CNN reports that rates for Ceasarean Sections in the United States have risen to almost 30% of live births. Almost a third of all births.
FACT: According to WHO, there is no reason — no reason — that any medical center have a C-section rate of more than 12%, and that high only for the centers dealing with the most critical and complicated of cases. So, more than half of the C-sections done in the U.S. are done unnecessarily.
U.S. public health officials have a goal of bringing the C-section rate down to 15% by 2010. It’s quite a lofty goal, given the current state of things, so I thought I’d make some friendly suggestions:
— More birth centers, more midwives, more doulas. These professions should be recognized as legal in all states and be covered by insurance, regardless of where the mother delivers (in a hospital, in a birth center, or at home.)
— All birthing women should have doulas.
— Low risk women with non-complicated pregnancies should see midwives in birth centers, or at the very least, be encouraged and supported to do so. Women who are high risk or develop risk patterns should be referred to OBs. OB practices should be limited to those who need OB services, i.e.: women who require medical intervention. (Incidently, this is the safest option for women with low-risk, normal pregnancies. Women who fall into low risk categories are the least at risk for complication by planning a birth outside of a medical system; delivering with an OB within a medical system actually places them in a higher risk category because of the strong likelihood (read: certainty) that they will receive medical interventions that are unnecessary.)
— Good birthing education should be given to pregnant mothers. Chuck the “welcome to your medicalized birth” psuedo-education offered at most medical centers.
— Train OBs to handle vaginal births. Including vaginal deliveries of twins and breech presentations.
— Breech deliveries should not be mandatory C-sections. My C-section was unnecessary.
— VBAC births should be commonplace. The CNN article misleadingly stated: “…doctors became worried by studies that showed that women who deliver vaginally after having a C-section earlier suffer a ruptured uterus — a potentially lethal complication for both mother and child — in about 1 percent of such cases.” What this is leaving out is that the ruptures were caused by the medications given to the women in labor, most specifically pitocin, which is a very dangerous drug that causes uterine muscle to contract. Why this drug may lead to an increase in uterine rupture for women with a Ceasarean scar should be obvious. There is no statistical increase in risk for women who proceed with a vaginal birth without these interventions.
Is a safe birth too much for American women to ask for?
eli | 17-Nov-05 at 6:24 am | Permalink
I would say some of this is driven by the insurance industry as well which has convinced Americans they do not need preventative or non-critical care.
As a graduate student it shocked me that my insurance would pay for an abortion, vasectomy, or any type of procedure surrounding STDs, BUT would not pay for birth control, would not pay for hospital stay due to pregnancy, would not pay for an annual exam for women! So the insurance would rather pay for critical care and “oops” than take the path of preventative care.
Now that I have insurance through my office, my choices are better but only because my employer makes pregnancy and motherhood a priority.
I realize too that many women are getting pregnant for the first time much later than our parents. As I prepare to get pregnant my friends and family offer more sound advice on all the options of pregnancy and motherhood. In fact if left to the doctors and insurance companies, the only options I would hear about are the ways to get pregnant through multiple birth fertility centers AND which hospitals offer the best post pregnancy care.
The only question about C-sections that I have to pose to some (not all by any means) women is did you pick it because it could be scheduled?
deb | 17-Nov-05 at 7:02 am | Permalink
There is some evidence that the increase in C-sections is related to scheduling a birth. More likely, though, the rise is related to physicians trying to protect themselves from malpractice suits. In truth, an insurance company would rather pay for a vaginal birth than a C-section. These same folks sell malpractice insurance for exhorbitant rates.
when a child is born with a congenital defect, the parents will ask all kinds of quesitons, and sooner or later, they will ask, did I get the right medical care during the birth? If they ask the right people, there will be a law suit.
The history of the medicalization of childbirth is an interesting one. Most physicians stayed away from childbirth until the invention of the high-forceps. Docs knew that most births were normal ones and that midwives and mothers could help the birthing woman without problems. They didn’t want to get out of bed to attend a birth since they really had little to add.
When instruments (forceps) could be introduced into the process, and doctors could control things, they started to take over. The result? Huge maternal death rates due to puerpural fever. Docs didn’t wash their hands between deliveries. Midwives only work with one woman at a time, and so they do not pass infections from one laboring woman to another.
There is lots more, but I won’t bore you with all of this for now.
I wish you luck, eli, with your parenting plans.
Violet | 17-Nov-05 at 7:24 am | Permalink
I don’t know about the research, I’ve been out of that loop for a long time, but I am working at a large teaching/research hospital, and from an observational standpoint it looks like many sections are driven by fear of malpractice (so, at the first irregular “blip” on the monitor, they run for the OR) and also the need to teach young docs how to perform the surgeries.
Holly | 17-Nov-05 at 8:00 am | Permalink
Yes, the pressures of malpractice absolutely drive the rise in C-sections. Or, better explained, the concern of malpractice encourages increasing levels of intervention (electronic fetal monitoring, for example.) The problem is that when you introduce one intervention, it leads to additional interventions… ending, finally, with the Ceasarean. In other words, the situations which “cause” C-sections are more related to the medicinal management of the birth than problems of the birth itself.
Birth is a natural, non-medical experience (i.e.: laboring women are not “sick”) and defining what is “normal” in labor is exceedingly difficult. What is outside the realm of what we define is “normal” is not necessarily “abnormal,” in fact many of the standards for “normal” in childbirth are somewhat arbitary. But, we are so accustomed to aggressively treating what is not “normal” that we rush to medical “solutions” when it is not entirely necessary. We are also raised with the (false) idea that birth is a trauma: filled with screaming and unbearable pain, driving women to be lunatics (remember Murphy Brown?) and in those situations, looking to doctors to “heal” us makes sense. (And frankly, being strapped to a bed without being able to walk absolutely makes labor unbearably painful! That’s a clue that it is probably not the best course of action!)
I’m not trying to give OBs a hard time. They go through incredibly rigorous training to learn how to save women and children, a noble cause by anyone’s standards. However, it is important to remember that this training occurs within a certain paradigm, and that this paradigm positions medicine intervention as the focus of care. Additionally, their training focuses on “normal” versus “abnormal” — even though those distinctions don’t work so well within the construct of childbirth — and are highly sensitive to risk of malpractice, which means they *want* to use medicine to control the delivery. It is in their best interest to have technological documentation (because we trust that so much more than we trust any one person’s experience, another problem within itself). Also, many women seek OBs specifically out of fear of pain in labor. So many OBs are simply giving women what they ask for… leading to a highly medicalized experience.
I could go on and on about so many issues here… fetal monitoring, induction, birth positioning, epidurals, and more, but the bottom line is that these are techniques developed for medicine, and are certainly important for those deliveries which are high-risk. However, for the overwhelming majority of women, these are unnecessary and lead to additional interventions that push the Ceasarean rate to unnatural highs.
The key, I think, is in changing our birth paradigm to one more aligned to childbirth as a natural process, rather than a medical event. Encouraging women to use the appropriate level of services, for example, midwifery care for normal pregnancies and OB care for high-risk pregnancies (as is done in many European countries) is a place to start.
Elizabeth | 17-Nov-05 at 8:30 pm | Permalink
I would only add the hospitals may also benefit from the increase in C-section rates since they can bill more. When I was researching this while pregnant I read that some hospitals stand to lose upwards of 1 million dollars per year if their C-section were to fall to an acceptable 15%. That said, they may have little to no interest in setting practice standards that would lead to a decline C-sections.