In no area of medical practice except in the delivery of babies is major ab dominal surgery considered a sound and simple alternative to the body's natural processes. According to this accessible, intelligent book, the assumption that a cesarean delivery is safer than vaginal delivery is false. Rosen, chairman of the department of obstetrics and gynecology at Columbia-Presbyterian Medical Center, and freelance writer Thomas use numerous examples from Rosen's three decades of practice to illustrate when a cesarean is mandatory, when it is unnecessary or unwise, and when the decision is a judgment call. Also discussed here are the medical and nonmedical reasons that physicians tend to over-recommend cesareans (more than one in four babies are born by cesarean section in the U.S., they maintain). The authors are particularly concerned when physicians choose cesarean delivery as a shield against potential lawsuits by parents of neurologically impaired babies. This book, they say, is intended as an effort to reduce confrontations by arming patients with data and by encouraging them and their obstetricians to form alliances of trust long before determinations about cesarean delivery must be made. (June)
Twenty-seven percent (about one in every four) of the babies born in the United States are delivered by Cesarean section. The rise in the Cesarean rate over the last several decades is investigated intelligently and with little bias in this book. Clearly the purpose here is to dispel such myths as that all Cesareans are safe and simple operations, and that subsequent vaginal births are impossible. Although medical circumstances are discussed, the prevailing issue is ethics being weighed against lawsuits: ``Americans expect to have perfect babies, and they hold their doctors accountable if they don't.'' The case studies used generously throughout the text graphically illustrate the dilemma faced by pregnant women and their physicians. Public libraries will want this.-- K.E. Megginson, VA Medical Ctr., Fayetteville, Ark.