October 4, 2011 | 9:30 AM |

Will The C-Section Rate Soon Hit 50 Percent?

FILED UNDER: Medicine/Science, Personal Health, cesarean delivery, childbirth

A doctor wonders how to stop the relentless rise in C-sections

Pretty much everyone agrees that the number of cesarean deliveries in the U.S. is too high: the rate has soared from 6% in the 1960s to 32% today.

In a recent editorial in the medical journal Obstetrics and Gynecology, Deputy Editor Dr. John Queenan suggests that we have yet to reach the peak. “The rate is likely to exceed 50% very soon in the U.S.,” he writes. “How can we curtail this runaway increase in cesarean deliveries?”

What’s really troubling, says Queenan, Professor and Chair emeritus at Georgetown University’s Department of Obstetrics and Gynecology, is that almost one-third of C-sections are for women who are having their first child, and that sets up a vicious cycle of future surgeries since vaginal births after cesareans (VBACs) are decreasing — some hospitals won’t even do them.

It didn’t used to be this way. In the past, C-sections required a prior consultation and full department review. Now, scheduled c-sections are often done at the patient’s request and vaginal delivery of breech babies “is no longer taught in many training programs,” he writes.

Of course, C-sections are safer now, but they are also more profitable for hospitals than normal, vaginal deliveries, and for doctors, they can be more efficient from a time-management perspective.

Nevertheless, if the numbers continue upward, Queenan says, “our profession will lose both credibility and the opportunity to determine our direction as third-party payers and the government will become involved.”

He offers a few suggestions to fix the problem:

1. A commitment from hospital obstetric departments to lower the c-section rate (this might also involve fewer labor inductions, which can also lead, inexorably, to surgical birth).

2. Better patient education so they are more fully aware of the risks and benefits of their choices.

3. Tort reform, so that ob/gyns don’t resort to C-sections as frequently “if any element of risk arises.”

4. Use more nurse midwives, whose “motivation to achieve vaginal delivery would be stronger.”

5. Provide equal compensation for vaginal and C-section births; compensate VBAC’s at a higher rate than normal delivery

6. Re-establish teaching and training for breech deliveries

Readers, childbirth experts, moms, do you have any other suggestions for this list?

About the author

Blogger, CommonHealth Rachel Zimmerman worked as a staff reporter for The Wall Street Journal for 10 years, most recently covering health and medicine out of the paper’s Boston bureau. Rachel has also written for The New York Times, the (now-defunct) Seattle Post-Intelligencer and the alternative newspaper Willamette Week, in Portland, Ore., among other publications. Rachel co-wrote a book about birth, published by Bantam/Random House, and spent 2008 as a Knight Science Journalism Fellow at MIT. Rachel lives in Cambridge with her husband and two daughters. View all posts by Rachel Zimmerman →

  • Kat

    Good points. I think this whole issue is centered around the birthing process and choices going out of women’s hands. It’s sad that most women, even those who are educated about their options, are often made to feel bullied or less adequate to make decisions about their labor, whether where it takes place or what interventions to agree to. In our society, MDs are seemingly coveted as gods who know everything because they are more educated than you, and are infinitely more wise in decisions about someone’s own body. An individual’s wishes should be listened to, not discarded as unnecessary, or optional. OBs can save women’s and newborns lives, and do. Modern medicine is amazing. Everyone’s saying how this problem is rooted in money, or legal problems, yeah it is. Guess what though? YOU pay for the service. Even in labor and delivery “good customer service” should be taken into account. Which means OB/GYNs should be trained to handle every kind of birthing experience their paying customer could want.

  • Lara

    C sections lead to ear infections??? There is no research to prove that bizarre claim.

    C sections cause the following complications for babies-
    1. Breathing difficulties (if performed prior to 39 weeks)
    2. Lower APGAR
    3. Very small chance of getting nicked

    Vaginal births can cause the following complications for babies-
    1. Brachial Plexus nerve injuries
    2. Cerebral Palsy
    3. Spinal cord injuries
    4. Brain heamorrheage
    5. Intracranial heamorrheage
    6. Facial nerve palsy
    7. In rare cases epileptic strokes
    8. Shoulder dystocia

    My advice is this: Make informed decisions.

    I do not not buy into either way of thinking- not the school of thought which regards c sections as evil and not the one which regards them as convenient.

    I fully support a woman’s right to choose a c section as long as it is after 39 weeks and she is fully informed of the risks and benefits of both options.