Will The C-Section Rate Soon Hit 50 Percent?

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?

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  • 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.

  • Mother-Baby Health Advocate

    As one poster mentioned below, the rising cesarean rate is a complex problem.
            In addition to the reasons for the rising rate that have been given in the article and comments, it appears that more cesareans are *necessary* now than 30 years ago. More women have pre-eclampsia, gestational diabetes, and other complications. We have an obesity epidemic. Immune disorders are rampant. We have more chemicals, more drugs, more toxins. In this kind of health environment, doesn’t it make sense that more cesareans would be necessary now than were in the past?
            This complex situation requires a multi-pronged answer. I like the suggestions from Mr. Queenan mentioned in the article on how to reduce the cesarean rate – they appear to address many of the problems that are contributing to the rise. In addition to those, I would like to suggest that we need to include health education for expectant parents. Not just educating them about the risks and benefits of cesarean, but helping them to lower their risk of cesarean and other pregnancy complications if they choose to do so. Not everyone will choose to act on the education, but some will, and the effect can be drastic.The couples I have educated have shown a drastic reduction in complications, most notably premature birth, with making some healthy lifestyle changes. I expect that similar results could be achieved with cesareans, if patient education to reduce risk were to be used in combination with Mr. Queenan’s suggestions.

  • saddoula

    Women in the Victorian era died of childbed fever in large numbers. The infection was carried to them on the hands of physicians who did not accept the germ theory. They said that “gentlemen do not carry fever”. Oh, and they used to bleed women in order to speed delivery or lower fevers. Well, we know how well that worked.  I wish I had more time to type in the history of childbirth in this country that took place a century ago. But for now I must leave it at this and attend to other matters.  Just because Tuteur is an MD does not mean she is right about everything.  

    Those interested in this subject can read Birth: the surprising history of how we are born by Tina Cassidy. This book is the only complete history of childbirth available. Judith Leavitt, PhD has also written some terrific books on the history of childbirth in the US,  

  • guest

    Let women make their OWN decisions, to have one or not.

  • guest

    Not only midwives, but family physicians providing obstetrical care also push for non surgical outcomes. And many very clinically astute Obstetricians have the ultimate goal of a vaginal delivery. I also agree with other comments made, the public needs to be reeducated regarding natural childbirth. So many women are afraid of childbirth and the pain associated with labor. The majority of women are strong enough to do this – but somehow society has made them afraid. In addition, the epidemic of obesity surely has an impact on the operative delivery rate — obesity increases many risk factors in pregnancy – including cesarean delivery. I am surprised by the generalizations made in this article.

  • miahmdparash

    Hello

    It’s a nice article it will help my research.

    Thanks

     

  • Lawrence

    Females: Stop scheduling C-sections and induced labor for your convenience. 
    Hospitals: Stop being motivated by greed and start thinking of what’s best for the babyPEOPLE: C-sections leave the child predisposed to ear infections and a host of other health problems. When possible, natural is always the best. And don’t forget to nurse your child, instead of buying into Wall Street’s messages that formula is a good substitute. IT ISN’T. 

  • Beez

    C-sections are sympton of our bloated health care system and the doctor’s who insist on scheduling them for the profit and convenience.
    Try natural childbirth. Try a birth center. Why are the rates of c-sections in these cases drastically lower than the rest of (the same) society?

  • Sue

    Hey GUEST
    GRANNYS right!

    • PaulClarkEMT-P

      Home Birth is on the rise.  Amy Tuteur cant argue that.  And most women who I know who choose home birth either do it because they are sick of Doctors who treat them like crap or push them into interventions they dont want. 
      Amy Tuteur has Zero experience with home birth or Certified Professional Midwives.  She does not practice medicine anymore and hasnt for awile.  So before you drink her koolaid and think she is the expert on everything please do the research for yourself. Amy gets a kick out of attempting to derail one certification.  She assumes that having a nursing degree somehow makes you a better midwife.  The RN does nothing to improve birth outcomes, and it teaches you nothing that would make you a better Midwife in a homebirth setting. The Certified Professional Midwife is the only certification that requires Out of Hospital Births.  No other training requires the midwife to attend out of hospital births before they go and to them.  And Amy Tuteur for someone who hails them self an expert has never attended a homebirth with a CPM so I’d write off anything she has to say about them.

