Mylonas and Friese arrive at the conclusion that cesarean section cannot be considered an equal alternative to spontaneous childbirth (1) and should be viewed with caution and only be performed when “clear advantages” are to be gained.
Doctors who follow this advice may be in for a nasty surprise in a lawsuit if a child is injured during a spontaneous vaginal delivery supervised by them (typically severe brain damage due to lack of oxygen).
The German Federal Court of Justice (Bundesgerichtshof, BGH) regards cesarean section as a treatment alternative to vaginal delivery (a view up to now backed by general approval of the medical profession) provided that the child is exposed to significant risk in case of performance or continuation of vaginal delivery and cesarean section is a medically acceptable alternative treatment, taking into consideration the mother’s constitution and current state of health (BGH VersR 2011, 1146). If this is the case, the woman about to give birth must be informed about this treatment alternative. She even has the right to make the final decision, i.e. the mother has the final say when balancing the risks associated with each of the two treatment options (BGH VersR 1993, 835, 836).
Thus, the point is not whether cesarean section offers “clear advantages” over vaginal delivery. Such a differentiation criterion is not suitable for clinical practice as from an ex ante point of view all that can be done is to compare risks; however, the evaluation of risk is always subjective in nature.
In addition, it is striking that in their list of relative indications for cesarean section the authors completely ignored two indications playing an important role in clinical practice (breech presentation, fetal macrosomia) (2, 3).
Footnotes
Conflict of interest statement
The author declares that no conflict of interest exists.
References
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