• The Debate Over Rising Rates of Cesarean Delivery

    On the Rise

    Birthing image According to the World Health Organization (WHO), rates of cesearean deliveries have been rising in many countries, including US, Canada, England, France, Germany, Italy, and Ireland. Now, countries like Brazil, India, and China are also seeing an increase in rates.
    While the WHO recommends rates below 15%, C-sections account for about 30% of deliveries in the US. It is estimated that about one mother in three has a C-section.
    Why is the rate rising? Reasons for C-sections range from life-threatening emergencies to simple convenience to threats of malpractice. Doctors agree that, when indicated because of complications involving either mother or baby, C-sections can save lives. And in the face of patients who demand the procedure and threaten malpractice suits if a vaginal birth goes wrong, the surgery may also save them time with their lawyers. Still, the major abdominal surgery has risks, including rare cases of death, infection, excessive bleeding, reactions to medicines, and injury to the baby. Many doctors and patients worry that rising cesarean rates indicate too much of a good thing.

    Informed Choices

    The American Congress of Obstetricians and Gynecologists (ACOG) advises that doctors and patients carefully weigh the benefits and risks associated with both cesarean and vaginal deliveries on a case-by-case basis. The earlier pregnant women begin conversations with their doctors about their delivery options, the better.
    ACOG advises women to speak frankly with their doctors and ask plenty of questions, such as:
    • What is your rate of cesarean versus vaginal deliveries?
    • Under what circumstances is a C-section necessary?
    • How is the hospital/birth center where I will give birth prepared for emergencies?
    • What if I want to schedule a C-section before I go into labor?
    • What if I do not want a C-section as part of my birth plan?
    Even if you had a C-section in the past that does not necessarily mean that you will have to have another C-section. In some cases, a vaginal birth after cesarean delivery (VBAC) can be a safe choice. By talking with your doctor, you can learn more about delivery options and make a birth plan that is right for you and your baby.

    RESOURCES

    American Congress of Obstetricians and Gynecologists http://www.acog.org/

    Childbirth Connection http://www.childbirthconnection.org/

    CANADIAN RESOURCES

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    The American College of Obstetricians and Gynecologists. Cesarean Delivery on Maternal Request, Committee Opinion, No.394. December, 2007.

    Aylin P, Bottle A, Jarman B. Social class and elective cesareans in the English NHS. British Journal of Medicine . 2004; 328: 1399.

    Births—method of delivery. Centers for Disease Control and Prevention website. Available at http://www.cdc.gov/nchs/fastats/delivery.htm . Updated November 30, 2011. Accessed June 25, 2012.

    Cesarean section. Childbirth Connection website. Available at: http://www.childbirthconnection.org/article.asp?ck=10456. Updated May 17, 2012. Accessed June 25, 2012.

    National institutes of health consesus development conferece statement: vaginal birth after cesarean: new insights March 8-10, 2010. Semin Perinatol. 2010;34(5):351-65.Obstetrics & Gynecology website. Available at http://journals.lww.com/greenjournal/Citation/2010/06000/National%5FInstitutes%5Fof%5FHealth%5FConsensus.26.aspx . Accessed June 25, 2012.

    Druzin ML, El-Sayed YY. Cesarean delivery on maternal request: wise use of finite resources? A view from the trenches. Semin Perinatol . 2006 Oct;30(5):305-8.

    Ibekwe PC. Rising trends in cesarean section rates: an issue of major concern in Nigeria. Niger J Med . 2004; 13(2):180-1.

    Menacker F, Declercq E, Macdorman MF. Cesarean delivery: background, trends, and epidemiology. Semin Perinatol . 2006 Oct;30(5):235-41.

    Minkoff H, Chervenak FA. Elective primary cesarean delivery. N Engl J Med . 2003; 348: 946-950.

    Nygaard I, Cruikshank DP. Should all women be offered elective cesarean delivery? Obstet Gynecol . 2004: 102(2): 217–219.

    Sufang G. Padmadas S, Fengmin Z, Brown J, Stones R. Delivery settings and caesarean section rates in China. World Health Organization website. Available at: http://www.who.int/bulletin/volumes/85/10/06-035808/en/index.html. Published October 2007. Accessed June 25, 2012.

    Vaginal birth after cesarean delivery: deciding on a trial of labor after cesarean delivery. American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq070.pdf?dmc=1&ts=20120625T1353426267. Updated August 2011. Accessed June 25, 2012.

    1/29/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Lumbiganon P, Laopaiboon M, Gülmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet. 2010 Jan 11.

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