Elective Cesareans
The National Institutes of Health (NIH) convened a panel on March 27-29, 2006 to hear testimony about the trend toward "elective cesareans." These so-call "maternal request" cesareans are performed when there is no medical reason or need for intervention.
The NIH panel findings were widely reported, often quoting the chair of the panel stating "We don't believe [cesarean sections] should be discouraged or encouraged." Many groups responded to this coverage with calls for more accurate reporting, including the American College of Nurse-Midwives.
What wasn't reported was that overall, the panel results strongly favored vaginal birth over cesarean birth. In fact, the main conclusion of the review was: "Without clear, compelling and well-supported justification for cesarean section or assisted vaginal birth, a spontaneous vaginal birth that minimizes use of interventions that may be injurious to mothers and babies is the safest way for women to give birth and babies to be born."
Many studies have demonstrated the risks for mothers and babies undergoing cesarean births.
Risks to the baby from elective cesarean section
Babies delivered by elective cesarean have an increased risk of neonatal respiratory distress syndrome (RDS), a life-threatening condition, and other respiratory problems that may require NICU care.
Babies delivered by elective cesarean have a five-fold increase in persistent pulmonary hypertension (PPH) over those born vaginally.
Babies delivered by elective cesarean are at increased risk of iatrogenic (physician-caused) prematurity, usually related to failure to conform to protocols for determining gestational age prior to delivery, or errors in estimating weeks of gestation even with the use of clinical data. Prematurity can have life-long effects on health and well-being, and even mild to moderate preterm births have serious health consequences.
Babies delivered by elective cesarean are cut by the surgeon's scalpel from two to six percent of the time. Researchers believe these risks to be underreported.
Risks to the mother from elective cesarean section
Up to 30% of women who have a cesarean acquire a postpartum infection. Infections are the most common maternal complication after cesarean section and account for substantial postnatal morbidity and prolonged hospital stay.
Other serious complications for women undergoing cesarean include massive hemorrhage, transfusions, ureter injury, injury to bowels, and incisional endometriosis.
Women who undergo cesarean report much lower levels of health and well-being at seven weeks postpartum than women who have vaginal births.
Women who undergo cesarean section have twice the risk of rehospitalization for reasons such as infection, gallbladder disease, surgical wound complications, cardiopulmonary conditions, thromboembolic conditions, and appendicitis. Rehospitalization has a negative social and financial effect on the family.
Women who undergo cesarean section report less satisfaction than women having vaginal births.
Women undergoing cesarean are at increased risk of hysterectomy in both the current and future pregnancies.
The maternal death rate is twice as high for elective cesarean as for vaginal birth.
In subsequent pregnancies, women with a prior cesarean have higher rates of serious placental abnomalities which endanger the life and health of the baby and the mother. Women are rarely told that a cesarean places future babies at higher risk.
After cesarean section, women face higher rates of secondary infertility as well as higher rates of miscarriage and ectopic pregnancy.
[Source: ICAN, "Position Statement: Elective Cesarean Sections Riskier than Vaginal Birth for Babies and Mothers"]
The CDC reports that
Cesarean rate for 2004 is 29.1% (the highest rate ever recorded)
The rate is up from 27.6% in 2003
U.S. cesareans have risen 40% since 1996
First-time cesareans are at an historical high of 20.6%
Many people attribute a significant portion of this increase to "elective cesareans" - a practice that was apparently sanctioned in 2003 when the American College of Obstetricians and Gynecologists (ACOG) issued an opinion that it is ethical to offer a cesarean section even if no medical indication for one existed.
In fact, over the past few years, there have even been a few physicians who have claimed that elective primary cesareans and elective repeat cesareans are safer for babies, and even for mothers, than vaginal birth.
However, the high rate of cesareans in the United States has not resulted in improved outcomes for babies or mothers. (The United States lags far behind other industrialized countries in maternal-child health outcomes.) A recent report by the World Health Organization (published in the Lancet) identifies complications from cesarean surgery and anesthesia as the leading causes of maternal death in developed countries, including the United States.
Elective cesarean surgery is often promoted as "patient choice", however women who want vaginal birth after cesarean (VBAC) are not able to enjoy this choice. More than 300 hospitals across the United States have banned VBAC and countless providers refuse to accept patients who want VBAC, despite medical literature showing it to be a reasonable option for many of these women.
Madison Birth Center offers the best quality care available in this region for healthy women experiencing normal pregnancies. We are nationally accredited and the only Baby Friendly™ facility in Dane County. This unique recognition is a testament to the excellent quality of our care.
We are proud of our very low cesarean rates, and we remain committed to helping women avoid unnecessary surgery. With a cesarean section rate of 3.2% last year, we believe we are making a difference in Madison!
An abundance of information about the NIH panel findings is available on-line.
Citizens for Midwifery has great links to most of the major midwifery and women's advocacy groups responding to the NIH study
Childbirth Connection (formerly, The Maternity Center Association) - one of the nations' oldest groups advocating evidence-based maternity practice and midwifery care - offers a very fine overview on the NIH study and information for women hoping to avoid cesarean sections.
The International Cesarean Awareness Network, Inc. (ICAN) seeks to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).
Relevant white papers and fact sheets:
Comparative Cesarean Section Rates for Low Risk Healthy Women in Home, Birth Center and Hospital Settings. Click here.
Why is the Cesarean Rate Higher than Ever, and Rising? Click here.
Elective Cesarean Surgery Versus Planned Vaginal Birth: What Are the Consequences? Click here.
The Risks of Cesrean Delivery to Mother and Baby. Click here.
