Scientists Expect C-Section Rate To Keep Rising

WASHINGTON — More women will be giving birth by C-section for the foreseeable future, government scientists said Monday, releasing a study into the causes of a trend that troubles maternal health experts.

Overall, cesarean deliveries account for about a third of births in the U.S. While much attention has recently focused on women having repeat C-sections, researchers with the National Institutes of Health found that nearly one third of first-time moms delivered by cesarean.

That is "somewhat surprising," said Dr. Jun Zhang, lead author of a study that looked at nearly 230,000 deliveries in 19 hospitals around the country. "It has consequences for future pregnancies."

Many doctors and hospitals follow a policy of "once a cesarean, always a cesarean."

The study also suggested a link between chemically induced labor and higher likelihood of a C-section. Women whose labor was induced were twice as likely to have a cesarean. The authors said more research is needed to clarify if there's a cause-and-effect relationship.

Many medical experts consider cesarean deliveries to be a major component of "overtreatment" in the U.S. – procedures and tests that provide little or no benefit while subjecting patients to additional risks. Indeed, new clinical recommendations say vaginal birth is safe for most women who've had a first C-section.

But the trend does not appear likely to reverse. Since the mid-1990s, the C-section rate in the U.S. has increased by more than 50 percent.

How low should it be? In Scandinavian countries it hovers in the 20 percent range, with no evidence of ill-effects for mothers or babies, Zhang said. How high can it go? In some countries 60 percent to 70 percent of babies are now delivered surgically.

"I hope that we won't get there," said Zhang. "The upward trajectory seems likely to continue in the near future."

Explaining the increase in C-sections is no simple matter. The study found a variety of reasons, some related, including heavier moms and babies, women giving birth later in life, an increase the number of twins and multiple births, and evidence that doctors may be opting for a cesarean if women encounter difficulties in the early stages of labor.

One factor that made no difference was whether the mother had private health insurance or was covered through a government program like Medicaid.

The study was published in the American Journal of Obstetrics & Gynecology.

Comments

[Joy Szabo]

08:47 PM on 10/01/2010

It should be up to the mother and the doctor to decide. But frequently it is up to the doctor alone as to whether a cs is necessary. If mother is even involved in the decision, the mother is given misleading information so as to coerce her into agreeing (often by saying "your baby could die"). Not offering alternatives. For example:
A failed induction sounds like this currently --"This induction has failed, we need to do a cesarean or the baby could die"
The more informative way would be more like - "This induction has failed and if we keep going, it is likely to get too stressful on you or the baby. You body may not be ready yet and we can have you go home, wait for a while and try again. OR I can try an AROM to see if that will get you going, with the understanding that we cannot undo that. OR I can do a cesarean."
Now you may notice that the second quote actually lists the alternatives to the proposed surgery while the first does not. The offering of alternatives is required in order to obtain real informed consent. Most of the time, women hear something like the first quote.

[erinwithane]

03:56 PM on 09/29/2010

Question: What is so bad about a C-Section? It is a safe medical procedure that saves lives. Shouldn't it be up to the mother and the doctor to decide what best for mom and baby?

You know, one of the leading causes of mental illness is brain injury caused by a traumatic birth.

Yeah, so the c-section rate is increasing....and the number of babies and mothers who die as a result of childbirth is very low.....and y'all are still complaining.......

Question #2-Is anybody EVER going to be happy?

[stes]

05:48 PM on 10/01/2010

We the Stats are actually evidenced based and women are actually informed about the risks of procedures to themselves and their neonates you can ask "What is so bad about a C-Section?"

Go an look at the number of babies born via section that end up i the NICU.
Also - while our mortality rate is semi low - and actually not that low when compared to other developed nations - we have an extremely high morbidity rate for L&D and post-postpartum in this country

[erinwithane]

12:30 PM on 10/21/2010

Don't be ridiculous, C-sections are rarely the cause of a baby ending up in the NICU. NICU babies are their for various reasons, Some of them of them were delivered via C-section because that was the safest way to get them into this world. They would not have survived a natural delivery. Some of them are there because they had a very traumatic natural birth, and need to be monitored for a few days. The reason the c-section is being performed is often the same reason the baby needs intensive care.

Some NICU babies are preemies, some have birth defects, some are just in very poor health, and some just wont thrive for reasons that are unknown. But, it is extremely rare that a full term, healthy baby is ever put in the NICU because of a bad C-section experience.

