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Doctors Look at Rising C-Section Rates
Almost one-third of all US births are by Cesarean section, the highest rate ever. Doctors are expressing concern about why this is happening, and some researchers are studying techniques that could help lower the rate of c-section births.
C-sections are one of those topics that can get people scrambling to their battle sections in seconds, so the balanced, well-researched tone of this excellent Detroit Free Press article is very welcome. Reporter Patricia Anstett lays out the reasons doctors believe C-section rates are climbing, including the fear of getting sued, fetal heart monitors which give bad data about a baby’s heart rate, labor-inducing drugs which can restrict a baby’s movement, and lack of good evidence about who might benefit more from a c-section (such as an older mother, or someone with high blood pressure or gestational diabetes).
Also, the article states, younger doctors rarely learn techniques to deliver a baby who’s in breech position. One doctor called such knowledge a lost art.
I think one of the bigger factors is the 2004 American College of Obstetricians and Gynecologists report which recommended that women not be allowed to try to give birth vaginally after a c-section unless their hospital had anesthesiologists and obstetricians available around the clock (not simply on-call). Most small and medium-size hospitals now forbid VBACs.
However, as this sidebar to the story says, a major NIH conference starting Monday is going to look again at the VBAC recommendations and is expected to issue new guidelines.
Dr. Ted Jones, interim chief of obstetrics and gynecology at Wayne State University, said the choice should be a product of a discussion between women and their doctors. “We wouldn’t want patients to feel they failed themselves or their child if they have to have a c-section. None of us particularly want the pendulum to swing the other way, so that women feel a c-section and a vaginal delivery are so essentially equivalent that women wouldn’t try a vaginal birth.”
Photo: Patricia Beck, Detroit Free Press
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8 Comments
Larissa commented on Mar 04 10 at 5:56 pmThe NIH conference is available on webcast to view live or after the fact. Check it out!
tcufrog commented on Mar 04 10 at 11:27 pmMaybe they should consult with some certified nurse midwives. Well trained ones seem to better at avoiding c-sections and episiotomies.
PlumbLucky commented on Mar 05 10 at 10:19 amFWIW – the hospital I went with for my first delivery was quite upfront (as in, it was in the paperwork you got from my doc’s practice during your first prenatal visit) that they would permit neither a VBAC nor a vaginal breech delivery due to insurance reasons, they were automatic C-section.
katekilla commented on Mar 05 10 at 10:22 amThis is such a big deal, and I wish more people were writing and talking about it. I have a lot of friends who had C-sections and while I would never want them to feel guilty or bad about having C-sections, many of them do. And many of them, when talking about why they had a C-section, talk about factors that I know are do not necessitate a section at all — for a “big baby” that turned out to be 8 pounds, for a posterior presentation (both of mine were, and they were born vaginally), for “failure to progress” after just a few hours labor. I think this is a trend that is strongly driven by doctors and hospitals and insurance companies looking to mitigate liability and ensure quicker, more predictable deliveries. And women get talked/scared into them because OF COURSE we all want healthy babies above all else.
Maybe the only way to truly address the issue would be to research and publicize further the actual risks to C-sections — too many women still feel they are somehow safer, at least for baby, when in fact they are MORE dangerous for women, and in many cases have adverse effects on babies as well.
hawkeyemom commented on Mar 05 10 at 2:09 pmI completely agree with katekilla;s comments. I had two c-sections, one for a breech baby and the second because the baby was posterior and transverse. The first one I had no choice due to hospital policy on breech babies. My second I tried for the natural birth I wanted, but after 27 hours and no progress plus horrendous back labor, they did an ultrasound and determined that the baby’s position made it almost impossible for me to have a natural birth. I don’t regret the decision that we made. We had a lot of great input and support from our doula, midwife and the obs. They were all proponents of vbacs, but all felt that the c-section was the best option at that time. I feel that my experiences are reasons c-sections should be used. That said, I feel that many women are hugely misinformed and uneducated about the true risks of c-sections to not only the mother but the baby as well. Too many people think it’s the easiest and safest option. I think there need to be stricter guidelines on when a c-section is truly necessary, especially for optional/scheduled c-sections. Doctors need to keep talking about it and being honest with their patients! And patients need to educate themselves about what the risks are and what is the best and SAFEST option. They need to ask the right questions of their doctors, and make sure they are given all of the information they need to make an informed decision.
tripmom commented on Mar 05 10 at 3:39 pmI wonder how much of the increase could be due to women choosing repeat c-sections because of convenience. I have had two successful VBACs, but both times I chose that option up front, the Dr. reminded me that I could have a repeat C and be able to schedule it after 39 weeks. Very appealing, especially as I had more and more little ones at home. Going into labor at 3 in the morning can be very inconvenient!
Kampygert commented on Mar 06 10 at 8:33 amSeven years ago when I skipped my scheduled birthing date and politely declined strong suggestions that I do a C (don’t even remember them bothering to give a ‘reason’), doctors treated me like a certifiable nut-job kook. “Vaginal birth is DANGEROUS,” they said. “Your baby could DIE!” After a completely normal uneventful vaginal hospital birth, they kept us for three days in the hospital waiting for signs of fever or other illness. When absolutely nothing bad happened, the hospital staff counted it as yet another example of how children survive despite their idiot parents. I really wanted to say, ‘hey, you don’t feel just a little ripped off that after all that time and money in obgyn school no one went over regular child birth?’
katekilla commented on Mar 07 10 at 8:49 amInteresting article about how one hospital has cut its C-section rate: http://www.nytimes.com/2010/03/07/health/07birth.html
A lot of it has to do with a culture in which women accompany other women giving birth, so that even younger women have often seen a birth or several before their own. I think this is interesting — so many modern American women have no idea what a natural birth looks like and of course it’s terrifying.
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