Understanding the High C-section Rate in the US

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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.

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