Cesarean section has become the most common operation performed in the US today.
Over the years researchers have studied the effects of the surgery on newborns more so than they have studied the immediate medical effects on the mothers. A recent USA Today article covers a new government study that finally does look at the moms and the medical effects cesareans have had on them.
What they found is that while cesareans have been rising, so too have the incidents of severe birth complications. The study looks at two time periods: 1998-99 vs. 2004-05. In 2006 (the most recent year for which statistics are available) 31.1%
of all U.S. births were cesarean, up 50% from 1998.
What the researchers found in looking at birth complications for these two time periods were strong increases in blood transfusions, blood clots in the lungs, kidney failure, respiratory distress, shock, and the need for a ventilator.
From the article:
While the study doesn't prove that C-sections
cause complications, tracking those complications could be useful, says
co-author Susan Meikle, a medical officer at the Eunice Kennedy Shriver
National Institute of Child Health and Human Development.
The actual number of deliveries with at least
one complication was 0.64% in 1998-99 and 0.81% in 2004-05. "Even
though the absolute numbers are low, the rates are increasing. … We
could do a better job at tracking these complications," says Meikle, an
obstetrician. "There may be short-term trade-offs and long-term
trade-offs (depending on mode of delivery). We don't know that yet."
The study did not cover the reason for the cesareans and whether the moms who had them were sick beforehand.
Michael Kramer, scientific director of the
Canadian counterpart of Meikle's institute, notes that in some cases, a
complication might have triggered a C-section, not vice-versa. Still,
says Kramer, co-author of a 2007 report that found more severe maternal
complications in planned C-sections than in vaginal deliveries, doctors
tend to underestimate C-section risks.
A related article was written on the same study in the Guardian newspaper and included the following quote:
"There
are rare adverse outcomes no matter what we do," said Dr Alan Peaceman,
chief of maternal foetal medicine at Northwestern Memorial Hospital in
Chicago. "I don't think anyone should be worried about it. But [the new
data] should be kept in mind and be part of the equation when
considering the risks and benefits of doing the procedure."
I disagree that no one should worry.
According to the World Health Organization the best outcomes for mothers and babies occur with cesarean
section rates of 5% to 10%. Rates above 15% seem to do more harm than
good. Currently, an astounding 1 in 3 women in the US is delivering via cesarean section.
Please don't misunderstand me: I am grateful that cesarean birth is possible. Many women and children owe their lives to this utterly amazing procedure. That is why it exists. But, a lot of women and babies who don't need this surgery are experiencing it. Going back to the Guardian article:
Dr Xavier Pombar, director of obstetrics at Rush University Medical
Centre in Chicago, said some women prefer a Caesarean because they view
it as easier to schedule and less likely to cause complications such as
urinary incontinence.
He said physicians are more inclined to do C-sections because they fear being sued if problems arise during a vaginal delivery.
"Everything in this country is pushing toward higher Caesarean rates," he said.
Childbirth Connection, a national non-profit founded in 1918, conducted a national survey of women who gave birth in hospitals in 2005. They say they were the first study to poll women about the decision to birth via cesarean in the United States. From their research, they reached the following conclusions on the reasons for the rising US cesarean rate. Interestingly, they did not find that more women are requesting to schedule cesarean births as we've been hearing. Rather, they found:
- Low priority of enhancing women's own abilities to give birth
- Side effects of common labor interventions
- Refusal to offer the informed choice of vaginal birth
- Casual attitudes about surgery and cesarean sections in particular
- Limited awareness of harms that are more likely with cesarean section
- Providers' fears of malpractice claims and lawsuits
- Incentives to practice in a manner that is efficient for providers
More on Childbirth Connection's survey findings here.
What can you do to lessen your chance of cesarean? Be mindful of your health during pregnancy and seek prenatal & birth care that enhances your body's innate capacity for giving birth. By this I mean, consider hiring a doula and/or a midwife and educate yourself before choosing where you want to birth your baby.
I think Diana Korte and Roberta Scaer put it best in A Good Birth, A Safe Birth: "If you don't know your options, you don't have any."
If you or someone you know has had a cesarean birth, please visit the International Cesarean Awareness Network to find resources and support in your area.
