Routine C-Sections in Veterinary Practice? What's Your Take?
Ever marveled at the movement in obstetrics towards surgical alternatives to normal biological parturition? Yep, that's med-speak for the so-called Caesarian section. Named after a Roman whose mother famously undertook to bear him by any means necessary, the procedure is growing in popularity in both the human and veterinary worlds alike.
A couple of weeks ago, I spent a semi-working weekend in the Florida Keys. Apart from the obligatory writing, we mostly kayaked and ate well in celebration of my boyfriend's birthday. While there, we spied my cousin's boat docked not too far from the house we rented. It couldn't have been anyone else's; not with the words "Sea Section" slashed across its side.
It’s not that she's had two C-sections and plans a third for her current unborn (she delivered her first two "naturally"). Rather, it's that her husband is an obstetrician who hails from a family of professional deliverers. And like so many boat names, Sea Section is a reference of gratitude to the profession that gave rise to such spoils — apart from being a pun on a service he presumably performs with some regularity (though not on his wife, it's worth noting).
This is something my cousin-in-law and I have in common. Though it's not a procedure I perform as often as he surely has cause to in Florida’s litigious medical environment, it's nonetheless one I've performed more often than most, having serially subbed for a repro specialist in my salad days.
But not all veterinarians harbor a distaste for the procedure. In fact some specialists actually subscribe to the belief that a C-section is always preferable to natural parturition. They claim that both mom and pup are better served by this more predictable, "less traumatic" approach to the natural birthing process.
As a person who can legitimately attest to having birthed a child "naturally," sans the kind of epidural intervention everyone considers humane nowadays (this was an accident, by the way, seeing as I'm the first to have elected for pain control), I'll say this for the procedure: It was such a relief to get rid of the parasite, I would have endured worse. But I still wouldn't have wanted a C-section if it'd been avoidable.
But who's to say what's safely avoidable or not? In veterinary medicine we tend to draw sharp lines at bully breeds and other big headed beasts (or for significant disparity in size to the female's disadvantage). Similarly, I see human physicians scheduling C-sections months ahead of time, based solely on a woman's morphology; or worse, based on her or her husband's personal choice.
Which is just not right. I mean, does Doc know what the father's genetics are like? And is an informed decision even possible in the presence of a husband who firmly believes he's going to get stuck with a flaccid vagina unless his wife gets a bikini-line scar instead? (Yes, I just said what many ignorant men think but which never seems to gets printed.)
Truth be told, I tend to get my hackles up on this issue not just because of the misogynistic spin, it's also the fact of "fast food" medicine at the expense of science that gets me. I mean, just because predictability of survival and lower risk of catastrophic outcomes are higher in C-section cases doesn't mean we're better off cutting every pregnant mother open at term.
To wit, last month at the Purebred Paradox conference a board-certified reproductive specialist presented the case in favor of routine C-sections. She claimed it was a widely accepted and scientifically verifiable truism that both pups and human babies are better off getting cut out rather than delivered vaginally.
To which I called bulls**t. Because the American Association of Pediatrics remains fundamentally in favor of the traditional delivery method except in three cases: mom's had a previous C-section (meaning she's high risk for delivery due to a now-compromised uterus), baby's heart rate has slowed, or "obstetrician feels that the baby's health might suffer if born vaginally." (Source: www.healthychildren.org)
Ultimately, it's because we suspect that (a) not only is a C-section more traumatic than we tend to think, but (b) the longer-term consequences of Caesarian sections are shaping up to look like they don't bode well for the procedure's continued routine use.
It's only in malpractice-happy states like Florida, New York and Texas that C-sections are employed more frequently on the basis of door number three (baby's health may suffer). But then, isn't it easier to legally defend yourself against catastrophic outcomes and manage a good night's sleep when you can predict the date and time of your patient's delivery? Maybe I'm a cynic, but…
Then there's the veterinary side of the equation: As I intimated above, C-sections are undeniably less traumatic for dogs of certain breeds. Disproportionately-sized heads, as for bulldog breeds, makes me want to recommend planned C-sections. I also recommend them in cases where a "mismating," or oversized dad, has led to similarly oversized fetuses relative to the mother's more delicate frame.
But most dogs can whelp far more easily than any human can. And without assistance. The assertion that every bitch needs a C-section on the basis of "that's how it's best done for humans" is way out of line. And this from a board certified theriogenologist!!
It's proof — yet again — that education is no match for a mindset determined to cherry-pick the science in favor of a personally preferred approach.
Dr. Patty Khuly