Understanding the High C-section Rate in the US

The percentage of babies born by Cesarean section remains high, with one in three first-time moms giving birth via the surgical method according to the latest government study.

Scientists belonging to the Consortium on Safe Labor, a research project supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, conducted a detailed analysis of when C-sections were performed to deliver more than 220,000 infants in 19 hospitals between 2002 and 2008. Overall, 30.5% of births were by Cesarean, and one third of first time mothers delivered their babies this way. Another third of Cesarean deliveries occurred in women undergoing a repeat, pre-labor Cesarean after delivering this way previously.

The high rate among new mothers was surprising to lead author Dr. Jun Zhang, who noted that factors contributing to the trend could include everything from the older age of mothers, higher BMI and greater multiple births. While the study did not specifically address these factors, other analyses have also pointed to issues such as rising malpractice rates for obstetricians which can push doctors to be more conservative in advising women who are older or have any chance of developing complications during delivery to chose C-section instead of vaginal delivery.

The current study seems to support that explanation, as among women who began labor and ended up having a C-section, many had the surgery when they were only 6 cm dilated, which is considered to still be an early stage of labor. The authors also found that 43% of women attempting vaginal delivery were induced, another trend that suggests physicians and patients are less likely to wait for a potentially lengthy labor to take its course. “It’s something that is important for practicing clinicians to know, that as long as maternal and fetal health are doing well in labor, they can wait longer and perhaps reduce the Cesarean rate,” says study co-author Dr. Katherine Laughon.

In a telebriefing, the authors noted that their findings point to several factors that may lower C-section rates in the US. For example, the success rate of women delivering vaginally after a prior C-section was nearly 60%, suggesting that more women could avoid C-sections as long as their physicians were competent and comfortable with allowing them to attempt vaginal delivery. Yet less than 39% of women who had had a prior C-section attempted to deliver their next child vaginally. The findings support recommendations by the American College of Obstetricians and Gynecologists which earlier this year noted that 60% to 80% of women who attempt to deliver vaginally after a previous C-section will be successful.

kelly415

The US is unique among industrialized nations in both it extraordinarily high rates of induced labor, C-sections, and quite notably, shockingly low use of certified midwives. The US also has inexcusably high mother & baby deaths in child birth. Hospitals and obstetricians are too influenced by financial and legal considerations to the detriment of mother-baby health. Note that induced labors are highest around 4pm and 10pm, hours of convenience to the doctors. A great many expectant mothers are frightened and coerced into induced labor and C-sections at a time when they are the most vulnerable. It is a major disgrace.

This from a recent CNN report:
“…the United States has the second worst newborn mortality rate in the developed world, according to a new report…
American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.

Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.” http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/
Also visit this website for good, reliable, non-commercially driven advice for expectant mothers: http://www.mybestbirth.com/
tinas64

Avoiding a repeat c section depends upon the Dr and the previous surgery.If the client has a vertical incision on the uterus, a uterine rupture is more likely to occur for a VBAC. Most women don’t get their detailed medical records for this information. If there is a healthy dialogue with the client, and midwives or Doulas are encouraged to be a part of the streamlined medical system this would help to reduce C Sections. If Dr’s performed and closed women in a consistent and complete manner, a successful recovery and better health would follow. One of the issues in recoverying from a cesarean is the lack of binding, the lack of scar care, and the fact that 50% of all Dr’s don’t suture the peritoneal sac, to reduce abdominal adhesions, and sometimes only suture the uterus on one layer, thereby creating a weak situation for the next pregnancy.There is information on c section recovery and kits available to women to promote education and awareness. This is a new part of the health care revolution.
melgirl425

Good coverage here of an important issue. It makes clear something that’s been known for a while. Many women are undergoing cesareans unnecessarily.

One note for Alice Park: I wish reporters would stop saying doctors are being “conservative” in being quick to do cesareans. This implies they are being cautious, erring on the side of safety. And, gosh, who can blame a doc for being extra careful with a mom and a baby? But, in fact, cesareans carry short term and long term risks – including blood loss, chronic pain, breathing problem in the newborn and death. Maybe OBs are being more “conservative” in terms of their own liability exposure, but when they make the decision to perform a cesarean on otherwise healthy moms, who often just need a bit more time/support to have a healthy vaginal birth, they are playing fast and footloose with both mom and baby. That’s not “conservative” to me, and implying that just perpetuates the myth that cesareans don’t carry risks and that vaginal birth is fraught with peril. Of course, every woman’s story is unique and cesareans can be lifesaving in many situations, but looking across large populations, it’s clear that cesarean is generally going to be a riskier way to deliver a baby.

For more insights into what’s really fueling the jump in the cesarean rate, look to Childbirth Connection for an excellent overview: http://www.childbirthconnection.org/article.asp?ck=10456
paclac

As perinatal experts, we are well aware that the more medical interventions a pregnant women has, especially elective inductions, the greater the chance of a C-section. We are concerned by the high rates of primary Cesarean Sections, and are working with hospitals, OB/GYNs, labor and delivery nurses, and other healthcare professionals to promote the use of evidence-based practices and standardized criteria for when to induce and/or perform a c-section.

Cindy Fahey, MSN, RN, PHN, Executive Director, PAC/LAC
http://laughs4dads.wordpress.com laughs4dads

The rise in C-section rates indicates, obviously, a dramatic rise in wisdom over the years. Personally, I think it should be closer to 85%, which would allow for a 15% incidence of masochism.

On one hand, we have: pick a date; make an appointment; have a safe operation; give birth to a baby without a misshapen head; rest up for a couple of days; go home.

On the other hand, we have: breathing classes; extreme pain; running around like lunatics; not being able to schedule meetings around the due date; not being able to print the birth announcements until after the birth; more pain; some pain for the mother, too; worrying about hitting traffic on the way to the hospital; and the baby coming out looking like a conehead. Then getting almost immediately evicted from the hospital by your insurance company. Or, of course, you still have a 3-in-1 chance of ending up with a C-section anyway!

How is that even a choice? Choosing a Caesar salad is a tougher decision! (more at laughs4dads.com)