      Take ownership of your birth ladies.  Be your own advocate.  Dads need to step up and be an advocate for their partners.  Trust your doctors as they are not all idiots… They trained for years to handle emergencies. Thank god we have them.  Educate yourself and you can have a great birth in a hospital or at home.

      We spend more time researching the next phone we want than the birth process.

  • Amy Tuteur, MD

    As H.L. Mencken said: “For every complex problem there is an answer that is clear, simple, and wrong.”

    The rising C-section rate is a complex problem and the idea that it can be addressed by increasing CPMs and doulas is clear, simple and spectacularly wrong. CPMs are a second, inferior class of midwife that can’t hold a candle to CNMs (certified nurse midwives). CPMs are grossly undereducated, grossly undertrained and don’t meet the requirements for licensing of midwives in ANY first world country.

    CPMs, and to a lesser extent doulas, privilege process over outcome. It is far more important to them how a baby is born than whether it is born healthy. Anybody can lower the C-section rate at the price of increasing the perinatal death rate. That’s hardly a desirable solution.

    The rising C-section rate is a result of a variety of factors, including societal expectations. Modern obstetrics has lowered the neonatal mortality rate 90% and the maternal mortality rate 99% in the past 100 years. As a result, Americans expect that every baby will be born perfect and want to punish someone if anything is less than perfect.

    Nearly all obstetricians will be sued at some point in their career and many will be sued more than once. Of the 9 leading causes of obstetric lawsuits, fully 6 out of 9 allege failure to perform a C-section or failure to perform a C-section
    sooner. In other words, performing a C-section when there is any doubt
    about the baby’s health, or even before there is any doubt, will
    virtually eliminate the chance of being sued successfully in connection
    with the delivery.

    You cannot say to obstetricians, “Give me a perfect baby or I will
    try to destroy you professionally and economically” and then express shock
    and dismay that obstetricians will perform C-sections in order to guarantee
    that you will have a perfect baby.

    Any attempt to address the rising C-section rate must deal with this issue. If the American public continues to believe that punishing obstetricians is the appropriate response to a less than perfect outcome, the C-section will continue to rise, regardless of any other efforts to halt that rise.

    • Ananda

      Dr. Amy, I am not sure why you have made it your career to slander home birth practitioners.  What do you get out of it?  How many home births have you ever attended, and why do you claim to be an expert on home birth if you are not experienced with it?  Parents who deliver with home birth practitioners generally express very high satisfaction with their care, and take on a high amount of personal responsibility for their decision to birth at home.  The top reason parents give for making this choice is the increased safety and decreased risk of unnecessary intervention they will encounter at home.  No one is insisting that all mothers birth at home, and no one is insisting that women birth at home without becoming educated about, and taking responsibility for, their care.  The only mothers I know personally whose babies have died are those who birthed in hospitals, due to fetal distress after the use of epidurals or induction drugs.  The field of obstetrics decreased maternal mortality in the past 100 years by finally admitting that lack of handwashing was killing mothers and babies, and by the develpment of antibiotics, when the cesarean rate was still BELOW 5 percent, not by increasing the rate of surgical births to unheard of proportions.  As for whether the use of CPMs and doulas reduces the rate of cesareans, the scientific evidence is clear.  There is no other intervention that has such a dramatic impact on the cesarean rate.

      • AKS

        I am amazed at this discussion happening in a first world. Obviously we have forgotten how the maternal mortality has decreased over the past 150 years dramatically (confidentially inquiry into maternal mortality UK). There was a time during the Victorian era when women were afraid to become pregnant simply because one out of 4 would die during childbirth! Getting pregnant was a slow march towards gallows. Good antenatal care, intrapartum care and dont forget postpartum care in the key to success. Improved asepsis, fluid resusitation, and safe anesthesia practice (avoiding general anesthesia) has reduced the maternal mortality in the Western world to negligible level! Unfortunately still on this planet maternal mortality is equated to one jumbo jet plunging into sea every hour! We are trying to shake the very foundation of safety which has brought us here…so hats off to Dr Tuteur for her bold comments.

    • Paul

      I’m a young man who knows little about the birth process, but this statement really sticks out to me:

      “Nearly all obstetricians will be sued at some point in their career and many will be sued more than once. Of the 9 leading causes of obstetric lawsuits, fully 6 out of 9 allege failure to perform a C-section or failure to perform a C-section 
      sooner.”
      If true, those numbers are shocking; and if I were an obstetrician, I know what I would do: more C-sections. This issue has little to do with health and everything to do with our litigious society.

