Cesarean Birth
Cesarean sections are a surgical procedure where the baby is delivered through a incision in the mother’s abdomen instead of through the vaginal canal. Cesareans can be life-saving procedures, and can protect the well-being of mothers and babies when a variety of medical conditions arise during pregnancy, or during the labor and birth process. They are appropriate when the risks of vaginal birth for mother or baby outweigh the risks of this major abdominal surgery.
The World Health Organization recommends an overall cesarean rate of less than 15%. Healthy People 2010, from the CDC, and the U.S. Health Resources and Services Administration, sets a goal for a cesarean rate of 15.5% or less for low-risk women, and a VBAC rate or 37% or more (VBAC is a vaginal birth for a woman who had previously had a cesarean birth.)
However, the percentage of American babies born by cesarean has skyrocketed in recent years, and is currently over 29%. In 2003, for a first-time mom, the chance was 27.1%, less if she’s a woman of color (22.5% for Hispanic), it’s more if she’s older (for low-risk first-time moms over 40, the rate is 48.8%) Source: CDC
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|
1996 |
2001 |
2002 |
2003 |
2004 |
change 2003-04 |
change 1996 - 2004 |
|
Total Cesareans |
20.7% |
24.4 |
26.1 |
27.5 |
29.1 |
á
6% |
á
40% |
|
Primary Cesarean |
14.6% |
16.9 |
18 |
19.1 |
20.6 |
á
8% |
á
41% |
|
VBAC |
28.3% |
16.4 |
12.7 |
10.6 |
9.2 |
â
13% |
â
67% |
Why this huge rise? Is it because something fundamental has changed in women’s ability to give birth vaginally?
Clearly that’s not the reason.
The reasons are complex, and have to do with: changes in women’s perception of cesarean birth vs. vaginal birth; changes in the population of women giving birth, and, most significantly, changes in doctor’s recommendations for births.
· In the media, you may have heard that there is an increase in women requesting an elective cesarean instead of planning a vaginal birth. According to a Health Grades study in 2003, patient choice cesareans did rise 20% between 1999 and 2001. However, they still only accounted for 1.87% of all births.
· Another trend you may have heard of is that more older women are giving birth, and older moms do have a slightly higher chance of cesarean birth. Also, fertility treatments are more common, and these are more likely to yield twins or triplets, who are more likely to be delivered by cesarean. Again, though, this trend is a small portion of the overall increase.
· There has been a significant increase in women having repeat cesareans rather than VBACs. This is due to changing recommendations from obstetricians, and changing hospital policies. These new policies are based on a study which did show a slight increased risk of uterine rupture for VBAC moms, and a significant increase in rupture for VBAC moms who are induced with prostaglandins. Many birth professionals feel the interpretation of the study should not have been to discourage VBAC, but instead to recommend that inductions should not be done for a VBAC.
· There are several other medical procedures in common use that have all been shown to increase the risk of cesarean. These include: Induction, Pitocin augmentation, Epidural Anesthesia, Artifical Rupture of Membranes, and continuous Electronic Fetal Monitoring.
There are several risks of cesarean that need to be taken into account when the decision for a cesarean birth is made, and the current cesarean rate is alarming, in light of the severity of these potential risks. Several organizations discuss these risks at: www.vbac.com/hottopic/highestrate.html
See: Ten
Ways to Avoid an Unnecessary Cesarean
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