Yep, still climbing.
It's my annual "the c-section rate is still climbing" blog and once again, we're breaking records. The data for 2007 (most current data available) was published last week by the Centers for Disease Control and National Center for Health Statistics. Drum roll, please.... here are the numbers:
- The cesarean rate rose by 53% from 1996 to 2007, reaching 32%, the highest rate ever reported in the United States.
- From 1996 to 2007, the cesarean rate increased for mothers in all age and racial and Hispanic origin groups. The pace of the increase accelerated from 2000 to 2007.
- Cesarean rates also increased for infants at all gestational ages; from 1996 to 2006 preterm infants had the highest rates.
- Cesarean rates increased for births to mothers in all U.S. states, and by more than 70% in six states from 1996 to 2007.
OK readers, I'm not going to get on my soapbox (even though I'd sure like to). I'm just going to repeat why the c-section rate is going up, up, up: VBAC bans, too many inductions, too much reliance on fetal heart monitoring (even though ACOG agrees it doesn't do much good for predicting which babies are actually in fetal distress), obesity, etc. None of this is new information. We're just seeing more compounding results. The more first-time c-sections occur, the more VBACs we'll see. That's how it works. That is, unless practitioners and patients start working towards reducing the numbers in a serious way.
On a more optimistic note, take a look at this press release from the National Institutes of Health: An independent panel convened this week by the National Institutes of Health confronted a troubling fact that pregnant women currently have limited access to clinicians and facilities able and willing to offer a trial of labor after previous cesarean delivery because of so-called VBAC bans. Many, even those at low risk for complications in a trial of labor, are not offered this option. The panel affirmed that a trial of labor is a reasonable option for many women with a prior cesarean delivery. They also urged that current VBAC guidelines be revisited, malpractice concerns be addressed, and additional research undertaken to better understand the medical and non-medical factors that influence decision making for women with previous cesarean deliveries.
Good for them, they're willing to give VBAC bans some thought. That's the first step in putting new VBAC policies in action and as far as I'm concerned, that can't happen soon enough.
It's going to take more than doctors and hospitals changing their policies and practices to make any real difference in these numbers. It's going to take parents thinking in a whole new way about the risks of having a baby. Malpractice insurance is one of the biggest influences affecting delivering doctors and midwives decisions about performing c-sections. They can't afford not to think about it. Malpractice insurance for obstetricians (the ones who do the c-sections) is outrageous. They can't guarantee every baby will be born perfect, even if they do everything by the book, with the best of intentions, upmost skill and care. They can't guarantee a perfect baby even if they deliver by c-section. The thing is, parents don't often sue for the c-section he/she did that results in a perfect baby. It's the one he/she didn't do that they sue for.
Parents want perfect babies. It's only natural. If their baby isn't perfect, they want someone to blame. Who better than the people who helped them deliver that baby? Sure, some doctors are lame and some nurses mess up. Not most though. Most are skilled, competent, highly trained, compassionate and willing to do almost anything for their patients' best outcome. And still, some babies have trouble. Don't kid yourselves, parents. C-sections don't guarantee perfect babies. Take a look at our infant mortality rates—they're climbing too.
So, every year I write about the new record-breaking c-section rate and now I want to turn the tables on you readers.
I want to know: Do you guys care if the c-section rate is too high or is it OK with you? How high are you willing to go? What would you be willing to do to help bring it down or to avoid a c-section yourself? Would you be willing to sign a legal agreement with your doctor saying you won't sue him/her? Would you be willing to ask for a second opinion (and not from one of your doctor's partners) before signing on for a c-section?
Would you be willing to give up inductions, epidurals or other standard obstetric procedures if it meant a better chance for a vaginal birth? Would you be willing to have a hospitalist (not your own doctor) perform your birth? Would you deliver at home with a midwife? Would you be willing to accept a certain amount of risk and uncertainty in order to deliver vaginally? What other ideas do you have? I really want to know.
There are no right or wrong answers for these questions and lots of c-sections happen even under "perfect" conditions. I'm just wondering. How much does this matter to you, the families currently affected and most likely to deliver during the highest c-section rates the world has ever seen?
Read my article on The Truth About Fetal Distress.
Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to email@example.com.
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