Cesarean Rates Are Rising
Women today face many decisions when it comes to having children. Should they breastfeed or bottle feed? Should they use disposable or cloth diapers? Should they have a vaginal delivery or a cesarean?Increasing numbers of women are choosing to have a c-section voluntarily, and due to rising numbers of pregnant women with serious health conditions, many more cesareans are necessary.
Although many surgical deliveries are in the mother and baby’s best interest, C-sections are sometimes performed for reasons other than maternal or fetal well-being. Many elective cesareans are done for patient or provider convenience, avoidance of patient pain.When a cesarean is necessary, it can be a life saving technique for both mother and infant. Women who deliver by cesarean are less likely to have pelvic problems than are women who deliver vaginally, according to a study done by the American College of Obstetricians and Gynecologists. It can, however, also pose many risks. A cesarean section is major abdominal surgery. The mother may be more prone to infections and be more likely to hemorrhage or need a blood transfusion. There may also be injury to major organs, complications with anesthesia, or psychological ramifications. An elective cesarean further complicates delivery as many of the infants born this way are premature, often causing breathing problems and possibly increasing the chances of the baby getting jaundice.Statistics indicate that about 967,000 cesareans were performed in the United States in 1989. The Public Health Citizen’s Research Group estimates one-half the c-sections done in 1989 were not necessary and resulted in “2500 serious infections, 1.1 million extra hospital days and a cost of over 1 billion dollars.” Five hundred women a year die from bleeding, infections, and other complications of cesarean sections, though many of these may be related to the reasons the operation was performed and not just to the procedure itself. Consequently, the mortality rate of mothers for cesareans is two to four times greater than for a vaginal delivery.
In the past thirty-five years, the cesarean section rates have nearly quintupled in the US to 27.6% in 2003, up from 4.8% in 1968. The four most common medical causes for women to require a cesarean are: routine repeat cesareans; dystocia, or non-progressive labor; breech presentation; and fetal distress . Cesarean rates are also influenced by non-medical factors. Cesarean rates are higher for women who have private medical insurance, and those who are older, married, or have higher levels of education. Since the average age at first birth has risen over 25 years of age, an all time high in the United States, so has the rate of infant and maternal illness during pregnancy, as well as the rate of emergent cesareans due to illness. In fact, the increase in maternal age has jumped the largest part in mothers age 35-44, and instances of births to women over age forty are higher than they have been in thirty years. Many doctors use the age of 35 as the rule when warning older mothers of the greater possibility of gestational diabetes, toxemia, and fetal abnormality.
Among those women who opt for an elective cesarean, many cite their reason as tocophobia, or the fear of childbirth. This may be because more information about childbirth is readily available, including birthing classes, books, videos, and even television programming. Fear of the pain they see or hear about via this information could influence a woman’s decision regarding whether or not to have a cesarean. Others may simply be unsure of their new role as mothers, and therefore afraid to actually give birth and then be responsible for the child. Whatever the reason for tocophobia, most elective cesareans are scheduled to accommodate mothers with the condition. Secondary reasons given for elective cesareans include fecal and urinary incontinence and convenience for both mother and doctor. For many women, regardless of whether their first cesarean birth was emergent or planned, they are scheduled for a repeat c-section. In the US, over one-third of all cesareans are repeat cesareans, due to liability issues and the rising cost of insurance for doctors due to lawsuits.
In thirty years, cesarean rates have skyrocketed due to the changes in the society in which we live. This shift in thinking has brought us to over a quarter of all births being surgical. It is feasible that women are waiting longer to have children, and many are opting to have them on a schedule because of these changes in American society. Although individual reasons may deviate slightly from generalized study results, most women will agree that cesareans are an acceptable, even expected, part of childbirth. This, in accordance with routine repeat cesareans and increasing primary cesareans, whether emergent or elective, will lead to even higher rates of cesareans.
