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LETTERS: Jacqueline Doyle Surgical solution is becoming acceptable, as for birth BMJ 2007; 334: 1179-d-1180-d [Full text]

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Needless Surgery

Robert G Buist   (9 June 2007)

Needless Surgery 9 June 2007
Robert G Buist, Visiting Obstetrician Royal Hospital for Women, Barker St Randwick New South Wales 2031 Send response to journal: Re: Needless Surgery	I disagree with Ms Doyle comparing labial cosmetic surgery with caesarean childbirth (1). The rise in ceasrean section rates has - in part at least - been based on evidence that in certain clinical situations caesarean section may be safer for the baby than attempted vaginal birth (2,3,4). In addition planned vaginal birth - even in uncomplicated women - is associated with risks for the baby (5) and the mother (6). Therefore a woman choosing a caesarean is trading off the maternal (and very rare perinatal) morbidity of a caesarean for the maternal morbidity, perinatal morbidity and (very rare) perinatal mortality of planned vaginal birth. This situation is not analogous to cosmetic surgery because not undergoing cosmetic surgery has no associated risk of physical (at least) harm. References: 1. Doyle J. Surgical solution is becoming acceptable, as for birth. BMJ 2007; 334: 1179 - 1180. 2. Hannah ME, Hannah W et al. Planned caesarean section versus planned vaginal delivery for breech presentation at term; a randomised multicentre trial. Lancet 2000; 356: 1375 - 83. 3. Landon MB, Hauth JC et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351: 2581 - 4. Smith GCS, Shah I et al. Mode of delivery and the risk of delivery - related perinatal death amongst twins at term: a retrospective cohort study of 8073 births. BJOG 2005; 112: 1139 - 44 5. Badawi N, Kurinczuk JJ et al. Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study. BMJ 1998; 317: 1554 - 58 6. Rortveit G, Kjersti Daltveit A, et al. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003; 384: 900 - Competing interests: None declared