The C-Section Epidemic in America

The World Health Organization recommends that a nation's rate of cesarean section births be at or below 15%. While most developed countries have a rate of around 20%, the c-section rate in the United States as of 2009 was a staggaring 32%. That's nearly 1 in 3! Why is this happening? A number of factors play into it, including the prevalence of inductions, increasing numbers of overweight mothers (often with gestational diabetes) giving birth to large babies, as well as the presumed convenience and ease of cesarean delivery. We can basically boil down c-section rationing into 3 reasons- fear, concern, or convenience.

Why Doctors and Moms are Opting for the Knife

The fear I am speaking of is not fear of health danger to the mother or baby. It's not a fear of the mother not being able to deliver successfully vaginally. It's a fear of lawsuits. In today's lawsuit-happy society parents may be inclined to file suit against a doctor and/or the hospital in the case of any health or cosmetic issue related to the vaginal delivery. While doctors do need to exercise caution, keeping safety of the mother and baby a higher priority than a natural birth, women shouldn't be pressured into surgery for failure to progress after only a short time period.

Another reason for c-sections is genuine concern over the baby and/or mother's health and safety. If a baby is struggling after being given ample time to move down on his own, a cesarian may be necessary. If baby responds poorly to contractions, showing signs of excessive stress, a c-section may be wise. In these circumstances the baby's well-being needs to be the top priority.

Unfortunately, one of the largest reasons for inductions and cesareans is convenience. The doctor or baby's parents want him out before Christmas, even though the due date is the 1st of January. The doctor has a golf game on Saturday, so lets get that baby out Friday night, even though mom's only been laboring on her own for a few hours. That baby is going to be big, so we need to induce at 38 weeks. The list of excuses for inductions and/or c-sections goes on. Some doctors simply schedule inductions during the 39th or 40th weeks to avoid the hassel increased fetal monitoring  (bio-physical profile ultrasounding and non-stress tests performed after the due date).

Cesarean Statistics
Having a c-section might seem like a simple procedure that gets the baby out quickly and safely. There are a host of reasons, however, why this major surgery should not be performed at the current rates.

• It is major surgery that involves many risks, including infection, scarring, and more.
• Complications lead to increased risk for the mother being further hospitalized and the infant needing time in NICU.
• Increased risk of uterine rupture during subsequent pregnancies (life threatening for mother and baby).
• Increased risk of placenta abnormalities in future pregnancies, causing hemorrhaging and possibly requiring a hystorectomy.
• C-section births make it difficult or impossible to have a large family.

What Can or Should be Done?
There are quite a few things that the medical community should be doing differently. Inductions need to be performed only in extreme health risk situations. Obstetricians should be resolute in fighting a woman's desire for a convenience-based induction. Pitocin should not be routinely administered. Women should be encouraged to move around and walk during labor to encourage regular contractions. This is only feasable if she is not hooked up to an IV and monitors. Doctors and nurses need to respect the fact that every woman labors differently, not necessarily at the standard 1 cm per hour pace. As long as her membranes are in tact and the baby is well, a mother should be able to labor as gradually as her body progresses naturally.

These changes aren't going to happen overnight. Until then, what can we do? Are we obliged to be victims of a careless and money driven medical machine? Absolutely not! You've got a lot of power. Up until recently, though, we haven't been exercising it. You can choose an obstetrician who cares about you, not just his or her assembly line of mamas. Better, still, you can choose a midwife and opt for a birth center or homebirth. Midwifery is on the rise in the US. Women are choosing natural childbirth, relying on techniques such as water and hypnosis to manage labor pain. If you choose an obstetrician and a traditional hospital delivery, do your homework. Have a heart to heart honest conversation with your md about your expectations for the delivery. If you want a drug free birth, remember that hospital beds are not the best choices for a comfortable labor. Bring a birthing (yoga/exercise) ball.

It's YOUR Birth!
Remember above all that this is your childbirth. Don't cave to an unecessary induction. Do switch doctors, even in your last trimester, if your current physician isn't meeting your expectations. Don't worry about your "due" date. It's only to give a general idea for the baby's expected arrival. Your baby doesn't suddenly become unsafe in your womb on this magic day. You might deliver as much as 2 weeks past this date. My own grandmother in-law went a whopping 43 weeks with one of her 4 pregnancies, delivering a healthy 7 pound baby. Most care-givers won't let you go past 42 weeks these days, but that's ample time for most pregnancies. Don't deal with any practitioner who won't at least give you 42 weeks. With proper fetal monitoring, there is little danger in going these few extra days.

I made a lot of mistakes in my first pregnancy/delivery. It was a painful experience, though, I thankfully did it vaginally. Second time around, I hired a midwife, and gave birth in a beautiful tub in a room filled with dim lighting and soothing music. I'll describe that magical experience in another post. The bottom line is that the skyrocketting cesarean rate isn't good for anyone- except possibly the doctors who make twice as much money from these risky deliveries. In developing countries, such as China, the rates are approaching 50% for this very reason. Women need to take a stand and take charge of their own births. The health of our moms and newborns is not improving as c-section rates increase. It's your baby and your body. Make the right choices, rather than what is convenient.