Family Matters

C-Sections on the Rise, Especially for Black Moms

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Get that scalpel ready: Nearly one of every three births in 2008 — 32% — was a C-section, according to an annual report that tallies trends in births and deaths. Black mothers were most likely to deliver their babies that way.

Since 1996, the cesarean rate has soared a whopping 56%, according to the Annual Summary of Vital Statistics: 2008, a report from the National Center for Health Statistics and the Johns Hopkins Bloomberg School of Public Health.

“I personally don’t think it’s a good thing,” says George Macones, vice chairman of the American Congress of Obstetricians and Gynecologists (ACOG) and an obstetrician at Washington University in St. Louis. “The rate is going up but we are not really improving the health of babies or moms.”

The report, published online today in the journal Pediatrics, is an annual feature that serves up lots of fascinating facts about how people arrived and departed from this world. For example, there were 2% fewer babies born in 2008 than the year before, when the U.S. birth rate hit a record high. There were 4,251,095 babies born in 2008; their life expectancy is 77.8 years. (More on Who’s Too Posh to Push? High Cesarean Section Rates Aren’t Moms’ Fault)

The steady march of C-section deliveries is of concern to many mothers and health professionals because vaginal birth is generally safer. But some women — and doctors — prefer to schedule delivery. And doctors and hospitals concerned about skyrocketing medical malpractice rates have increasingly turned to cesareans rather than risk a bad outcome via vaginal birth. In some areas of the country, it can be difficult if not impossible to find a doctor who will agree to let a woman attempt a VBAC, or vaginal birth after cesarean, due to worries about uterine rupture.

The trend cuts across demographics, with cesareans increasing for all racial and ethnic groups as mom gets older. In 2008, black women had more C-sections than any other group — 34.5% delivered via cesarean in contrast to 32% of whites and 31% of Hispanics.

Is it because black women have more troubled pregnancies? Probably not; in 2005, a study showed that black women had a better chance of having a C-section, even among low-risk first births. (More on Time.comUnderstanding the High C-section Rate in the US)

C-sections can be more common when the mother has diabetes or hypertension or has labor induced, yet those conditions didn’t appear to explain the discrepancy. What might be to blame is obesity, which research has shown ups the likelihood of cesarean deliveries. Black women are more likely to be obese than white or Hispanic women.

“Although it seems that obesity has an influence on the differences in cesarean-delivery rates according to race and Hispanic origin, it is unclear how strong that influence may be,” states the report. “Other possible contributing factors…are maternal choice, patient education, and physician practice patterns.”

“It was just a suggestion—the obesity explanation,” says Michelle Osterman, a member of the natality team at the National Center for Health Statistics and an author of the 2008 report. “We’re just putting it out there to say hmmm, maybe. Black women have consistently had these higher rates since 1994. We’re trying to figure out why. There’s no one answer.”

Earlier this month, a black mother who delivered her first three children via C-section defied her doctor and triumphantly birthed her fourth child vaginally, with the help of a midwife at home. She was unable to find a doctor who endorsed VBAC, but other women in similar situations may soon find doctors more open to the idea. Over the summer, ACOG issued a recommendation to its members to discuss the option of VBAC with their patients, indicating a shift in the group’s willingness to consider the procedure for moms who have previously had a C-section. (More on Time.comPolicy Change Aims to Reduce C-Section Rate)

Any woman having a baby should care about the cesarean rate,” says Desirre Andrews, president of the International Cesarean Awareness Network, an advocacy group that promotes vaginal birth. “They should be concerned about the likelihood of ending up in the OR because we know what is healthiest is unfettered birth. Women are starting to believe they can’t have babies. It’s becoming the cultural norm for women to believe they’re broken.”

Other interesting tidbits from the report:

* Teen births declined by 2%; rates had increased in 2006 and 2007.

* For the first time since 1978, births to women between 35 and 39 declined — by 1%. Births to women between 20 and 39 also dipped, in contrast to births to women ages 40 to 49, which rose.

*Fewer babies were born too soon: the preterm birth rate decreased by 3% to 12.3%.

* Fewer babies died: the infant mortality rate dropped by 2%.

* Unintentional injuries were responsible for 39% of deaths in children ages 1 to 19. The second leading cause of death in this group? Homicide.

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