C-Section Rate May Reach 50 Percent

operating room c-sectionTempers often flare every time c-sections are mentioned, but one thing is clear: Our rates in the United States are way too high. Despite a goal set in 1998 to have the rate in 2010 at 15 percent, instead we went the other way. The c-section rate is now around 32 percent. That's almost 1 in every 3 babies being born via cesarean. It doesn't take an anthropologist to know that something is wrong here -- our births do not have that many complications to make that high number necessary.

Deputy Editor, Dr. John T. Queenan writes in an editorial that the rate is likely to soon exceed 50 percent, and if nothing is done to curtail it, he feels that doctors will lose credibility and perhaps the government will become involved.

Yikes. But what CAN be done? And what is the problem in the first place?

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Queenan points fingers at insurance and malpractice, as do many people -- despite the knowledge and push to encourage VBACs, many malpractice insurances don't cover them, so doctors, or even entire hospitals, refuse to do them. Also many doctors are paid much more for c-sections, but VBACs are more time-consuming since the doctor is required to be there on-hand throughout the labor in some places. Many people suggest paying doctors the same regardless, though many argue that a natural birth shouldn't cost the same as someone who underwent major surgery.

More fingers are pointed at the fact that breech births often aren't even taught anymore (though proven to be safer than a c-section), and some OB med students graduate, saying never once in their training did they see an actual intervention-free birth.

Dr. Caroline Signore of the Eunice Kennedy Shriver National Institute for Child Health and Human Development says that since for the most part, moms and babies usually come out of c-sections okay, women have a false sense of invincibility -- or at least an inflated sense of safety about a surgery that is still much more invasive than a gallbladder or appendix removal.

Another need is honest education from OBs and other sources about the risks that are involved and education on the causes of unneeded c-sections, such as induction and other interventions that often snowball what could be a typical birth into one that is an emergency. In fact, research with the American College Obstetricians and Gynecologists suggests that many mothers are still requesting inductions even with an unfavorable cervix (which makes the induction likely to fail) for reasons like having control over the timing of their maternity leave.

The World Health Organization says that a push back to evidence-based practice (something the ACOG has been under fire for not following) would help lower the rate all by itself, and that constant monitoring often creates false worries which many doctors act on prematurely or unnecessarily.

Honestly, I think we just need less intervention, more patience, less legal jargon, more VBACs. But it isn't that simple. How do we stop doctors and patients wanting a c-section? That answer is so much more complicated.

What do you think would help lower c-section rates in the US?

 

Image via isafmedia/Flickr

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