New government statistics show that close to one-quarter of babies are delivered by Caesarean section, a seven percent increase from 2001, and the highest rate recorded since the data was first collected in 1989. This surgical procedure accounts for some 24 percent of all live births, and now the issue of whether Caesarean births, or C-sections, are beneficial to women and their babies is creating controversy among the medical community.

Many women are opting for the procedure for fear of long, painful vaginal births and its effects on the body. Natural childbirth can result in pelvic floor disorders -- damage to muscles, ligaments and tissues that result from childbirth and labor. This damage can result in urinary and fecal incontinence -- some 20 percent to 30 percent of women become incontinent after one vaginal birth -- as well as a lessening of sexual sensation.

However, C-sections come at a cost, and some say that doctors favor surgical deliveries because they can be conveniently scheduled and create more income than natural births. But, as with any surgery, there are risks and recovery time to take into account, and supporters of natural birth say that the risks of surgery outweigh the risks of pelvic floor dysfunction. Further, some say that the link between vaginal delivery and risk of pelvic floor disorders has not been established.

In the 1980s and 1990s an effort was made to reduce the number of C-sections performed, particularly those routinely done because a woman had had one in the past, as it was thought that performing repeat Caesareans was often unnecessary. However, after the reduction, reports of birthing problems increased and in 1996 the Caesarean rate began to rise once again.

In 2001, the number of women who had a vaginal delivery after having had a Caesarean decreased by 20 percent, reaching 16.5 percent, the lowest percentage yet. Some say that the rising costs of malpractice insurance may be playing a role in making doctors reluctant about natural birth. Often, doctors and hospitals refuse to let women have a vaginal birth after a previous C-section because of possible risks.

At the heart of the debate are women who want a Caesarean for their first baby -- such cases increased five percent in 2001, to 16.9 percent of all live births. Some say the increase is due to the population’s obesity problem -- overweight mothers tend to have bigger babies, who are harder to deliver -- and the increasing number of women having babies at older ages, which can increase the risk of complications.

Women are also choosing to have C-sections when no danger to their, or their baby’s, health exists. While this is relatively unusual, there is a general consensus that this practice is increasing.

Washington Post December 16, 2002; Page A01