      Thank you, Dr Tuteur, for enlightening me on this issue.

    • Theadocious

      Your doctorate must be in hateful insinuation.  You hate midwives, doulas and natural birth.  You hate that anyone would treat birth as a natural normal occurance.  You think society and lawyers are the cause, and OB’s are somehow forced to behave the way they do.  But the worst thing you said is that OB’s use cesareans to guarantee a perfect baby.

  • http://www.electivecesarean.com/ Pauline Hull

    Firstly, I’d like to point out that if a cesarean is “done at the patient’s request”, and it is carried out at the recommended 39+ weeks’ gestation, then this is perfectly legitimate – and should not be the type of cesarean birth that is targeted in any effort to reduce overall rates.

    Secondly, I’d like to suggest a few other areas that the author may want to consider when
    listing what might “fix the problem” of rising cesarean rates. Namely – addressing the fact that increasing numbers of pregnant women are overweight or obese, and are giving birth at an advanced maternal age.

    Blaming obstetricians, blaming inductions, blaming litigation, blaming hospital finances, blaming lack of training etc. will only get you so far. We also need to be honest with women about their individual risks, and their likelihood of achieving positive outcomes with different birth plans, by telling them how these can be affected by their personal circumstances too.

  • Toadeodeos

    While I was in labor with my third son I made the decision to go into the hospital. I was given the option to have an epidural and pitocin. I made the decision to wait and let my labor proceed naturally. Because I was already 9 days over due (this was a planned pregnancy so the conception date was acurate) they kept me there. Ten hours later I was progressing wellat 9cm and everything stalled. The docs again offered pitocin but I said no. my labor had progressed well and I wanted to give my body time to adjust. Just then the baby’s heart beat dropped almost to stopping and all at once it seemed that half the hospital was in my room. I assumed that what would come next would be an emergency c-cetion but I was wrong. The staff was amazing. They had me push with all my might, and even though I tore alot, the baby was delivered and rushed to the nicu. Had I been at a birthing center my baby would not have been able to recieve the emergency medical care he needed in time and probobly wouldnt be here with us today. Demonizing the medical commumity and scrutinising mothers who choose to have medical care is not the answer. I am truely gratefull to all of the docs and nurses who helped my family and continue to help families every day. I believe that education is key. Each birth is different as is each mother and while I disagree with medical intervention simply for convenience, I think to each their own. Untill you have walked a mile in each persons shoes, you have no way of knowing where their motivations come from.

  • saddoula

    Stop unnecessary inductions and that likely means most inductions. I am a doula with over 280 births. I see more and more and more inductions for a mom at just 41 weeks or LESS!

    I also have begun to see again almost universal electronic fetal monitoring (EFM).  I watched a client of mine recently suffer greatly because she was nearly impossible to monitor but they tried and tried and tried her whole labor interfered with by that miserable monitor. The monitoring was unnecessary but she wrongly believed her doctor was trying to protect her. There is no benefit of EFM to low risk mom or baby.  But there is the danger of a higher rate of cesarean in monitored moms. Check the literature for yourself. 

  • Regina

    How about take birth out of the hospitals and leave only the really complicated high risks birth for the hospitasl where the surgeons are trained to cut. Additionally, why not look at western European countries such as the Netherlands, Finland, Norway etc where their maternal infant mortality is significantly better than the United States. The answer Midwives who are trained in the art of birthing and women who provide mothers with physical, emotional, and spiritual support.

  • Arwhatley

    Programs from the March of Dimes like 39 week Tool kit should help with this; also CenteringPregnancy Group Prenatal Care implemented by OBGYNs can help include the educational piece and Doula’s can help to reduce induction rates, which decrease the cesarean rates. 

