Caesarean delivery of babies has long been creeping up on nature, and now nearly one in four babies born in the United States is delivered surgically.
In some hospitals, 30 percent to 40 percent of deliveries are surgical.
To take advantage of this trend, researchers have developed a stapler that in one motion automatically slices into the uterus and seals edges of the resulting wound with staples while creating an opening for removing the fetus. The wound later is stitched shut; the staples eventually are absorbed by the body.
This stapler is intended to reduce the amount of blood lost during a caesarean and to cut down on time needed to remove the baby, said Jon Hiltunen, a spokesman for United States Surgical Corp., which began selling the device this year.
Hiltunen said it is hoped that the cleaner wounds produced by the stapler will reduce recuperation time for a mother following a caesarean section.
One obstetrician-gynecologist who has used the stapler, Dr. Scott Pierce of Melrose Park, said he found it helpful in treating a patient whose religious beliefs forbid blood transfusions. The stapler reduced her blood loss during surgical delivery, Pierce found.
Another obstetrician, Dr. Arturo Manas of Rockford, agreed that putting staples into the wound as soon as the incision is made indeed reduces blood loss for patients and makes closing the wounds after a baby is delivered slightly faster.
Manas said he hasn`t found any difference in recovery time, however.
Although the new equipment may make surgical delivery of babies somewhat quicker and easier for physicians, that by itself shouldn`t influence the medical decision to choose caesarean delivery, doctors agree.
``The trend has been to bring staples into new areas of surgery, so it was only a matter of time until they brought it to the uterus,`` said Dr. Norbert Gleicher, chairman of obstetrics and gynecology at Chicago`s Mt. Sinai Hospital.
The increasing rate of caesarean deliveries ``is appalling,`` Gleicher said. ``Every year, it goes up another percentage point.``
In 1981, when the rate of caesarean deliveries was 17 percent nationally, a gathering of experts at a ``consensus conference`` sponsored by the federal National Institutes of Health agreed that too many surgical deliveries were being done and that doctors should try to cut the rate.
Despite that consensus, about 23 percent of all babies born in this country now are delivered surgically.
At Gleicher`s hospital, an effort was made to educate doctors about when surgical delivery is appropriate. Peer-review committees and a second-opinion procedure were instituted on a voluntary basis.
``When we started, our caesarean rate was about 17 percent,`` he said.
``Now it has dropped to around 11 percent while the national rate went up to 23 percent.``
Nationally, public hospitals, teaching hospitals and others that handle high-risk pregnancies tend to have the lowest rate of caesareans, Gleicher said, while suburban community hospitals that treat low-risk pregnancies have the highest rates of surgical deliveries.
What this suggests, Gleicher said, is that physicians delivering babies to healthy mothers in affluent suburban settings are quick to opt for surgery for reasons that have little to do with medical need.
Their doctors may fear being sued if the baby is born with any kind of defect unless they did everything possible, including surgical delivery, to ensure that the infant got top-notch medical care utilizing the latest in high technology, Gleicher said.
In some parts of the country, obstetrician-gynecologists have stopped delivering babies altogether because they say it costs too much to buy insurance against malpractice suits.
Some doctors and their affluent patients also may opt for surgery over natural delivery because of convenience. Instead of waiting for many hours through what can be a painful and tedious labor, women may ask for surgery simply to end the ordeal, and doctors who once would have declined to grant the request may now accede, he said.
Caesarean deliveries tend to build upon themselves as well. Although many studies have shown that women who have a surgical delivery can go on to deliver subsequent babies naturally, many doctors still subscribe to the old saying that ``once a caesarean, always a caesarean`` because they fear the wall of the uterus thereafter is weakened by the initial incision.
The new stapling equipment is intended to provide a more even incision and, hence, a stronger healing of the wound, its manufacturer claims. This theoretically could make doctors more confident about natural birth to a woman who has had a previous surgical delivery, Hiltunen said.
Gleicher discounted that notion, saying there is no danger now in letting a woman deliver a child naturally after she has once had a surgical delivery, so nothing the new equipment can do will change the situation.