One of the things that I've learned as a doula is that every decision during pregnancy, labor, and delivery comes with its own set of benefits, risks, and alternative options. For example, a vaginal birth has the benefit of shorter recovery time, typically more immediate bonding, and generally fewer post-delivery complications. On the other hand, C-section birth can save a baby's life, it can save a mother's life, it can even enable women who would otherwise not be able to birth their children due to an anatomical reality (for example, paralysis) to carry and birth their own biological children!
The World Health Organization estimates that C-sections are necessary for the health of mother and baby in approximately ten percent of births. Ten percent is not nothing, mind you. That's one out of every ten children you know, on average, who has been saved by this highly advanced surgery.
The fact of the matter is this: according to the CDC, the United States has an average C-section rate around 32%. So instead of one out of every ten children being born by C-section, we are seeing one out of every three children born by C-section. That's a deeply concerning statistic because unnecessary C-sections increase complications for mothers during labor and delivery. Worse yet, if they're truly unnecessary they increase those risks for no valid reason. The American College of Obstetricians and Gynecologists (ACOG) has been making great strides in the recent years to square their recommendations with best practice and evidence-based maternal and fetal care. That means that they recognize that the United States is over-prescribing C-sections to laboring mothers.
Now, if a first time mother has a C-section, it can be difficult for her to find a provider who will allow her who will support her in pursuing a VBAC (vaginal birth after cesarean). ACOG has updated their stance on VBAC somewhat recently. They agree that interval between births is not a contraindication for VBAC. In other words, if you have a cesarean and get pregnant shortly after, and you want to attempt a vaginal delivery with that second pregnancy - there is no medically justifiable reason that you should not be able to attempt a VBAC. As with any medical condition, unique conditions may make a specific mother a poor candidate for VBAC. However, poor candidacy is rare according to ACOG's new evidence-based conclusions.
Unfortunately, for every update that ACOG makes, it takes about 15 years before we see a change in practice in the field. Although ACOG now says that spacing between births is not a valid reason to recommend a second (or third or fourth) subsequent cesarean, we won't see most obstetricians following this recommendation for another 15 years! At which point, most women who are currently having babies probably won't be birthing more babies. That's a whole generation of mothers who will have to (literally) labor under the care of doctors who are likely NOT using the most up-to-date information in their practice. Since C-section increases the risk for placenta accreta, which is a very dangerous and potentially fatal complication, it is extremely upsetting that Obstetricians are not making a more rapid update to their practices regarding C-sections and VBAC.
Concerns about VBAC are just the tip of the iceberg! I'll be adding more in Part Two later this week. Stay tuned for a deeper dive into the State Of Obstetrics In The U.S.
What specific issues would you like me to cover in this series? Share your thoughts with me on Twitter @pi3sugarpi3 with #ObstetricsInTheUSA