C-sections can be lifesaving procedures when needed. However, many researchers, doctors, and parents believe that they often aren’t necessary or could have been prevented. In the last 15 years, the rate of births via C-section has gone up by 50 percent in the United States. According to the CDC, 1,284,551 babies were born via C-section in 2014.
A 2015 study published in The Journal of the American Medical Association stated that a C-section rate of approximately 19 percent seems to be ideal for the health of mothers and babies. The study analyzed the childbirth statistics of 194 countries, and in the United States, about one in three births happen by C-section. By contrast, about 16 percent of births in Finland and 24 percent in the United Kingdom are from C-sections. Data from 2011 shows that Germany and Italy have high C-section rates similar to the U.S., coming in at 32 percent and 38 percent, respectively. Low-income countries like Afghanistan and Kenya had yet to reach even 10 percent.
The World Health Organization stresses that doctors in many wealthier nations are performing unnecessary C-sections, which can put mothers and newborns at risk. In 2015, the WHO stressed a worldwide C-section rate for countries to aim for: 10 percent. If the rate is less than that, maternal and infant mortality rates rise. If the rate goes higher than that, risks increase but mortality rates don’t improve. The rate of C-section births in the U.S. in 2013 was 32.7 percent, well above the WHO’s ideal target percentage. Why is the C-section rate in the U.S. so high?
15C-Section Rates And Mortality
According to the World Health Organization, if a country’s rate of C-sections tops out at around 10 percent, health outcomes for both mothers and babies will likely improve nationwide. However, the World Health Organization also claims that there is no evidence that health care quality for mothers and babies continues to improve once a country’s rate exceeds 15 percent.
American College of Obstetricians and Gynecologists recently released a statement indicating that there are about 13 deaths for every 100,000 women after C-sections. There only about 4 deaths for every 100,000 women after a vaginal delivery. For the past few decades, while the rest of the world has reduced the number of mothers who died during childbirth by about a third, maternal mortality rates have nearly doubled in the U.S. In addition, instances where a woman has complications from childbirth so severe that she nearly dies are up 27 percent in the U.S.
14Risks To Mom
A C-section is a major surgical procedure with increased risks for mothers in comparison with a standard vaginal delivery. Possible short-term dangers for moms include the increased risk of unintended surgical cuts, infection, unintentional damage to internal organs, blood clots, a sometimes difficult and painful recovery period, and even death. Some women who have a C-section are more likely to have ongoing pelvic pain and perhaps even experience infertility in the future, possibly due to surgical scars and adhesions.
Some conditions may be more likely to occur in future pregnancies, such as ectopic pregnancies, placenta previa (where the placenta covers the cervix), placental abruption (where the placenta separates from the uterus), and uterine rupture. Women undergoing a C-section face the risk of increased blood loss and the possibility of needing an infusion. There can also be complications from anesthesia, such as allergic reactions, lowered blood pressure, and pneumonia.Women who deliver via C-section may also have trouble breastfeeding and may be at a higher risk for postpartum depression and stress.
13Risks To Baby
Babies face risks during C-sections, too. They may accidentally be cut or may asphyxiate if the medical staff has difficulty retrieving the baby. Babies born by C-section are more likely to experience respiratory distress, and may wind up with asthma later in life. C-section babies are also more likely to develop several chronic conditions, including childhood-onset diabetes and allergies with cold-like symptoms and asthma.
The fetus of a mother who’s already had one cesarean also seems to be at increased risk because of the complications that can occur while growing and developing in a uterus with an existing surgical scar. Babies in future pregnancies are more likely to need help breathing and may have extended hospital stays.
Babies born by C-section spend more time separated from the mother and are more likely to spend time in the neonatal intensive care unit. This period of separation can be difficult for both the mother and the child, and can possibly create bonding and breastfeeding challenges.
12Emergency C-Section Rates
When the mother or baby is in distress or there are other factors that make a vaginal delivery dangerous, childbirth by C-section can be a lifesaver – for both the mother and baby. However, some doctors estimate that only around 5 percent of C-sections are true emergencies. In addition, only around 3 percent of C-sections are thought to be completely elective, meaning there’s no medical reason for the surgery whatsoever. In other words, most C-sections fall into a big, gray area, and can be performed for a number of reasons. A doctor may recommend a C-section if the mother has gone past her due date or if the baby is measuring on the large side. The doctor may encourage a natural delivery at the onset of labor, but if labor doesn’t seem to be progressing, may suggest a C-section after all. Many critics, medical professionals and parents alike, wonder if these otherwise healthy pregnancies should end in surgery.
