Why is the national U.S cesarean section rate so high? Excerpt from http://www.childbirthconnection.org/article.asp?ck=10456
More recent studies reaffirm earlier World Health Organization recommendations about optimal rates of cesarean section. The best outcomes for women and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006). The national U.S. cesarean section rate was 4.5% and near this optimal range in 1965 when it was first measured (Taffel et al. 1987). Since then, large groups of healthy, low-risk American women who have received care that enhanced their bodies’ innate capacity for giving birth have achieved 4% cesarean section rates and good overall birth outcomes (Johnson and Daviss 2005, Rooks et al. 1989). However, the national cesarean section rate is much higher and, after more than a decade of increasing steadily, has recently experienced the first dip since the mid-1990s. With the 2010 rate at 32.8% (Hamilton et al. 2011), about one mother in three now gives birth by cesarean section.
Why? Because most cesareans are UNNECESSARY! Many cesareans are performed due to hospital dictated time constraints and so called “fetal distress”. Additionally, did you know that the majority of repeat cesareans should be VBAC (Vagainal Birth After Cesarean)? A repeat cesarean carries MORE risk than a VBAC. I’m reading an excellent book right now, in which I highly recommend to women that have had a cesarean and those thinking about VBAC. It’s an older book, but nonetheless, very well written. “Silent Knife” Cesarean Prevention & Vaginal Birth After Cesarean. Authors Nancy Wainer Cohen & Lois J. Estner. For more information on VBAC, please see the “Resources” section.
Excerpts from 4th Edition Pregnancy Childbirth and the Newborn The Complete Guide Authors Simkin, Whalley, Keppler, Durham and Bolding
Reducing your chances of having a cesarean birth/Ten steps to improve your chances of having a safe and satisfying birth
1. If your baby is breech at 35 weeks, attempt to turn her using positions, moxibustion, acupuncture, or chiropractic techniques.
2. AVOID induction for NON-MEDICAL reasons. Research shows that induction INCREASES ths risk of cesarean.
3. If labor is slow, try a variety of positions and movement to speed it up. Or try self-help techniques, including nipple stimulation, relaxation techniques, eating or drinking and emotional support to reduce fear and anxiety (have a doula!). Note: Epidurals greatly restrict movement. Eating & drinking is not allowed during labor at most hospitals. Not staying well hydrated and not eating can stall labor. Your body needs energy! It’s working hard! Not all birthing centers have this policy. Know your options. If you are planning to deliver at hospital, stay home as long as you can.
4. If your caregiver recommends a cesarean for “failure to progress” or “fetal distress”, ask the following questions:
How much time do we have to decide?
Can I labor for another hour before having a cesarean?
What other options can I try?
Can I change positions?
Start or stop Pitocin?
Start or stop pain medications?
Have oxygen or IV fluids?
Use tests to check my baby’s well-being?
Use vacuum extraction or forceps delivery?
If you’re uncomfortable with your caregiver’s response, ask for a second opinion. Continue to ask questions until you feel that you understand your caregiver’s answers. Once you do, you can make an informed decision.
Cesareans planned for CLEAR medical reasons
- placenta previa
- malformed or injured pelvis
- severe preeclampsia
- genital herpes, if infection occures late in pregnancy
- HIV, if the viral load is over 1,000 copies per ml
- transverse lie
- twins if the first baby is breech; triplets or more
- certain birth defects, problems with the baby, or medical problems with the mother
Cesareans planned for LESS CLEAR medical reasons
- prior cesarean (Talk with your caregiver about VBAC–vaginal birth after cesarean. Know your options!)
- recurrent genital herpes with active lesions at the beginning of labor
- breech presentation (Again, research your options! There are things you and others CAN do to attempt to turn a breech baby. Also, here in Utah there are multiple providers who will support you in a breech birth.) https://evidencebasedbirth.com/what-is-the-evidence-for-using-an-external-cephalic-version-to-turn-a-breech-baby/
- twins if the first baby is presenting head down
- large baby (https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/)
Cesareans planned without medical reason
- fear, convenience, and so on
Unplanned cesareasns for situations that arise in labor
- failure to progress/cephalo-pelvic disproportion
- variations in the baby’s heart rate that indicate possible distress
- placental abruption
- prolapsed cord
- uterine rupture
- urgent health problems with mother or baby