That the c-section rate in the US has been on the rise in the last decades probably isn’t news to anyone who has been reading this blog. There is lots of speculation as to exactly why this is and we have looked at some of these factors in the past. Recently Yale School of Medicine researchers conducted a study to explore the causes for the rising number of c-section deliveries.
The study found that 50% of the increase was due to a rise in repeat c-section delivery in women with a prior c-section birth. The other 50% was attributed to increases in first time cesarean delivery. The factors such as slowly progressing labor and fetal heart rate concerns were the main causes for the first time c-sections. The full breakdown was as follows.
The relative contributions of each indication to the total increase in primary cesarean rate were: nonreassuring fetal status (32%), labor arrest disorders (18%), multiple gestation (16%), suspected macrosomia (10%), preeclampsia (10%), maternal request (8%), maternal-fetal conditions (5%), and other obstetric conditions (1%).
There are a couple of important facts that come out of this data. The first, but no the most important is only 8% of new c-sections are elective c-sections by demand. Maybe now we can finally put the idea that this is a major contributor to the increasing c-section rates in it’s proper place.
The second and most important is that 50% of the increase is repeat c-sections. An examination of the rates of VBACs )vaginal birth after cesarean) will show a matching decline in their numbers. This then gives two clear ways of decreasing the numbers of c-sections. One – reverse the decline in VBACs. Two – increase education and guidelines for physicians and maternal units to reduce the number of first time c-sections due to avoidable interventions.
However, the current situation is that 1 out of every 3 hospitals that offer labor and deliver services in this country have completely banned VBAC as an option in recent years for reasons of cost and liability. Additionally waiting for change in medical birthing practices is likely to be a slow and painful process, given that they are the primary causes of the increase in c-sections.
So the answer is education and empowerment of women to know what their options and rights are based on facts and not opinions or speculation. If you are reading this then you have begun that process and we applaud you and encourage you to continue.
Published in the July issue of Obstetrics & Gynecology, the study was led by Yale researcher Jessica Illuzzi, M.D., of the Department of Obstetrics, Gynecology & Reproductive Sciences.Illuzzi and her co-authors analyzed indications for cesarean delivery on prospectively collected data from over 30,000 births at Yale-New Haven Hospital from 2003 to 2009.