  • Debbie

    Childbirth Education has to change from the hospital based ones which teach women how to be a good patient & go along with the medical model to something more along the lines of HypnoBirthing.  We will be way more successful by educating women rather than trying to change doctors and medical schools, although, I do believe medical schools need to include natural birth as part of any OB rotation.  When a woman understands about the fear-tension-pain cycle (per Dr. Grantly Dick-Read) they will begin to understand that it’s the fear that causes the pain during childbirth, so they can decide to take a different route than an epidural.  Insurance companies need to stop paying for routine epidurals and non-medically necessary c-sections.  HypnoBirthing has a 16% C-section rate.  Big difference.  And if we make changes like tort reform and stop inducing when not necessary, that rate could go down to what the World Health Organization Recommends- about 10%.  How we birth is really up to each and every woman. Women need to stop being scared and take back their power, get educated and decide how THEY want to bring their baby into the world.  I’ve been a childbirth educator & labor companion for many years.  I can only ask, why is it that home births go so well?  My first home birth client said it perfectly “…because we trust”.  Women have been birthing since the beginning of time…when  Pitocin and epidurals weren’t given out like candy.  Women have to want a different scenario. If not for them…how about for their babies????

    Debbie Catz, M.S.W., C.Ht
    norcalhypno.com

  • Yogabec

    I heartily agree with what everyone seems to be saying. I am a Birth doula myself, and have attended over 100 births. Yes, doulas make a huge difference and we should be making more effort to have those services covered under insurance, and better integrated as part of the birth team, but the biggest challenge I see in hospitals is this idea of managing labor. We need to get away from believing that we as humans know better how the body must birth and start trusting that women are fully capable of having babies without someone rushing in to save them from a failing body. I feel that Hospitals have become so bogged down by protocols and dilation curves that we have forgotten this process involves a person. The body is not a machine, and I just wish that modern obstetrics (which has some wonderful interventions, when needed) would step back and look to see if they really needed to induce for being late, or to insist the mother remain in bed, or on a monitor. We need to stop doing so much, and let Nature so what she already knows how to do. Stop interfering in the body’s natural process!

    • Hannah

      Hospitals are designed to service a broad range of people in the most efficient manner possible and to make  profit doing it.  Birth is personal.  No two women birth the same.  It is not like gall blader surgery.  Hospitals are a lousy place to birth.

  • http://laborpainzsupport.blogspot.com/ Martha

    I saw in Fit Pregnancy in the doctors office that it does have some pro-doula articles and info about how they can reduce your c-section rate. One that I saw today said this one liner “You can reduce your chance for a c-section by 27% if you have a labor support person (doula) at your labor and delivery.” 

  • doulalee

    I am also a certified birth doula, and I have to agree with Grannygoo.  My clients are terrified of being forced into a C-section, and try everything in the book to avoid it.  It’s such a shame, and she did end up with the surgery in the end.  It’s ridiculous and unnecessary.  We need to take birth back.

  • Denise

    See now
    I agree with the need to reduce the Cesarean Rate in the US. In order to
    accomplish this unbiased patient education has to take place, proper training
    for Labor & delivery nurses and OB’s for
    natural birth and us as a society rejecting the political & financial
    greed. However, I do not agree that someone who is birthing in a Normal Biological
    State should be paying
    the same or more than the high rate of a major surgery.

  • mmw

    How many natural births that do not include interventions, pain medications or an epidural does the average Obstetric or Nursing student see in their training?  It would seem quite challenging for these medical caregivers to become fully comfortable with attending a totally natural birth when this is not the bulk of what they have seen.  That coupled with the fear of litigation and the reality that many, many women do not take responsibility for fully informing themselves on the risks and benefits of some of these interventions and you have a big problem.  Women in the US are very afraid of giving birth and statistics like this illustrate why.  

    • Samquilla

      My cousin did her med school OB rotation while I was pregnant with my daughter. She asked me at a holiday gathering if i had any questions for her. I had one – did you see any completely intervention-free births? Answer – nope.

  • Carson O’Keeffe

    having a doula present at birth reduces risk of c-section by 50%! if we ‘required’ doulas to be present at every birth, we would reduce the NATIONAL c-section rate by 50% as well as each individual woman’s risk….

    • kmb

      I think this is a mis-statement — having a doula present at a birth can reduce the risk by 50%, but having a doula does not guarantee the desired outcome.

      If OBs etc could abandon the labor progression tools (based on Friedman’s curve) as they are, this may also go a long way towards reducing the total number of “required” cesareans. I really like Midwife Thinking’s blog on this subject called “The Assessment of Progress” published 24 Sep 2011 (a ‘reprint’ of her article written for the AIMS Journal). See http://midwifethinking.com/2011/09/14/the-assessment-of-progress/ .

