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When it comes to rising C-section rates — the most recent available numbers show 32 percent of births in the US are Cesarean — the list of reasons is fairly stable. There are pressures from hospitals that fear law suits, medical interventions like induction, a rise in multiple births, a rise in repeat C-sections, scheduling considerations for doctors and patients, limited training in alternatives to C-section, the list could go on. But a lack of medical research is not usually on the list, and yet that’s just what doctors in England are setting our to change by researching medications that could be used to reduce C-section rates.
VBACs are great, but maybe not for everyone
Writing on the Babble blog Being Pregnant, Danielle Elwood notes that, despite the American College of Obstetricians and Gynecologists’ recent guideline changes encouraging doctors to support women who want to try for a vaginal birth after having had a C-section (VBAC), in many areas of the country, women still have difficulty finding a doctor or hospital willing to support that choice.
“It got me thinking about this, when there are no other options, what happens to these women?,” Elwood writes. “Sadly the answer is pretty cut and dry. They are forced to undergo a cesarean section again, when it is not medically necessary, or even wanted in the cases of the mother. Sounds like a human rights violation considering this is not something they wish to take part in.”
Elwood, rightly, worries about the safety of these women who, bereft of options, sometimes take matters into their own hands, “like a woman I spoke to earlier in the year who planned to have an unassisted birth at home, because her local hospitals had banned VBAC, and it was illegal for a midwife to attend her delivery in her state because of outdated birthing laws.”
Elwood writes that the lack of choices these women face – and possible consequences – makes her angry. It makes me angry, too. I wholeheartedly agree that every woman who is giving birth should have access to the full panoply of choices available to her, and be able to weigh the benefits and demerits of each and make her own decision.
But as a woman who very deliberately chose to have a second C-section after having tumbled down a complication-strewn slope (low amniotic fluid led to induction led to an “idiosyncratic response,” which led to … you don’t want to know) into the first one, I also worry a little bit about a backlash brewing for women who don’t choose to attempt VBACs. Continue reading »
A study released yesterday in the American Journal of Obstetrics & Gynecology confirms one thing we already knew: the rate of cesarean births is rising–it has doubled since 1996 and now accounts for one third of all births in the U.S.
What it also shows is that elective c-sections aren’t the culprit. Only nine percent of scheduled cesareans are performed for non-medical reasons (making them truly elective). The real rise in c-sections may be due to the practice of inducing labor before baby and mom are really ready.
The study of 230,000 deliveries shows that moms who are induced are twice as likely to have a cesarean birth as moms whose labor starts spontaneously. And after labor does start, almost half of c-sections happen because of “failure to progress.” Research seems to show that inducing, even when baby is considered full term, carries certain risks. But lots of doctors choose to do it anyway.
There’s nothing wrong with choosing a c-section–the problem here is that moms who don’t want a c-section are ending up with one anyway. Continue reading »
How’s this for a reversal?
The American College of Obstetricians and Gynecologists is set to issue a new set of guidelines intended to make it easier — easier! — for women who have already undergone a c-section to give birth vaginally.
ACOG’s new guidelines say that normal birth (meaning vaginal) is safe for most women who have had prior Cesarean sections, as long as the incision was low and horizontal — the typical cut for c-section births.
Women’s health advocates praise the new guidelines, especially in light of the evidence that VBACs are safe. Some 60 to 80 percent of women with a prior c-section who are allowed a trial of labor in subsequent pregnancies have successful VBACs. Continue reading »
Concerned that doctors and hospitals are thinking more about legal ramifications, rather than a woman’s health, the National Institutes of Health issued a statement today essentially telling doctors and hospitals to stop banning vaginal births after cesareans.
Instead, a NIH consensus panel recommended that pregnant women and their caregivers use evidence-based decision-making in deciding whether to attempt a trial of labor rather than scheduling a c-section. In other words, enough with the anecdotes, we know you’re putting potential lawsuits ahead of patients, look at the science. Continue reading »
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, Continue reading »
If you’ve already got nine kids, getting your tubes tied is certainly not an outrageous decision to make. Perhaps especially if you’re only 35, unmarried, unemployed, and at least partially dependent on public assistance. But even so, it is not a decision to be made lightly. It is a surgical procedure with all the risk that implies (mortality rate in industrialized nations is 4 in 100,000) and may cause post-procedural side effects. So imagine the outrage of a woman who went into the hospital for a cesarean section and came out with a tubal ligation as a bonus!
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