Secondly, If a woman hasn't been 'informed' about the c-section procedure, its more than likely because she planned on or envisioned nothing except a completely natural delivery, and for reasons that were beyond her control that natural delivery didn't work out, and she ended up having to have an emergency c-section to save her life or the life of her baby that was completely unexpected.

[pc51]

08:40 PM on 09/06/2010

Certainly, there will always be a small percentage of women who through no fault of their own require medical assistance. The problem is that there is soooo much more money to be made by making sure that as many women as possible require this assistance. Too bad, natural childbirth is one of the most spiritually profound and growth inducing experiences a human being can ever have - a privilage that women have been taught to fear and avoid. Their infants starting life out in a drug induced haze - both mother and child denied the all important initial bonding period in the name of profit.

[Susan Shaffer]

04:24 AM on 09/09/2010

i had twins and it is strongly recommended that you have a c section as there is an 8 fold increased chance of death for the second twin.
i can tell you that in spite of not going through "natural" childbirth i was still moved emotionally by giving birth to my babies. you cannot know another persons feelings so do not judge yours to be superior.

[dajmd]

07:34 PM on 09/17/2010

agreed.

[stes]

05:49 PM on 10/01/2010

If we had not stopped teaching breach births the rate of morbidity to the second twin would not be so high.

[Absolon]

06:58 PM on 09/02/2010

No, it is DOCTORS who expect the c-section rate to rise.

[dajmd]

09:18 PM on 09/01/2010

has there ever been a study or article about the difference between having a 'natural' delivery with and without a doula?

the reason i ask is b/c every doula says that their way is 'more natural'. but you rarely see animals giving birth with doulas...what you do see is that animals go off in a corner, pop out a baby animal, eat the placenta, and then nurse the baby.

no. doula.

maybe people who are really interested in natural birth should more closely follow the natural model.

[vim876]

09:25 PM on 09/01/2010

Most primates give birth with the infant facing the mother. Humans usually give birth with the infant facing away, making giving birth alone a much more complex proposition.

[blinkthink]

10:07 AM on 09/07/2010

How sad and pathetic.

[dajmd]

09:08 PM on 09/01/2010

i'm going to drop some knowledge bombs here b/c there's just too much misinformation and rumor.

oxytocin is a hormone that signals the beginning and progression of labor. some women have a decreased response to their body's own oxytocin, so it can be given to induce or augment labor. it may very well be that women who have c-sections also have a decreased response to oxytocin and therefore wouldn't progress in their labor given all the time in the world. The study also suggested a link between chemically induced labor and higher likelihood of a C-section. Women whose labor was induced were twice as likely to have a cesarean. The authors said more research is needed to clarify if there's a cause-and-effect relationship.

regardless, women who fail induction and go on to c-sections may be the same women who would die in childbirth (or have stillborns) 100 yrs ago. it's therefore no surprise that the rate of c-section is higher when labor is induced.

most physicians would agree that the rate of c-sections is too high. but you never truly know which c-section is unnecessary, unless you're willing to allow some babies to suffer the consequences of bad deliveries just to pad your numbers.

[dajmd]

09:00 PM on 09/01/2010

just last week I had a patient who had labored at home with a doula and midwife for 2 days (!) before coming in to the hospital. she ended up having an emergency c-section. when they were doing it, they found that she had a ruptured bladder. turns out the baby's head had been compressing the bladder and urethra, preventing her from urinating. the mom and baby made it through the surgery OK, but she's now going to be incontinent for life.

now, do you think the doula and midwife have any responsibility for this outcome? do you still think that doulas and midwifes are the panacea, and that medical doctors are here only to make a profit off of you?

[jogirl27]

04:49 PM on 09/02/2010

No. There are bad doulas and midwives just as there are bad doctors. I do not blame all doctors for every death on the table from a completely avoidable medical mistake. If doctors worked more closely with midwifes and doulas, maybe the picture would be a bit more rosey. But, if you want to demonize midwifes, go ahead, you will not be the first or the last.

[dajmd]

05:42 PM on 09/02/2010

i'm not demonizing midwives.

i am, however, tired of hearing about how physicians place paychecks over their patients, and how we do things out of convenience.

[Absolon]

07:07 PM on 09/02/2010

Propagandist! Mothers deliver babies naturally all over the world without doctors and the US has one of the highest rates of infant mortality. US Doctors and the hospitals who rule them do not give a flip about pregnant women or their babies and they are treated that way. "Little baby, you will be delivered on my time, with your parents dime." Your grand parents were likely delivered at home and, somehow, we get your chiming self-supreme "the DOCTOR said" crap. Go tell it to women who have no health insurance. Go tell it to women all over the WORLD who deliver babies every day, and have for millions of years. Go tell it.