      I also really like the oft quoted statement from Dr John Kennell MD, “If a doula were a drug, it would be unethical not to use [one].” Just think how it would be if doulas were pushed in the hospital as much as epidurals are… It would mean a recognition of the value of low tech interventions and perhaps even a respect for the psychology, emotional, and even spiritual aspects that can be and are a part of birth. May the nationwide change come in your and my lifetime.

  • http://insteadofinstitutions.blogspot.com/ jessica

    Like all public health concerns there are many, many variables which influence the rising cesarean rates…. malpractice insurance, birth in a teaching hospital, private vs medicaid insurance coverage, the race, age, income, education, and parity of the mother, geographic location of the birth, etc, etc, etc. Given that the World Health Organization has stated 15% to be the *maximum* cesarean birth rate, and research tells us that best outcome for mothers and babies are achieved at a 5%-10% rate it is an outrage that our health care system is putting women and infants at risk in this manner.

    The article touched on several good starting points for lowering rates – I would include more out of hospital birth options (birth centers and homes), increased use of Certified Professional Midwives (the only birth professionals guaranteed to have training for low-risk, low-technology births), increased use of doula support for laboring families, and an increase in the number of family physicians who attend births (like CNMs they are not surgeons and tend not to turn to surgery as quickly).  From a training point of view, increased training on supporting women who are giving birth to twins to do so vaginally.  And of course it is well known that the use of induction, continuous monitoring, and epidurals all contribute to unnecessarily high cesarean rates – any of the above would help with decreasing those interventions. 

    • Guest

      So we should use CPMs because they are trained in low-risk birth (“guaranteed”) over an obstetrician or properly-trained CNM because they have knowledge of birth complications, which can happen to anyone? 

      • kmb

        @34684c6f15f22ea03ba2484ae5cde0b0:disqus in reply to jessica, FYI — CPMs *are* trained in birth complications, as well as normal birth. Just because they are experts in normal delivery with little intervention does not mean CPMs will not recognize or respond efficaciously to complications and emergencies in labor and birth. A CPM is a great choice if you plan to have a home birth as OBs never attend home birth, and CNMs may or may not attend them depending on the legislation in the State they are practicing in (eg in my State of NM, CNMs can only attend home births if they are also CPMs and then Licensed Midwives in NM).

        I think what jessica meant by CPMs being “guaranteed” to have training in low risk birth is referencing the fact that OBs are not required to ever observe labor progression without interventions or surgery as part of their training (they may never see “natural, normal” birth before they start practicing). In fact, OBs do not need to attend nearly as many births as CPMs do in order to meet their licensing and certification requirements. I am grateful there are so many skilled surgeons as their skills are needed, but I am in the camp of “not as often as currently seen”. The cesarean section rate is abominable, imho.

        • Amy Tuteur, MD

          “Just because they are experts in normal delivery”

          That’s like being a meteorologist who is an expert in sunny weather, in other words, useless.

          The CPM credential is not recognized by any other first world country because CPMs lack the education and training required for midwives in the UK, the Netherlands, Australia and every other industrialized country. The only other country that ever recognized the CPM was Canada and it abolished it several years ago because of the deficits in education and training of CPMs.

          “OBs are not required to ever observe labor progression without interventions or surgery as part of their training”

          That is flat out false. Moreover, half of obstetricians are women and most have given birth. They are both educated and experienced on every aspect of labor and delivery, complicated and uncomplicated.

          • Hannah

            What else do the countries mentioned share.  Socialized medicine and a high number of home births.  They also practice differently than America does in cases of Group B strep and other common tests and treatments done here.  Oh, and they have a lower maternal and infant mortality rates than we here in America do.  Yet we only have 1% of babies born out of the hospital here.  I personally know several MDs.  None saw a normal natural birth in all of their training.  Dr Amy, why are you the only one in your mind who can generalize?