11Different Hospitals, Different Rates
When it comes to delivering your baby, there's something else to keep in mind. Location, location, location. While there are many factors that can increase the likelihood of needing a C-section, one of the biggest factors might very well be the hospital that the mother chooses to have her baby in. A 2016 Consumer Reports study investigated more than 1,200 hospitals across the U.S. and found that C-section rates for low risk deliveries seemed to vary widely, even in the same areas.
Part of the reason why is that different doctors and nursing staffs view labor and delivery differently. Some doctors consider mothers of very big babies to automatically be a candidate for a C-section. Some doctors might watch closely for any complications on the fetal monitor, and others might take a more relaxed approach to observing labor. In addition, some doctors may be more likely to let labor progress naturally, no matter how long it takes, and some doctors may suggest a C-section to speed up the process and deliver the baby as quickly as possible.
Doctors rely on technology now more than ever to catch potential problems during pregnancy, labor, and delivery. From numerous ultrasounds that predict the size and weight of the baby to fetal monitor belts that check the baby's heart rate during labor and delivery, technology provides information and reassurance for mothers throughout the pregnancy, labor, and delivery. During labor, if there's a hint of trouble, doctors are more likely to play it safe and perform a C-section.
In the majority of hospitals, continuous fetal monitoring is a standard part of obstetric care. A 2005 study found that 87 percent of women were hooked up to a fetal monitor most of the time they were in labor. Although the use of fetal monitoring was originally intended to detect fetal distress and to possibly reduce the occurrences of cerebral palsy or fetal death, the practice became widespread very quickly as a standard practice, even for women with low-risk pregnancies.
These days, more and more women are waiting until they are older to have children, and often, these “high risk pregnancies” are more likely to end in a C-section. Older women, or women of “advanced maternal age” are more likely to have medical problems that can complicate delivery, have a harder time with pushing, and are more likely to eventually request a C-section.
Also, as many older women come to rely on drugs and fertility treatments to get pregnant, they often end up pregnant with twins or triplets; such multiple births often require a surgical delivery. Often in multiple births, even if the first baby is delivered vaginally, it is hard to predict how the second baby will be delivered. Because multiple babies are sometimes in more awkward positions, many doctors prefer to deliver twins and triplets via C-section to avoid any complications. In a way, C-sections have become the default method for delivering multiple babies.
Some doctors believe that overweight women typically have heavier babies, which are more difficult to push out. In addition, excess fatty tissue can prevent the baby from transitioning smoothly through the birth canal. Women who are overweight or have a higher percentage of fat may also have difficulty absorbing medications that are supposed to speed up labor. Overweight or obese women are also more likely to have medical conditions such as diabetes or high blood pressure, which would require their labor to be induced. Some research has also shown that obese women are more likely to have babies in poor positions for delivery.
Several recent studies found that nearly one-half of obese first-time mothers ended up with a C-section. However, there are some precautions that obese women can take to try to avoid a C-section. They can practice good nutrition and exercise habits throughout (and before) their pregnancy. They can also consider more nontraditional birth environments, and check for doctors with low rates of intervention, who are less likely to perform a C-section unless it is truly necessary.
Some of the labor interventions designed to make labor progress more quickly and smoothly may also wind up increasing the chances of needing a C-section. The stripping of uterine membranes, or the induction of labor, has been found to increase the likelihood of C-sections. The thought is that the process doesn’t work as well as natural labor, and sometimes a C-section is required to get the job done.
With the number of inductions at an all-time high (according to the American College of Obstetricians and Gynecologists, nearly a quarter of all births are the result of an induced labor!) it’s no wonder that the number of C-sections performed has risen as well.
An epidural that is administered during labor without an accompanying high dosage of Pitocin may also increase the chances of birth via C-section. Epidural pain relief also seems to increase the risk of fetal distress, and many C-sections are performed in response.
In addition to monitoring mothers and babies to catch any potentially hazardous situations, some doctors use C-sections as a form of preventative medicine, or "defensive medicine." Some studies have shown that C-section rates are slightly higher in states that have higher caps on malpractice settlements. The thought is that a doctor isn’t likely to get sued for performing a C-section, because if the doctor performs a C-section, they are intervening and attempting to do everything they can to ensure a safe and successful delivery. If a baby is born via C-section and there’s a bad outcome, the doctor can say that they did everything they can. If there is a bad outcome during a vaginal birth, questions will be raised as to why a C-section wasn’t performed.
