Used to be that cesarean sections were a rare surgical procedure, considered a last resort for doctors and women alike. But it seems like the tide has shifted in a way that's not best for moms and their babies. Info on a new Consumer Reports investigation of more than 1,500 hospitals in 22 states finds that in many hospitals, far too many unnecessary C-sections are being performed.
Here, what you need to know about the findings ...
- The average C-section rate for low-risk deliveries among the hospitals Consumer Reports looked at was about 18 percent—a dramatic jump from the national average of 12.6 percent in 2000.
- While the C-section rate is going up, the infant death rate in the U.S., while low, is higher than that of most other industrialized nations. And the maternal death rate actually increased slightly from 1990 to 2013, according to an analysis published online in The Lancet medical journal.
- C-section rates vary dramatically—even between neighboring hospitals. For instance, almost 55 percent of pregnant women anticipating low-risk deliveries (in other words, they haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned) end up undergoing a C-section at Los Angeles Community Hospital. But at California Hospital Medical Center, also in Los Angeles, the rate of C-sections for low-risk deliveries is 15 percent; at Western Medical Center Anaheim, 28 miles away, it’s about 11 percent. And because a hospital’s C-section rate can be hard to find, it’s likely that most families are unaware of the huge differences in medical practice, notes Consumer Reports.
- C-section—the second most commonly performed surgical procedure in the country, requiring a 6-inch incision in the abdomen and a second through the uterus—is major surgery, and thus takes longer to recover from than a vaginal delivery and also carries additional risks.
- Nineteen percent of women who’ve had a C-section report pain at the incision site being a major problem in the two months following delivery, according to a national survey called Listening to Mothers III.
- Almost two-thirds of women in the Listening to Mothers survey who had their first C-section said their doctor was the decision maker, and more than one-quarter said they felt pressured to have the surgery.
- Women with C-sections were more likely to say that the pain lasted six months or longer, too.
- Compared with women giving birth vaginally, healthy, low-risk women undergoing their first C-section were three times more likely to suffer serious complications—such as severe bleeding, blood clots, heart attack, kidney failure, and major infections—according to a 14-year analysis of more than 2 million women in Canada.
- Babies delivered vaginally are less likely to suffer breathing problems and more likely to be breastfed.
- Some research suggests that over the long-term, babies born vaginally may be slightly less prone to chronic ailments such as asthma, allergies, or obesity, perhaps due in part to a protective effect from beneficial bacteria transferred from the mother during birth.
- Far fewer babies are born on holidays such as the Fourth of July or days around Thanksgiving or Christmas, according to data on births compiled for Consumer Reports by the Centers for Disease Control and Prevention. That may be because hospitals tend to schedule C-sections for times when they are well staffed—or because doctors, and even some mothers, may not want deliveries to interrupt their holidays.
- Attempts to schedule births requires increased use of interventions such as inducing, or starting, labor before a woman’s due date, which might increase the risk of cesarean delivery, or just scheduling a C-section from the start.
- Many doctors intervene because they think that labor is moving too slowly and that longer labors lead to complications. But those assumptions are based on outdated information.
- High C-section rates make hospitals more money, because Medicaid and private health insurance pay about 50 percent more for C-sections than for vaginal births. So there's less incentive for them to lower the rates.
- As a result of soaring C-section rates, numerous health organizations have made it their priority to lower them. For example, in March 2014, two major women’s health organizations—the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM)—teamed to publish new practice guidelines aimed at preventing unnecessary cesarean births.
Does this change the way you think about cesarean sections?
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