  • IRGrannyGoo

    I am a certified labor doula.  I have attended 3 births in the past 2 weeks.  Two mother’s had their labor induced, one mother went into labor naturally.  In all three births, c section was the top fear of these mothers!  The first birth, mom was induced with a “non friendly” cervix.  Rather than waiting to rupture the amniotic fluid, that was done immediately, setting mom up for a c section if her cervix did not respond to induction.  The second inuced birth, cervix was ready (100%effaced, dialated to 4 cm) before induction.  That mom stalled at 7.5 cm for 3 hours and again stalled at 9.5 cm for 3 hours at which point  doctor recommended a c section.  The third birth, mom stalled at 7 cm and again, c section was mentioned.  All three of these mothers ended up with an epidural which of course prevented using changing positions, the birthing ball or other interventions to help move the baby down and further dilation of the cervix.  Luckily, all three of these mothers were able to deliver healthy babies vaginally!  It just amazes me how quickly the medical community will artificially interfere in births and then immediately go to surgery to fix the problems that they havev created!  I think we need to re educate the physicians and nurses as to what is truly the “safer” alternative to birthing.  If we can change the mind set of “more is better” when it comes to pharaceutical, mechanical and emotional interference in birth, I think we can finally see the c section rate start to decline.

    • Guest

      You propose educating obstetricians?!  Your credentials must be off the chart!  Who certified you as a doula, ACOG?

      • Yogi Barrett

        Obviously, IRGrannyGoo wasn’t recommending that she be the educator.  Who do YOU think YOU are, Anonymous Guest, to presuppose that all OBs know more than everyone else? Everyone should always be open to learning.  Playing God/know-it-all is one of the biggest problems in maternity care these days.

        • Another guest

          “I think we need to educate…” 

          Doesn’t seem so obvious to me. 

        • Mrs Robinson

          Don’t be silly.  OB/GYNs know more about women’s health and childbirth than a high school grad.

      • kmb

        @34684c6f15f22ea03ba2484ae5cde0b0:disqus …. I think IRGrannyGoo’s suggestion is actually a good one. If obstetricians (and many nurses) were actually trained in how to (not) manage normal labor, and to not reach for the high tech intervention tools first (as seems to be current practice), they may actually change their philosophy about the need for surgical birth in most cases. The tools they are trained to use do not include a great emphasis on or understanding of things like changing mom’s position in labor or other low intervention options to aid labor progress. Why should we be surprised then that an OB may not be comfortable with using things that are not already in their tool box? I’m with Granny–let’s put some low tech tools in the obstetrical tool box with complete instructions on how to use them and when.

        • Another guest

          The idea that today’s doctors and nurses do not understand simple positional changes for birthing is laughable.  I’m a mom of three (all hospital births) and former doula and your sweeping generalization of OB nurses is terribly inaccurate.  Perhaps I’ve just “lucked out” and seen only good nurses at the dozens of births I’ve witnessed?  Where are all these evil interventionist nurses hiding then?!  Please.  The problem here is fear of litigation, as Dr. Amy pointed out below.  This has nothing to do with ignorant nurses and their supposed lack of education about the benefits of labor positioning. 

          • saddoula

            I have seen really amazing, wonderful, caring nurses who really put themselves out for their patients. I am in awe of them. I have also seen nurses who do the wrong thing for the patient over and over again during that labor. 

            I walk into the birth room of each of my clients greeting their nurse as my new best friend because I know together we can do more for the mom in labor than either of us alone.  I plan on them being on the same team I am on — the mother’s team.

      • http://profiles.google.com/tcnoble Tim Noble

        What’s your solution, Guest?

  • http://www.rockymountaindoula.com Rockymtnddoula

    Doulas!  If every woman had a qualified, well-trained doula, the cesarean rate would be MUCH less!  Study after study shows this unequivocally.  Want to do something about this appalling trend?  Train to become a labor doula.  http://www.cappa.net

  • MomRob

    My children range in age from 26 to 11.  All were vaginal.  None were induced.  In my experience, American culture has created a generation who expects “gain without pain”.  Childbirth is not easy, and it does carry risk, BUT it is arguably our reason for existence.  We should be teaching our caregivers and pregnant women to view childbirth as natural – and to keep ceasareans, drugs, etc. out of the labor and delivery process as much as possible.  yes – I’m saying that even pain medications should be a last resort.  When I was pregnant with my first child, I was taught two enduring lessons by my birthing instructor: 1) labor pain is intense muscle contractions – therefore nothing to fear, and 2) pain can be managed very well by mental exercises, once you have taken the fear of the pain out of your mind.  I was alert and engaged in every one of my four births.  For my second birth, when labor wasn’t progressing, we had the nurses roll a breast pump into the room (they didn’t want to, by the way – they suggested pitosin).  A minute or two of nipple stimulation did the trick – no pitosin necessary.  I feel sorry for the moms who let their fears rule them, rather than trusting the power of their own minds and bodies to serve them in this most natural bodily function.