C-Section Rate at All-Time High in U.S.

Doctors concerned that convenience factor may be driving the trend

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By Kathleen Doheny
HealthDay Reporter

THURSDAY, Aug. 17, 2006 (HealthDay News) -- The Caesarean section delivery rate stands at a record high in the United States, resisting efforts by federal health officials to reduce the rate to 15 percent by the year 2010.

Nearly 1.2 million C-sections -- 29.1 percent of all births -- were performed in the United States in 2004, according to the National Center for Health Statistics. In 1996, the rate was 20.7 percent.

Furthermore, a new report by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality found that:

  • Use of C-section has increased by 38 percent since 1997, when about a fifth of all American babies were delivered this way. Now, more than 1 in 4 babies is delivered by C-section
  • The rise was accompanied by a 60 percent decline in the rate of women giving birth vaginally after having a previous child born via C-section, and conversely, by a 33 percent rise in the rate of repeat C-sections.
  • The national bill for childbirth as a whole in 2003 totaled $34 billion, with hospital stays involving C-section delivery accounting for nearly half this amount -- $15 billion.
  • Medicaid -- the medical assistance program for needy persons -- was billed for 43 percent of childbirths overall and 41 percent of those involving c-section delivery.

While Caesarean births are sometimes medically necessary, factors such as convenience are driving the rate too high, some experts contend. And the delivery method carries with it risks that aren't acceptable if a C-section isn't necessary to preserve the health of the mother or baby, doctors say.

Multiple factors explain the growing rate of C-sections, said Dr. John Zweifler, chief of the University of California, San Francisco-Fresno Family and Community Medicine Department. He has done extensive research on C-sections as well as vaginal births after a woman has had a C-section, called VBACs (vaginal birth after Caesarean).

Patient preference is one, with some women requesting them for convenience -- they can schedule the birth and plan time away from work and set up child care for other family members, for instance. "In our society, everything is on demand," Zweifler said, adding, C-sections can be "convenient for our lifestyle -- the doctor's and the patient's."

Dr. Lawrence M. Leeman, a physician who specializes in family medicine, obstetrics and gynecology at the University of New Mexico, said, "There's a kind of normalization of C-sections. As the C-section rates get higher, more and more women have had them, and it doesn't seem as scary any more." He also said many women are having elective induction of labor, and that in itself increases the chances of having a C-section.

Some experts contend that the obesity epidemic may be partially driving the increasing C-section rate. The reason: Heavy women are at higher risk of high blood pressure and gestational diabetes, which could lead to a doctor-recommended Caesarean birth.

A C-section is considered major surgery, as the physician cuts into a women's abdomen to remove the baby. Infection is a risk, as is increased blood loss and decreased bowel function. And recovery time is typically longer following a C-section, Zweifler said: "It can take four to six weeks to heal tissue."

After a vaginal birth, he said, "it takes time for the uterus to shrink to normal size." But even so, many women are back to normal activities within a few days of a vaginal birth, while those who have a C-section tend to take longer -- sometimes up to six weeks -- due to soreness and pain.

Among the valid reasons for having a C-section, Zweifler said, are the baby is in breech -- or feet first -- position in the womb; twins in the womb aren't lined up head first; or there's evidence of fetal distress or maternal hemorrhaging.

Both Zweifler and Leeman suggest that women not consider a C-section just for convenience, especially if they plan to have more children. Repeat C-sections increase the risk of bladder or bowel problems.

And, Leeman said, "Most women don't want a C-section. Most women want to have a vaginal delivery."

"Birth is a very empowering process for women," Zweifler said. Having a C-section "is taking it out of the hands of women and putting it in the hands of a surgeon in a very sterile environment. If you have a life-threatening condition or a fetus in distress, a C-section can be life-preserving. But to do it on a routine basis when there is no risk to the mother and baby, you may be causing harm, and you need to be very cautious."

Women who want to avoid a C-section should search for a doctor, midwife or hospital with a low rate of such deliveries, Leeman said. They should also consider hiring a doula -- a support person who stays with the woman throughout labor and delivery. Such assistance has been shown to reduce the need for a C-section.

More information

To learn more about childbirth, visit Childbirth.org.

SOURCES: John Zweifler, M.D., M.P.H., chief, University of California, San Francisco-Fresno Family and Community Medicine Department; Lawrence M. Leeman, M.D., M.P.H., department of Family and Community Medicine, University of New Mexico, Albuquerque; National Center for Health Statistics

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