[dajmd]

09:48 PM on 09/02/2010

"US Doctors and the hospitals who rule them do not give a flip about pregnant women or their babies and they are treated that way"

and i'm the propagandist??

my grandparents gave birth at home, but they also had several stillborns that likely could have been avoided with better prenatal care and real medical care. one childbirth left my grandmother so anemic that she was too weak to care for her other children for months. but you're right...doctors are evil.

[Bigleague]

10:15 PM on 09/04/2010

Sure. And I'd have been dead with either of my two pregnancies/deliveries if I were at home. One vaginal and one c-section. Either one would have killed us both without direct intensive medical intervention.

[bgofca]

02:29 AM on 09/01/2010

i know the trend is to try to have less c-sections and that is good, but if it is necessary, it needs to be done. a healthy baby is what is most important, not one who had a lack of oxygen because he couldn't get out of the birth canal without receiving brain damage.
what i really worry about is the new trend to try vaginal deliveries after a c-section (often called a v-bac). If a person is trying this, as soon as the dr says it isn't progressing , as it might in some cases, please listen to the medical advice and have another c-section. If the dr is worried about the delivery, please take the medical advice. I went to the emergency birth of a failed v-bac. the dr had been trying to talk the mother into a c-section, but she declined, then her uterus ruptured and there was a "crash c-section" the baby was born having seizures due to lack of oxygen and low blood supply (the placenta wasn't able to help her anymore.) They were able to save moms uterus even though she lost a lot of blood and needed transfusions. the horrible thing is that the beautiful baby girl died and the parents will never forgive themselves for not taking the medical advice. choose a dr you trust, then allow him or her to be your dr.

[jogirl27]

02:39 PM on 09/01/2010

bgofca,
I see that you are repeatedly interjecting your opinion. My father is a physician.My mother is an RN. I had a homebirth with a very well trained midwife and doula. I researched my options extensively. In the city I reside, the c-section rates at hospitals range from 57-70%- rates that are completely unexceptable. I understand that you are compelled to comment but the point of this article isn't to say that c-sections are unnecessary and not critical to the survival of many mothers/babies but that the rates are out of control. As a nurse, I hope that you can take a step back and realize that this is not a good thing for the health of mothers/babies. You should be advocating for non-surgical intervention. C-sections should be a last resort. VBACs should be attempted in almost all cases. It is the duty of our doctors & nurses to abide by the Hippocratic Oath and not get wrapped up in fear of suit or completely disconnect themselves from the natural birthing process(a connection that is quickly being lost).I don’t think that the majority of drs are scheduling sections so they can make tee time but many are suggesting induction to manage their schedules. I visited 4 practices before going with a midwife. Please, stop instilling FEAR! Instead, why don't you work on bringing better practices into play. Use that excitement to improve maternity care and take women out of the OR!

[bgofca]

09:06 PM on 09/01/2010

i'm not spreading fear; i want people to understand the risk of vbacs and not just get the mindset that all c-sections are bad and just for the drs to make more money or for their convenience, etc. It is ok to do a vbac, but the person needs to realize that the dr. will be telling them the truth if the vbac is unsuccessful and another path needs to be taken. When moms get the idea that all c-sections are evil, they don't always listen to what is best for them and their baby. After many hours of attempting, if the babies heart rate shows difficulty or the baby doesn't progress , then a c-section may prevent the tragedy of a ruptured uterus and a dead baby. Pink your dr ; someone you trust, and believe them if they tell you there are problems. a healthy baby is what is most important.

[dajmd]

09:21 PM on 09/01/2010

"In the city I reside, the c-section rates at hospitals range from 57-70%"

probably because of all the patients who try a home birth with a midwife and doula and have to be rushed to the hospital for an emergency c-section.

OR because there are some patients who are simply too unstable for labor and choose to have a c-section rather than chance leaving their newborn without a mother.

[literal chaos]

12:17 AM on 09/01/2010

As someone who had a necessary c-section, I'm getting really tired of people describing an experience they've never had as being "less painful" than vaginal birth. They are both extremely taxing on the body, and most of us who end up having c-sections also had to endure many hours of labor beforehand. I had my son, via c-section, 3 weeks early because he was stuck in the wrong position and had ran out of room to grow, he sent my body into early labor. This was followed by a 6 week healing period, in which I had to take care of my child all by myself. Within the second week I had managed to develop an abscess at my incision site and was admitted back into the hospital for 9 more days while the rather incompetent doctors tried to fix the problem. There's no such thing as a simple birth,so please, stop generalizing all c-sections as being "the easy way out"

[pilatesmom]

08:47 PM on 08/31/2010

Find a midwife, find a birth center and go natural! I did it for my first and had a wonderful, no-drug birth. I had nothing hooked up to me, I could move freely and had a huge, supportive team of nurses and midwives around me plus a doula that tended only to my needs as a laboring mom. It was cheaper than a hospital birth (covered by insurance too - that was a huge fight)!

