safely pass through pelvis), abnormal (breech) positions of baby, previous C-sections, prolonged labors, fetal distress, postmaturity (baby overdue), placenta previa, hemorrhaging, multiple gestation, advanced maternal age, and maternal diseases such as disabetes, hypertension, toxemia, heart disease, herpes simplex, RH disease, and obesity. In all of these cases, however, a C-section need not be automatic, some doctors say. “C-sections have become protocol in cases where there exist alternative ways of dealing with birth problems,” contends Dr. Allan Hedges, director of the Portland Naturopathic Clinic. “For instance, I’ve had good success turning babies from breech to correct positions by taking the time to facilitate. Many times doctors will just go ahead and operate in these situations.” Hedges, a naturopathic doctor who has delivered “around 80” babies, also notes evidence suggesting that C-sections may not be necessary with herpes virus infections. “ In the secondary active lesion situation, the antiseptic Batidine apparently kills the virus if used properly. Also, after the primary infection, the mother builds antibodies which are passed on to the baby,” he adds. Dr. Kenneth Burry, associate professor of obstetrics and gynecology at the University of Oregon Hospital, comments that “doctors here are becoming more receptive to giving mothers who have had previous C-sections or those who face frank (buttocks first) breeches a chance to deliver vaginally if all other indications are good." “The manpower and time commitments are very great in these situations.” he continues. "We are delivering more repeat C-sections and frank breeches vaginally than we used to.” confirms Dr. Leon Speroff, professor and chairman of the department of obstetrics and gynecology for the University of Oregon Health Sciences Center. Despite a high risk patient population. the University of Oregon has posted C-section rates lower than many Portland community hospitals. “High C-section rates in community hospitals is currently a very sensitive issue,” comments Dr. Speroff. “There is concern on the part of the hospital as to why our C-section rates are so high,” offers Dr. R.T. Gustafson, chief of staff for Woodland Park Hospital. “We’re looking into the statistics to see what’s going on.” Spokespersons for Woodland Park and Dwyer Hospitals say that both hospitals have a high number of C-section repeats, a factor that inflates the total C-section rate, “As long as you’re getting healthy mothers and babies, the number of C-sections doesn’t make a damn bit of difference," states Dr. C.W. Cotterell, an obstetrician who performs surgeries at Woodland Park. “ In general, and for good reasons, doctors are intervening earlier than they used to and performing C-sections.” Reasons for the rate increase of C-sections are variously speculated. Doctors say they are not doing complicated forcept deliveries as they have in the past, and agree that more breech births are being delivered C-section. “Once a C-section, always a C-section” remains the rule, even though some doctors will deliver subsequent pregnancies vaginally. Babies are being taken by C-section sooner in cases of prolonged labor, doctors say. Fetal monitoring devises, electronic devises that measure fetal distress, have been used more in the last ten years, and many doctors suggest the devises have prompted more C- sections. Most doctors interviewed say they use fetal monitoring devises and speculate that this kind of extended electronic capability can help avoid tragic results. However, a study conducted at the Denver General Hospital in Colorado found that while electronic monitoring did not improve neonatal outcomes, it did increase markedly the rate of C-sections. The study was published in the American Journal o f Obstetrics and Gynecology in 1979. Those interviewed cite another reason for increased C-section rates: Fear of malpractice suits. “Obstetrics is one of the highest risk fields in medicine,” comments Dr. Speroff, “and fear of malpractice suits does contribute to higher C-section rates.” Dr. Donald Scott, a Portland obstetrician, agrees. “Threats of malpractice charges are causing more defensive medical practices,” he says, “and C-sections are one.” Dr. Scott estimates that his malpractice insurance rates have jumped from “about $700 to $13,000” over the last ten years. “ I’m sure the threat of malpractice charges do enter into the judgement of doctors,” comments Dr. Peter Bours, a Forest Grove family practitioner. “While I do deliver Some previous C-section and breech cases vaginally, I must require that the patients sign an informed consent paper. The “informed consent” establishes that the patient has been informed of risks, thereby diffusing any malpractice charges, he explains. “Even so," he adds, “ It seems to be to me that some doctors may be awfully quick to give C-sections.” Critics assert additional reasons for C-section rate increases. They say some doctors do not want to invest the time and attention necessary to monitor long or difficult deliveries. “Some doctors are just nervous and operate at the first sign of potential trouble,” says one critic. Others speculate that some doctors do more C-sections to make more money. “There’s no doubt about it,” comments Ms. Woodward, “Both doctors and hospitals do make more money with C-sections.” Although costs vary, the total expense for a C-section birth is usually more than double that of a vaginal birth. At Woodland Park Hospital, for example, the total cost estimate for a C-section is “ around $3,000” and “around $1,100” for a vaginal birth. Statistics do not support the notion that lives are being saved in the Portland area as a result of increased numbers of C-sections. According to Oregon State Health Division vital statistics, the infant mortality rates have remained stable over the last ten years in Multnomah County. The infant mortality rate (number of deaths out of every 1000 births) is listed as 15.2 in 1970 and as 15.0 in 1978. The number of maternal deaths has ranged from 0 to 3 per year from 1970 to 1978. “Death rates may not necessarily drop when C-section rates rise, but the important thing to consider is the quality of survival over a period of time,” cautions Dr. John Yount, a University of Oregon Hospital neo- natalogist. “C-sections do, most often, mean healthier babies.” In terms of emotion, doctors, natural childbirth practitioners, and parents agree that a C-section can be a frightening, heartbreaking, experience. A Caesarean support group formed to assist and educate parents has recently been established in Portland, in cooperation with the Prepared Childbirth Association. “Most Caesarean births are not anticipated,” says Susan Hunter, an educator and spokesperson for the support group. “Through education, our group tries to take away some of the fear associated with C-sections.” “Resentment, disappointment, repression, and guilt are emotions many Caesarean mothers have to deal with,” adds Patti Smith1 , also a support group member. “Our group feels that the more education and understanding a woman has, the more she’s able to know the joy of being a mother.” 50waysto belt your lover lor xmas Give your friends, relatives, or yourself, a gift that will delight for a lifetime.The Basic Belt, in a choice of 15 colors, goes for $7 to $12, complete with solid brass buckle. Plain or tooled, all Leatherworks belts are made of the finest top-grain French leather. 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