28 July, 2009

More on the U.S. rate of C-sections

Now I'm just fired up.

Based on the complexity of childbirth and cesarean sections in this country and my hesitation to throw the kitchen sink in the previous post, here is some additional information on C-sections in the United States that may be helpful for first-time moms or others considering/anticipating additional children.

First, I freely admit my bias, as previously stated, that pregnancy and childbirth are natural processes that require minimal-to-no medical intervention in most cases, but I have attempted to provide good representation of the facts.

According to the American College of Obstetricians and Gynecologists, the reasons for a C-section include multiple births, failure of labor to progress, concern for the baby, a problem with the placenta, or a previous delivery by C-section.

Vaginal birth after C-section carries a risk of 1-4% of uterine rupture; that's serious, no question. At the same time, cesareans are not without their own risks, to both mother and child.

The U.S. has one of the highest C-section rates of any developed country, and one has to wonder why we're different. I'm not convinced that doctors or our healthcare system bear all the blame, though the latter certainly plays a big part. Consider:

Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.
With that surge has come an explosion in medical bills, an increase in complications -- and a reconsideration of the cesarean as a sometimes unnecessary risk.
It is a big reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good.
It's true: scheduled, repeat cesareans are not "medically indicated," at least not according to the research evidence. After a cesarean birth, a woman is left with a scar on her uterus, and there's a small risk of that scar rupturing in subsequent deliveries, which has led to concerns about vaginal birth after cesarean (VBAC). But a VBAC baby has excellent odds—the risk of severe harm or death is 1 in 2000—the same odds as for a baby born vaginally to a first-time mother.
The cesarean delivery rate rose 3 percent to 31.1 percent of all births, another record high. The cesarean rate has climbed 50 percent since the 1996 low.
Obstetricians' rising malpractice insurance premiums may play a role, too. Individual doctors in many states now pay upwards of $100,000 a year for coverage, a figure that can spike if they're sued for something that goes wrong during labor, regardless of the legal outcome. "If there's no labor, there can be no lawsuit related to labor," says Flamm, who points out wryly that parents rarely sue over unnecessary C-sections.

For more information, check out these government agencies and other organizations


  1. One aspect of VBAC you didn't mention is their limited availability which is driven by insurance coverage and hospital accreditation (rather than medical appropriateness). As I understand it, in order to offer VCABs a hospital must have an anesthesiologist on staff 24/7 - not simply someone available on call, but a genuine, licensed, ready-to-work anesthesiologist sitting around on the premises with possibly nothing else to do. That requirement (again, as I understand it, and I may be wrong) comes from insurance companies and/or hospital accreditation agencies, and is simply too expensive for many hospitals to justify. Hence, limited VBAC services in many parts of the US, notably the lovely area where you and I live. Soo... if I were ever lucky enough to have a second child, I would be an automatic C-section if I wanted to deliver locally with my own (beloved) OB.

    My first C-section was medically justified, but my second should not be dictated by my zip code!

    Keep blogging, I love reading!

  2. Yes, you are right about all of it. VBAC availability is tied to having an anesthesiologist on staff and an OB willing to perform it.

    We shouldn't be penalized because of where we live, which is why I'm so fired up on this issue. I also don't mean to come across as downplaying the risk of uterine rupture, it is very serious.

    But, access to healthcare and medical options available should not vary by zip code.