I will do anything to never have a baby near an OB/GYN or a hospital unless there is real, absolute danger to my child or myself. Birth is natural and should be treated as such - except for the small percentage of exceptions.

Oh and I am tired of hearing of moms that schedule births, especially inductions - completely unnecessary!!

[bgofca]

01:36 AM on 09/01/2010

i hope you are always able to have a healthy delivery. many moms are able to deliver there safely and that is great. it is important that you be somewhere that can transfer you quickly into a hospital if you or your baby develop problems. sometimes bad things start to happen and there isn't much time to save the mom and baby. A safe delivery is most important. Working in a neonatal intensive care unit for many, many years, i had several little patients who were home deliveries that didn't go well. This is a horrible ordeal for the baby and the family. It is also horrible having to take a brain dead baby off of life support, having the parents blaming themselves for not having the baby in the hospital so the injuries wouldn't have occurred. Sometimes c-sections are necessary. My first child, a vag delivery received very bad brain damage. I chose to have a cs for the rest of my deliveries and the babies were healthy and survived. A healthy safe delivery is most important and people who are able to have a no problem delivery are lucky, but they shouldn't be judgmental of those who chose what they consider a safe way for them. Also, inductions are often necessary due to being post dates (over 41 wks is dangerous for the baby ), mom having high pregnancy induced hypertension.

[dajmd]

08:47 PM on 09/01/2010

i'm glad you had a healthy delivery and hope that your future ones are the same.

however, if you are at a natural birthing center and something goes wrong, i also hope that you are very close to real medical help.

birth is natural, but so is death and illness and a lot of bad things. areas that have completely "natural" birthings by default (ie, sub-saharan africa) also have the highest infant and maternal death rates. there's a reason for that.

i'm tired of hearing about doulas and midwifes - completely unnecessary!!

[vim876]

09:30 PM on 09/01/2010

"i'm tired of hearing about doulas and midwifes - completely unnecessary!! "
Actually, the biggest factor in reducing maternal and infant mortality is the presence of a trained person to assist with the birth. I don't have a particular stake in this question, as my medical conditions mean I will have to give birth in a hospital if I have kids, but this is fairly well known stuff.

[Debbie338]

04:30 PM on 08/31/2010

Does it not make sense that the more obese women there are, the higher the rate of C-sections? Or am I missing something? How do we compare with other countries who have nearly the same rate of obesity, like Australia and Germany?

[bgofca]

02:17 AM on 09/01/2010

having worked in healthcare (taking care of sick newborns and going to lots of deliveries) I would have to agree that if a mom is obese she is more apt to need a cs. also if she is overweight she is more apt to have gestational diabetes and pregnancy induced hypertension (high blood pressure which can lead to seizures and strokes). All of these reasons are indications for cs.
other reasons for a cs is a herpes outbreak (delivery with active herpes can lead to illness and blindness for a baby), a big baby for a little mom (not just the size of the mom but her birth canal which can be smaller in a regular sized woman, but sometimes adequate in a small one.)
we would all be healthier if we would try to eat properly and try to loose wt if we are over wt. men included.

[LivingFreely]

01:53 PM on 09/01/2010

Australia and Germany are nowhere close to having the same obesity rate as the US. Where are you getting your information from?

[dajmd]

11:27 PM on 09/01/2010

actually, according to the WHO, Australia and Germany do indeed have obesity rates that are similar to those of the US.

[Debbie338]

11:46 AM on 09/02/2010

Germany is farther down than it used to be. I should have said the UK and Australia, because they're #3 and #6 after the U.S. Germany is #14. Still pretty high. So, my question still stands about how do their rates of c-sections compare?

[pojnkee]

04:21 PM on 08/31/2010

Here's a study to consider:

chemically induced labors ( a convenient "trend"?) and C-sections ("50 percent increase since the mid-90's"-- another convenient "trend"?) vs high rate of autism.

How convenient the "trend"?

[Alexish]

04:32 PM on 08/31/2010

Here is something to consider:

An increase in autism rates Also increases as the term "autism" widens in definition, the tests that indicate autism become more common.
Also, the more medical attention one receives as a baby, the better chances are that a doctor will find reason to suspect a mental disorder if your child is born with one.

