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 StatisticsWhen it's Needed Risks Seven Ways to Avoid One Resources A cesarean birth is an operation that results in a baby being brought into the world through an incision in the mother's abdomen and uterus. Because of the inherent risks involved, cesareans were originally performed only in emergency situations. Now, however, cesareans are the most frequently performed surgery in the United States, with almost a million and a half pregnant mothers giving birth via cesarean in 2007 (the last year for which statistics are available). Statistics: The cesarean birth rate in the Unites States is now at an all-time record high of 31.8%, according to the most recent statistics from the Centers for Disease Control. The U.S. has posted record high cesarean rates every year since 1996, a trend that concerns the American College of Obstetricians and Gynecologists, quoted here in a recent New York Times article. In the article, an ACOG spokesman says that while the number of cesarean births is increasing, the outcomes for mothers and babies isn't improving. By comparison, in 1970, the cesarean rate in the United States was just 5%. The six-fold increase in cesareans over the last four decades has been attributed to a number of factors:
The World Health Organization states that a cesarean birth rate that is higher than 15% imposes more risks than benefits to mothers and babies. When is a cesarean medically necessary? We'd like to think that because pregnancy and birth are natural events, there are never any complications. But that's just not true. Challenges do sometimes arise that can affect the health and safety of both the mother and the baby during pregnancy or labor, with cesarean surgery the only solution to having a safe outcome. According to the American College of Obstetricians and Gynecologists, here are some of the medical reasons why a cesarean would be necessary:
Risks to the Mother and Baby:  Surgery is risky, and cesarean operations, considered major abdominal surgery, are no exception. With a cesarean, it's not just one, but two people who are put at risk by the surgery.According to a report in the journal Obstetrics and Gynecology, "Cesarean delivery was associated with a significantly increased risk of maternal death from complications of anesthesia, puerperal infection, and venous thromboembolism. Cesarean delivery is associated with an increased risk of postpartum maternal death. Knowledge of the causes of death associated with this excess risk informs contemporary discussion about cesarean delivery on request and should inform preventive strategies." (Obstet Gynecol 2006;108:541—8) The Centers for Disease Control also states in its most recent report on cesarean rates in the U. S that "Cesarean delivery involves major abdominal surgery, and is associated with higher rates of surgical complications and maternal rehospitalization, as well as with complications requiring neonatal intensive care unit admission (3—5). In addition to health and safety risks for mothers and newborns, hospital charges for a cesarean delivery are almost double those for a vaginal delivery, imposing significant costs (6)." Seven Ways to Help Avoid an Unnecessary Cesarean: Don't be induced. According to a report in the journal Obstetrics and Gynecology women who went into labor spontaneously had a cesarean birth rate of just 7.8%, but women who were induced for any reason—medical or elective—had a cesarean birth more than 17% of the time. Another study by the Intermountain Healthcare Agency shows a 51% chance of a cesarean in women who are induced but who have a low Bishop Score, an indication that their body is just not ready for labor. Become educated. Knowing what to expect in labor—including the risk of complications—is key to helping avoid an unnecessary cesarean. If you know the facts, you'll know what questions to ask if or when a cesarean is recommended. Learn online, in-person or by phone. Choose your caregiver carefully. Ask your obstetrician or midwife if or when they would recommend a cesarean. Find out, based on your current health status, what they think your chances would be of needing a cesarean. Knowing your hospital's cesarean birth rate might also be helpful. In some states, the Department of Health keeps those statistics, or you can contact the hospital directly. Choose good labor support. Your partner, friend or relative might make an excellent labor supporter, as long as they are knowledgeable about labor and have either read or taken a class about how to support a woman in labor. Otherwise, you might want to consider a professional labor supporter, called a doula, who can help you adhere to your birth preferences while offering support through positions, massage and verbal encouragement. Doulas are certified through several agencies, including DONA International the Childbirth and Postpartum Professional Association (CAPPA) and the International Childbirth Education Association(ICEA). Allow the water to break on its own. A review of the studies has found that "breaking the water" does not conclusively start or speed up labor. What we do know for sure is that once the water is broken, it increases a mother's risk for uterine infection and can also set a time limit on how long she will be allowed to labor before another intervention, such as pitocin, is recommended.  Electronic Fetal Monitoring (EFM): Opt for Intermittent not Continuous:A review of the studies found that laboring women whose babies were monitored continuously had higher rates of forceps deliveries, vacuum extractions, and cesareans. So ask your caregivers—obstetrician, midwife and nurses—if they can monitor the baby's heart rate intermittently instead of continuously while you're in labor. Remain low-risk. You have a better shot at a birth without any medical interventions, such as a cesarean, if you don't have any health problems, such as gestational diabetes, high blood pressure or severe weight gain. Eating healthy foods and exercising regularly can help you stay low-risk throughout your pregnancy. FOR MORE INFORMATION: American College of Obstetricians and Gynecologists (ACOG) American Pregnancy Association International Cesarean Awareness Network (ICAN): The International Cesarean Awareness Network is a non-profit advocacy and support group whose mission is to improve maternal and child health by preventing unnecessary cesareans through education, provide support for cesarean recovery, and promote vaginal birth after cesarean (VBAC). National Institutes of Health: Explains cesarean surgery with your choice of slide presentations or printable PDF pages. |
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