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:

• "More C-sections, more problems" in the LA Times (May 17, 2009):

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.

• "Can we please stop blaming women for C-sections?" in RHRealityCheck.org (January 21, 2009):

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.

• Births: Final data for 2006 (pdf) by the CDC National Center for Vital Statistics Reports, v.57 No.7 (January 7, 2009):

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.

• "A risky rise in C-sections" in U.S. News & World Report (March 28, 2008):

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

• Medline Plus (National Library of Medicine and National Institutes of Health)
• Women's Health (Dept. of Health & Human Services)
• American College of Nurse Midwives
• Childbirth Connection
• March of Dimes
• RH Reality Check