Cesarean section: science or ritual surgery?

Cesarean section has proven to be a powerful weapon in saving fetal and maternal life when scientific criteria are used in a variety of emergency conditions. However, because of the high incidence of false positive readings with fetal heartrate monitoring, cesareans are often resorted to unnecessarily. In addition, there are other marginal, nonscientific human concerns such as patient and doctor preference, convenience, fear of litigation, wish to avoid pain of labor, and other unspoken and often unrecognized issues that can lead to cesarean section. When cesarean section is resorted to for the above reasons, it becomes ritual surgery. It is time to recognize two sets of criteria for cesarean sections: first, scientific criteria that would save the life of the mother or fetus, or unequivocally guarantee better fetal outcome; and second, nonscientific criteria based on personal preference of doctors and patients. If doctors were candid about these two sets of criteria, patients would not be pressured into cesareans by minor, often transient and misleading, abnormalities on fetal monitors. They would not have to experience ritual surgery unless it was clearly their choice to do so.