly tripled in the past 15 years. Possible negative outcomes, including respiratory distress for newborns and longer recovery for mothers, outweigh the benefits of a speedier delivery. Patients, insurers, and medical professionals should embrace the new guidelines. Sometimes a caesarean section is preferable, and sometimes it’s not. On that, at least, Caesar and today’s policy makers can agree.