Last week, a Huffington Post headline read: Christy Turlington Burns Says C-Sections As The Norm In U.S. Are 'Dangerous For Both Moms And Children,' and it sounded like maybe Christy and Every Mother Counts, the nonprofit organization she founded, might be anti-C-section. Like many issues, things are not as black and white as they can sometimes seem, and oftentimes, especially on topics that get an emotional reaction from people, words can be taken out of context, and when that happens it can be confusing to the public. When you are trying to educate people about the challenges and solutions that impact maternal health outcomes, it's important to use these opportunities to minimize any confusion.
What does Every Mother Counts think about C-sections? We think they can be lifesavers and among the most important surgeries performed when they are absolutely necessary. They allow providers to deliver healthy babies to healthy mothers in situations where, without the capability of performing one, a mother or baby (or both) might die. In many countries where proficient healthcare providers and surgical supplies are inaccessible, they're not performed often enough to prevent mothers and babies from dying unnecessarily. And in others, there are circumstances where C-sections are overused, which can also put mothers and babies in danger.
One of the unintended consequences of this particular emergency obstetric care (EmOC) intervention is that when they are accessible to more women, more women receive them, whether it's critical or not. This can and does set these women up for future birth complications with serious associated risks. This is something we are seeing more of in the U.S. as C-sections have become routine. And now this overuse of C-sections is negatively impacting maternal health outcomes rather than saving women's lives.
While the World Health Organization recommends that the C-section rate should fall somewhere between 10 and 15 percent, it's difficult to say for certain what rate is appropriate. This range represents the percentage of pregnancy and birth complications that are best treated by timely surgical delivery (AKA C-section). When a country does fewer than that, it's because they don't have the capability of doing more. There is a global human resource shortage which means that there aren't enough doctors, anesthesiologists, specially trained midwives, or fully equipped hospital operating rooms with electricity, surgical supplies, sterilization and/or other necessary components required to perform safe C-sections. When countries do more than 15 percent, such as in the U.S., they may be performed for non-essential reasons where a vaginal delivery may be safer and more appropriate.
In the United States, C-sections have become routine, even to the point where healthy women whose pregnancies are not considered high risk now think of this procedure as an acceptable option. The national C-section rate currently stands at 33 percent and some states' individual rates are much higher. In New Jersey and Louisiana, almost 40 percent of women have C-sections where as in Alaska and Utah, the rate is just over 20 percent. C-section rates vary widely from hospital to hospital within individual states, even when patient populations are similar. For instance, according to a recent Consumer Reports study, low-risk women delivering at Los Angeles Community Hospital stand a 55 percent of having a C-section. Just a few miles away at California Hospital Medical Center (in Los Angeles), low-risk women have a 15 percent C-section rate.
Why do some hospitals and states do so many more C-sections than others? It's frequently a matter of hospital culture, doctor preference, and fear of being sued, just in case something goes wrong. In very rare instances, non-medically necessary C-sections are done because a woman requests it, but so few women fall in that category, they don't significantly add to statistics. There are even some people who are advocating for "The Right to have a C-section."
The problem with doing C-sections when they're not medically necessary is that they're still a major abdominal surgery and every surgery includes risks for infection, hemorrhage, scarring, adhesions and complications from anesthesia. For many mothers, it's not their first C-section that causes them trouble; it's the next one or the one after that. Many hospitals and doctors refuse to do vaginal births after cesarean (VBAC) because one of the rare, but life-threatening complications associated with VBAC is ruptured uterus. The American Congress of Obstetricians and Gynecologist say however that they're safe and appropriate for the vast majority of mothers. Still, insurance mandates and hospital standards make it nearly impossible for many women to have VBACs, which forces them to undergo another C-section. Each repeat C-section a woman has puts her at higher risk for pregnancy, birth and surgical complications.
Recent studies published in The Lancet indicate that currently the United States is ranked 60th in the world in terms of maternal mortality and our maternal death rate is rising. Approximately 800 women die every year right here in the U.S. and while many of those deaths are caused by pre-existing medical conditions like diabetes and hypertension, many are caused by complications related to surgery. That's the real danger of doing too many C-sections.
What do we think of C-sections? We think that every woman should have access to emergency obstetric care, but we also think that physiological birth should be the norm because it is. We know plenty of women and babies whose lives were saved because they had access to people with the skills to perform C-sections and we advocate so that more people can become trained to provide the whole range of comprehensive services so that more women and children around the world are able to survive childbirth.
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