Essentially, if you think that an increase in medical intervention Means that there is causal increase in autism rates, then you could just as easily make the argument that if you go to the dentist, and he keeps finding cavities, that if you stop going to the dentist, then less cavities will be found. Because by that reasoning, the dentist was causing the cavities to begin with.

[bgofca]

01:39 AM on 09/01/2010

there has also been a greater increase in autism in the past decade as more woman breast feed.
The trouble with statistics is anyone can twist numbers around even if they know nothing about what they are talking.

[jetle25]

03:58 PM on 08/31/2010

Watch the Documentary "Business of Birth". It shows the alarming rate of C sections practiced in the US. While most of the world does it the way Mother Nature Intended. IT DOESN'T MAKE SENSE...and I'm a guy.

[pojnkee]

04:25 PM on 08/31/2010

"The Business of Being Born" http://www.thebusinessofbeingborn.com/

[Clovie]

10:16 PM on 08/31/2010

Loved that one! It really made me look at birthing in a completely different way.

[MsNatTurner]

03:46 PM on 08/31/2010

c-sections are more convenient for doctors to perform than natural birth. c-sections can be done on schedule, thus leaving physicians the flexibility to plan weekend golf and vacation trips without having to wait around for proper uterine dilation or any other variable related to childbirth.

[MommyMD]

10:03 PM on 08/31/2010

Please stop overgeneralizing. As a mother, my children would not be alive without two C-Sections. As a young doctor, I can assure you, that paying liability insurance and 8 years of student loans at a minimum wage training salary, does not not allow much golf or any vacations. Please be respectful. We chose to be MDs because we love caring for patients. If I wanted $, I'd have been a lawyer or I-banker.

[blinkthink]

10:42 AM on 09/07/2010

Heartened to hear you care about your patients.
I worked for a group of four doctors, five nurse practioners and I can tell you it was the most toxic work environment I ever experienced. Profitability was first and foremost concern. It was about what they could charge patients, what insurance would cover. Every morning before patients came in was about who owed them money.

One doctor demanded only minor illnesses be scheduled for him because he wanted to spend no more than 10 minutes with each patient. And yes, at times he would be on call and that rule still applied. Because he operated this way, he regularly overmedicated patients per his nurse. It happened to me, personally, that is why she warned me.
Another doctor didn't want to touch patients. Another doctor screamed at the office personnel like a psycho. It was the twilight zone of medicine.

[bgofca]

02:10 AM on 09/01/2010

having worked in healthcare for many years as a neonatal intensive care nurse, i have attended many cs. There are many lies told about drs. that are not true. I have never seen a dr choose to deliver by cs because they need to go somewhere else. We sometime knew a cs would be within a few hours because a mom would start having troubling signs (very high b/p, failure to progress, bleeding, etc.) or because the baby was having bad heart rate signals they may mean the cord is getting compressed or the heart rate is dropping too low. if all efforts were not leading anywhere, a cs would be done. This was not taken lightly. Too often we've had patients who declined the suggestion of a cs even after the dr explained that the baby was in trouble. They didn't want to do it because they believed the cr*p you read on this post about drs doing cs for their convenience. After a few days in labor (one for almost 4 days ) the babies were finally born by cs. On some occasions there was an abruption of the placenta and the babies nearly died. If someone doesn't trust their dr to make medical decisions for them, then they should find a different dr., but once they're in the hospital, they need to listen to the drs. medical advice. there'll be less damaged babies that way.

[MommyMD]

02:30 AM on 09/01/2010

Listen to the smart RN, who seems like she's been around a while.

[William Bone]

02:09 PM on 08/31/2010

There are 2 things which cause C-Sections; 1. Lawyers 2. Mothers demanding it because they are 16 years old, don't know who the father is and "it hurts".

[nicole44]

03:17 PM on 08/31/2010

Thank you! I would even add 3) doctors who don't want to cut their vacations short to come back and deliver babies. We are living in the age of convenience, and last time I checked, childbirth itself is a risk. Why would you make it riskier by having a surgery you don't need? (And yes, I know that there are necessary c-sections).

[Clovie]

10:20 PM on 08/31/2010

What does not knowing who the father is have to do with anything?

I get your point, but that's a cheap shot. It makes it sound like you think women who aren't sure of who the father is wouldn't care about the birth process or the baby. (I can't conceive of not knowing who the father of my child is, but I'm sure there have been a few thoughtful, intelligent women who have had to face that before.)