Saturday Special – Cesarean Birth in the US

The Rise of Cesarean Births in the United States
by Baby Steps 2008

In 1970, the cesarean rate in the United States was about 5%2.  The electronic fetal monitor, though invented in the 1960s3, came into wide use in the 1970s.  This device brought with it a rapid increase of cesarean rates.  The studies on the electronic fetal monitor all say the same thing: it increases cesarean rates without improving outcomes for babies.  It is widely used to provide evidence for malpractice lawsuits, but even its benefit to doctors in lawsuits is unproven at best, because of the subjective nature of interpretation of the strips EFM produces.

Other medical interventions may increase the risk of cesarean.  More than 80% of women in the United States give birth with an epidural, and at least 60% of births  are artificially induced with a synthetic hormone that simulates contractions.  These interventions and others may increase the risk of fetal distress or “failure to progress,” leading to more cesareans.

There is a lot of talk these days of “maternal choice” c-section.  If you watch the news you might believe that the majority of women are having c-sections by choice.  However, according to the Listening to Mothers II Survey from 2006, maternal choice c-section is rare.  Of the 252 women in the survey to have cesareans, only one was by choice. 4 While celebrities having elective cesareans are all over the news, we rarely hear about the many celebrities who choose to give birth at home, or in the hospital vaginally.

More than anything else, we hear about lawsuits driving the cesarean rate up.  It is true that obstetricians pay very high malpractice insurance premiums, and that courts tend to view cesareans as the gold standard for birth. However, the risk of being sued is not as high as most  probably believe.  Why do many homebirth midwives maintain cesarean rates of 3-5% without the ever-present fear of lawsuits?  There are many reasons for this, but one is the personal connection made with a midwife.  When women are given the information they need to make their own decisions about their care, they feel empowered and in control of their care.  Many families have reported that they sued simply to find out what happened.When families are given full information to make an informed consent or refusal, they are less likely to sue when things go wrong because they were involved in the decisions, and there is no question about the care they received.

Risks and Benefits of Cesarean Sections

There is no doubt that when a c-section is truly necessary, it can be life-saving for a mother and/or baby in trouble.  We are lucky to live in an age where technology is available to us when we need it.  Still, there are many risks involved in having a cesarean that aren’t present with a vaginal birth5 and the decision to do one should be weighed carefully:

The maternal death rate from a cesarean birth is 1 in 2,500, compared to 1 in 10,000 from vaginal births.

Risk of surgical injury to the bladder, uterus, and blood vessels (about 1 in 200)

Increased risk of maternal hemorrhage and hysterectomy

Blood clots in the legs

Pulmonary embolism

Paralyzed bowel

Increased risk of infection, as much as 50 times more likely than with vaginal birth

Increased pain and longer recovery times

Twice the risk of rehospitalization

Increased risk of postpartum depression

Increased risk of subsequent infertility, miscarriage, placenta previa, placental abruption, or premature birth

Increased risk of breathing and breastfeeding problems in the newborn

Risk of the baby being cut during surgery (1 to 2 per 100)

When a mother or baby is at medical risk, sometimes a c-section is the safest thing, but risks must be weighed against benefits in each individual woman’s situation.  Many reasons given for cesarean section are not supported by scientific evidence.

1 http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07_tables.pdf

2 http://www.nlm.nih.gov/exhibition/cesarean/cesarean_4.html

3 http://inventors.about.com/library/inventors/blfetalmonitor.htm

4 http://www.childbirthconnection.org/article.asp?ck=10401

5 For a complete list with citations, visit
http://www.motherfriendly.org/Downloads/csec-fact-sheet.pdf