The Article in Brief

Patient Choice Vaginal Delivery?

Lawrence M. Leeman, MD, MPH, and colleague

This essay argues that, with cesarean delivery rates consistently on the rise (from 4.5 percent in 1965 to 26.1 percent in 2002), a woman's option to choose vaginal childbirth should be preserved, specifically after a previous cesarean delivery or with a breech presentation. The authors question why cesarean delivery is framed as a woman's choice, whereas vaginal delivery often is not. The choice of a cesarean delivery can effect a woman's reproductive future, with a higher risk of certain pregnancy complications. The authors suggest that before a universal right of women to choose elective primary cesarean delivery is adopted, studies should be conducted to compare the risks of cesarean and vaginal delivery. They conclude that, if the issue is one of patient choice, then the choice of vaginal birth must be accepted and available.