Top Reasons for Drastic Rise in Caesarean Births in the U.S

Caesarean sections births have become the most common major operation in American hospitals. 1.4 million C-sections have been performed in 2007 and the rates have been steadily increasing since 1996.

Critics point out that the World Health Organization and US health agencies advise that only 15% of women need this operation. Experts say that this surgery is performed too often and that doctors are needlessly exposing both women and babies to major risks - so why are one in three women or 32 % of the women in the US, having this operation instead a vaginal birth?

Understanding C-sections
A Caesarean involves the delivery of a fetus via a surgical incision through the abdominal wall and the uterus and is considered major surgery. Even if when needed, it can save both mother and child from injury and possible death, it should never be administered lightly.^*1

Complications
Though the majority of c-sections have little complications other than the pain associated with a prolonged recovery period and an extended stay in hospital following childbirth, Caesarean section births put the mother and child at a higher risk of infection and blood cloths .

An Increased Risk to the child
Last December, the British Medical Journal reported that babies delivered by elective c-sections 3 weeks before their due date had four times the risk of breathing complications and 5 times the risk of serious lung problems because of immature lung development.^*2

Side effects for the mother
Caesarean section births increase risks associated with adverse reactions to medications and anesthesia.

Adhesions ( a scar tissue forming a connection between tissues and organs) can cause pain, vomiting, severe abdominal and pelvic pain and in some cases even bowel obstructions.

In many cases a mother who has given birth via a c-section will be advised to have other c-sections in further pregnancies due to the scar in her uterus.

What experts are saying
Dr George Marcones, chairman of Obstetrics and Gynecology at Washington University in St Louis, and spokesman for the American College of Obstetricians and Gynecologists, advises that the increasing rise in c-sections does not improve either the health of the baby nor the mom.

Further complications
Every Caesarean a woman has to go through, rises the odds that the uterus will rupture in a subsequent pregnancy - a major life threatening event, both for the mother and the baby.

Caesareans also increase the risk of abnormalities in the placenta (technically called placenta previa) and can cause hemorrhaging, a possible hysterectomy and make it nearly impossible to have a large family.

Notwithstanding all these risks, the report published on the New York Times in March of this year states that c-sections have reached an all time high in the US with the highest rates being in New Jersey (38.3%) and Florida (37.2%) and the lowest in Alaska (22.6%) and Utah (22.2%)

Why is this happening?
Though initially one might think that a major contributor to this rise is the increase in multiple births because of fertility treatments that often require Caesareans, c-section rates for singletons increased substantially more than those of multiples.

Another amazing finding is that though older women are giving birth and they are more likely to have Caesareans - women under 25 have the greatest increase in c-sections from 2000 to 2007.

Legal and financial issues seem to be a major contributor to this sudden increase. Dr Marcones points out that Caesarean sections are going up because of professional liability and the possibility for the doctor to end up in court.

In other words, obstetricians are increasingly choosing this procedure because they are afraid they might be sued if they harm the baby during normal child birth.

In an article published in the journal of Obstetrics and Gynecology in February of this year, the Obstetrician's College reported that approximately 30% of a poll of nearly six thousand members said they were performing more Caesareans because they feared lawsuits, and 8% said they quit delivering babies. (Nearly a third of these did it, because they are afraid of lawsuits.)

Another contributor to this increase in C-sections is that more mothers are requesting a surgery that is not medically necessary, possibly because Caesareans have become so common that people don't realize the extent of the risk they are unnecessarily getting into.

The increased tendency to induce labor before a woman's natural due date, out of convenience, has also pushed up the Caesarean rate, because induction seems to be very likely to result in a Caesarean.

In addition the celebrity trend to have an elective c-section before their due date, in order to minimize stretch marks and sagging skin, has created a social trend where an elective c-section is the "in" thing to do.

Dr Marcones said that patients also pushed to do inductions for social reasons such as an impending development of a husband to Iraq or Afghanistan, or because they wanted visiting relatives to see the baby before they left.

Repeat Caesareans are another part of the problem. Approximately 600,000 of those 1.4 million Caesareans occur because in many cases hospitals ban a mother who had a c-section in the past to give birth normally in her subsequent pregnancies, and fewer than 10% of women who had Caesareans had vaginal births.

In many cases hospitals banned vaginal birth after a c-section, because of the strict guidelines set by the Obstetricians' College which said surgeons and anesthesiologists had to be "immediately available" whenever a woman with a prior c-section was in labor.

Conclusion
Though experts in the National Institute of Health urge to reduce the barriers to vaginal birth after a Caesarean and ask the obstetrician's group to reconsider its guidelines on "immediately available", and hospitals to publicize their rates of vaginal births and c-sections, so that women can make informed decisions where to give birth, they failed to give a specific recommendation to solve the major issue of malpractice suits against doctors.

Unfortunately unless patients fully grasp the reality of the increasing risks associated with this major surgery, and doctors resolve their fear of malpractice suits, the tendency for Caesarean section birth rates is likely to keep going up not down in the near future.

Works cited

^*1"What are the side effects of a c-section?" yourhealthquestion.com

^*2 "A risky rise in c-sections" D. Kotz USnews.com

"Caesarean births are at high in the US" Momlogic.com