Wednesday, March 24, 2010

C-Section Rates Are at All-Time High

March 24, 2010 — Cesarean deliveries have reached an all-time high in the U.S., with nearly one in three babies now delivered by C-section compared to one in five just a decade ago, new government figures reveal.

Roughly 1.4 million newborns were delivered surgically in 2007 -- a 53% increase from the mid-1990s, when rates started to climb after remaining steady for several years.

Rates rose for both older and younger mothers across all racial groups and all regions of the U.S., making cesarean delivery the most commonly performed surgery in the nation.

The C-section rate increased by annually between 1996 and 2007, from a low of 21% to 32%.

"Every state has seen an increase in cesarean sections over the last decade and rates continue to climb," National Center for Health Statistics (NCHS) statistician Fay Menacker, DrPH, tells WebMD.

The new figures were published today by the NCHS, which is a division of the CDC.

Vaginal Birth After Cesarean

The NCHS report did not address the reasons for the decade-long rise in C-section deliveries, but an expert panel convened by the National Institutes of Health weighed in on the issue a few weeks ago.

The panel looked at why so few women in the U.S. who have had C-sections are having nonsurgical deliveries for subsequent births.

The practice, known as vaginal birth after cesarean, or VBAC, was common in the mid-1990s. But today, fewer than one in 10 women who have had a previous C-section attempt labor.

Studies suggest that 75% of women who labor with a pregnancy that follows a C-section delivery successfully have a vaginal birth, and outcomes are also good in the vast majority of cases where VBACs are unsuccessful and surgical delivery is required.

But in slightly less than 1% of cases, VBACs lead to uterine rupture, a potentially catastrophic complication for both mother and baby, panel chairman F. Gary Cunningham, MD, tells WebMD.

Several leading medical groups now call for a surgeon and anesthesiologist to be available when a woman who has had a previous C-section attempts labor, and this guideline has led many hospitals to stop offering VBACs, he says.

In recent surveys, about 30% of hospital administrators said their hospitals stopped performing VBACs because they could not comply with the guideline.

Uterine rupture often leads to fetal death or brain damage. When this happens, hospitals and ob-gyns are often sued and massive settlements are not uncommon.

"Their position is understandable. You can't make a hospital offer VBACs," Cunningham says. "But on the other hand, there is a growing voice out there of women who would like a trial of labor, but it is not available to them."

The panel concluded that VBAC is a safe alternative to C-section for most low-risk women who have had just one prior surgical birth, Cunningham says. Panel members also called for ob-gyns to discuss VBACs with appropriate patients and honor their patients' delivery preferences whenever possible.

Primary C-Sections on the Rise

Maureen Corry, who is executive director of the birth research and advocacy group Childbirth Connection, applauds the panel's action.

But she tells WebMD that lack of access to VBAC is just one of several factors driving the steady increase in C-section deliveries in the U.S.

"There has also been a big increase in the number of first-time cesarean sections over the last decade," she says.

Women who are older and those delivering more than one baby are more likely to have C-sections.

Corry says older maternal age and rising multiple birth rates may be factors in the rising rate of surgical deliveries, but they are not driving the trend.

Likewise, few women are demanding medically unnecessary surgical births, even though so-called "C-section on demand" has received much attention in the media, she says.

In a 2005 survey conducted for Childbirth Connection, just one in 1,600 women reported having a planned, first C-section for no medical reason at her own request.

Economics and litigation fears play a big part in this, she says. Surgical births are more lucrative for hospitals and doctors.

"From the doctor's point of view, a scheduled 45-minute surgery would have to be preferable to getting up in the middle of the night to attend to a woman who might labor for many hours," she says.

And while hospitals and ob-gyns are often sued when labor goes wrong, this is not the case with surgical deliveries, Northwestern Memorial Hospital ob-gyn Lauren Streicher, MD, tells WebMD.

Streicher is an assistant professor of obstetrics and gynecology at Northwestern's Feinberg School of Medicine.

She tells the story of a patient who delivered a severely brain damaged child following an uncomplicated pregnancy and scheduled C-section.

"She is still a patient, and she tells me people often ask her how much she sued for," Streicher says. "Her response is that she didn't sue because no one did anything wrong. But had she labored, there would have been no way to know that the delivery didn't cause the brain damage."


National Center for Health Statistics Data Brief: "Recent Trends in Cesarean Delivery in the United States," March 2010.

Childbirth Connection web site: "Why Does the National U.S. Cesarean Section Rate Keep Going Up?"

Fay Menacher, DrPH, statistician, National Center for Health Statistics, CDC.

F. Gary Cunningham, MD, professor of obstetrics and gynecology, University of Texas Southwestern Medical Center, Dallas.

Maureen Corry, executive director, Childbirth Connection.

Lauren Streicher, MD, assistant professor of obstetrics and gynecology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago.

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