C-section Epidemic Part 1

Legend has it that Julius Ceasar came into the world through an abdominal incision, which is where the word cesarean came from. That's probably quite unlikely though, since no mother in those days survived the operation, yet history shows his mother lived past the birth of her son.

In 1970, 5% of American births were surgical. That rate has been climbing at an average of 1% a year since. In 2010, the US C-section rate was 32.8%. Have that many women's bodies changed in 40 years time where they are unable to give birth vaginally? What is going on? One must ask themselves that question. 

The increase in Cesarean births has not shown a corresponding improvement in mortality rates for mothers and babies- yet many of these "emergency C-sections" are because the life of the mother or baby is at risk. The women most likely to have a surgical birth have higher levels of education, are married, older, and richer- the group that one would think would be healthier and most prepared for birth. 

The World Health Organization recommends a C-section rate of no more than 5-10%. Rates above 15% seem to do more harm than good. (source: http://childbirthconnection.org/article.asp?ck=10456) Currently in America, about 1 in every 3 mothers is giving birth by Cesarean.

"Researchers have found that cesarean section rates are going up for all groups of birthing women, regardless of age, the number of babies they are having, the extent of health problems, their race/ethnicity, or other breakdowns. In other words, there is a change in practice standards that reflects an increasing willingness on the part of professionals to follow the cesarean path under all conditions. In fact, one quarter of the Listening to Mothers survey participants who had cesareans reported that they had experienced pressure from a health professional to have a cesarean.(source: http://childbirthconnection.org/article.asp?ck=10456)

So what has caused this alarming rise in C-sections? According to the above referenced article by Childbirth Connection, there are a number of factors.

1. Low priority of alternative changes that enhance a woman's ability to give birth.

-Example: using manual manipulation to change baby's breech position.Too many doctors are quick to jump to Cesarean instead of using a "watch and wait" approach in which the baby will often naturally turn on its own.

2. Too many labor interventions

-Inducing labor in first-time mothers when the cervix is not soft and ready increases the likelihood of Cesarean birth. Continuous Electronic Fetal Monitoring (EFM) has been associated with an increase in Cesareans. Having an epidural too early in labor is also associated with the increase.
-Hospitals make use of I.V.'s and monitors, drugs that speed up/slow down labor, epidurals, and more. In a few instances, these things can be life-saving, but it often leads to the mother paying a surgical price.

3. Refusal to offer the choice of a vaginal birth.

-Many doctors and/or hospitals are now unwilling to even offer the choice of a vaginal birth to women in certain circumstances. In the current environment, 9 out of 10 women are having repeat C-sections rather than being given the option of a VBAC (Vaginal Birth After Cesarean). 

4. Casual attitudes about surgery and C-sections in particular.

-C-sections have become so normal that I think sometimes people forget that it is major surgery. A woman who goes through a C-section has a much longer recovery period than a woman who births vaginally. There are also many other side effects like increased risk of infection, difficulties breastfeeding, and sometimes difficulty bonding with the baby. 

-Celebrities like Victoria Beckham have popularized routine elective c-sections. This has become normal in society. Other celebrities that have had an elective scheduled section include Britney Spears, Elizabeth Hurley, Claudia Schiffer, and Christina Aguilera. Christina Aguilera was infamously quoted saying: 

"I didn’t want any surprises. Honestly, I didn’t want any [vaginal] tearing. I had heard horror stories of women going in and having to have an emergency C-section [anyway]. The hardest part was deciding on his birthday. I wanted to leave it up to fate, but at the same time I was ready to be done early!"

 CC
Check out the folowing link:


http://abcnews.go.com/blogs/health/2012/01/09/did-beyonce-get-posh-push-caesarian/

5. Limited awareness of risks and side-effects of C-sections.

-I mentioned this in number 4. Other risks include surgical injury, blood clots, emergency hysterectomy (rare), intense and longer-lasting pain, poor overall functioning. Babies are at risk of having a surgical cut, breathing problems, asthma in childhood and beyond. Other side effects :ongoing pelvic pain, bowel blockage, injuries in future surgeries, and future infertility. There are other issues associated with the placenta, pelvis, and uterus as well. 

6. Malpractice Claims and Lawsuits.

**This is a big one now. If doctors didn't do everything they could to intervene, it could later on come back to get them in the form of a lawsuit. Many providers are quick to jump to C-sections at the slighest indication of a problem, without taking any chances.
-A 1993 study showed that the greater the number of malpractice suits in a given area, the greater the number of C-sections in that area. If a doctor "did everything," including a C-section, and the baby was still less than perfect, the jury is less likely to find the doctor at fault. Some doctors may have a fear that "the only cesearean I'll be sued for is the one I don't do."


7. Incentives for the care providers.
-According to the article, "A planned cesarean section is an especially efficient way for professionals to organize hospital work, office work and personal life. Average hospital charges are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit."

For more info:

http://www.childbirthconnection.org/pdfs/cesarean-birth-mothering-ponte.pdf 

http://www.nhpf.org/library/details.cfm/2889

C-sections only for medical reasons?
http://www.lvrj.com/news/c-sections-some-question-whether-surgery-occurs-only-for-medical-necessity-145467485.html

http://www.reuters.com/article/2012/03/23/us-cesarean-idUSBRE82M0Z020120323

http://www.theunnecesarean.com/blog