The fear of legal action and malpractice claims can also be used to explain why so many doctors caution patients against VBACs (vaginal birth after Caesarean.) Many doctors feel that women who had a C-section previously should have one with their subsequent pregnancies, to safeguard against any complications. This theory would also contribute to the increase in C-section rates across the country.
Many people think that the C-section rate is so high because women just schedule a C-section to get out of having to give birth vaginally. While it’s true that some women may plan a delivery via C-section around work or travel plans or even their doctor’s availability, the number of truly elective C-sections is relatively small. According to a 2010 study by the National Institute of Health, C-sections for non-medical reasons accounted for just under ten percent of all scheduled deliveries in the U.S. Furthermore, a 2013 study from the American College of Obstetricians and Gynecologists found that elective C-sections only accounted for 2.5 percent of all U.S. births.
Women in the U.S. are fortunate to have the option to electively choose a C-section if they desire. They can choose the date, the doctor, and the location. They have much more control over childbirth rather than waiting to go into labor naturally. The process of labor and delivery, which can take hours, even days, is condensed into an operation that can take less than two hours.
4Benefits Of Having An Elective C-Section
In addition to being able to select a day and time that is convenient, electively scheduling a C-section has many other benefits. For one thing, it can reduce the stress and anxiety that comes with preparing to go into labor. Women feel a greater sense of control over the situation knowing exactly when their baby will be born. This can help with planning for baby's arrival by giving the parents a deadline for when to have the nursery set up, when to have the car seat installed, and when visiting family and friends should expect to arrive.
An elective C-section has medical benefits, too. There is a decreased risk of oxygen deprivation to the baby during delivery. There is also a reduced risk of birth trauma to the baby that can possibly occur when the baby passes through the birth canal, or from a forceps or vacuum extraction. For the mother, there is a possible decreased risk of incontinence and sexual dysfunction for the first three months after delivery
3Risks Of Elective C-Sections
A C-section is major abdominal surgery and the recovery period afterward is typically longer than that of a vaginal birth. A woman and her baby will be required to stay in the hospital for a longer period of time after a C-section than what is required for a vaginal delivery. Women who deliver via C-section may experience pain for as long as six weeks of post-op pain and bleeding, versus the bleeding that may occur for two to four weeks after a vaginal birth. Women who deliver via C-section are encouraged to take it easy for a longer period of time, and even avoid lifting heavy objects, using the stairs, and driving.
Women who have a C-section for their first baby may face risks for following pregnancies, like a higher chance of the placenta implanting or growing abnormally. Elective C-sections aren’t recommended for women who want to have several children, given the increased risks of placenta previa or placental abruption.
2Vaginal Birth After Cesarean (VBAC)
Having a first baby by C-section leaves a woman with a 90 percent chance that subsequent births will be by C-section as well. And with each C-section, the risk of serious complications rises. Having multiple C-sections raises the risk that the placenta will implant abnormally. Also, after a 1999 study showed a slight possibility that an existing C-section scar could rupture, posing a risk to both mother and baby, a vaginal birth after a Caesarean (VBAC) is rarely performed these days.
Trying for a vaginal labor after a previous C-section has become a rare practice. Many doctors prepare for a C-section in advance in case the trial of labor isn’t successful. Some doctors may suggest or even require a woman to have an epidural during labor, so that in the event, she needs a C-section, anesthesia is already in place.
The American Congress of Obstetricians and Gynecologists recommends that doctors attempt to perform VBACs only in hospitals that can provide emergency C-sections.
Having a baby via C-section can often cost between 30-50 percent more than a vaginal birth. According to a 2016 report by Castlight Health, delivery costs vary widely across the United States, and even within individual cities. The big differences in cost exist for both normal vaginal deliveries and C-section surgeries.
The Castlight Health study shows that the average national cost for a routine vaginal delivery is $8,775, while the national average for a C-section is $11,525. The study showed that the highest cost for a routine vaginal delivery was in San Francisco – an astounding $28,541. The lowest cost for a routine vaginal delivery was in San Diego, $3,243. When it comes to C-sections, the range of costs was even more broad. The lowest cost of a C-section was found in Pittsburgh, Pennsylvania, at $4,419. In Los Angeles, the cost of a C-section was nearly ten times higher - $42,530.
Sources: StatNews.com, New York Times, Slate, National Partnership for Women and Families, Huffington Post, Harvard Magazine, CNN, Wired, Salon, Parenting.com, Baby Center, Live Science
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