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Cesareans Once Again on the Rise

Use of surgical technique regaining popularity

MONDAY, Jan. 7, 2002 (HealthDayNews) -- Cesarean deliveries are on the rise again, after declining during the first half of the '90s, a new government report shows.

The U.S. cesarean rate dropped 8 percent between 1991 and 1996, and then swung back upward 6 percent between 1996 and 1999, the Centers for Disease Control and Prevention (CDC) reports. Preliminary data for 1999 and 2000 finds the cesarean rate jumps another 4 percent.

In addition, the once-controversial vaginal births after previous cesareans (VBACs) increased from 1991 to 1995, and then declined to early 1990 levels by the end of 1999.

"As you know, lowering the rate of cesareans has been a goal established by the Surgeon General for the past two decades," says study author Fay Menacker, a statistician in the reproductive statistics branch of the CDC's National Center for Health Statistics. "The rate of cesareans in the United States had been increasing in the 1970s and 1980s, to a high of 25 percent of all the deliveries done in this country. There has been impetus to lower the rate, given the greater risk of surgical complications, longer post-operative recovery and increased medical costs."

Cesarean deliveries accounted for almost 1 million of the approximately 4 million annual deliveries in the United States in 1988, according to the CDC. At that time, the U.S. cesarean rate was the third highest among 21 reporting countries, exceeded only by Brazil and Puerto Rico. The World Health Organization and the American College of Obstetricians and Gynecologists (ACOG) suggest a cesarean rate goal of 15 percent of all births.

The new CDC review of all U.S. birth certificates reveals that in 1999 there were more than 862,000 births by cesarean section, for a rate of 22 per 100 births, compared to the rate of 22.6 in 1991. Teen-age mothers had the fewest cesareans, with the number of surgeries increasing with maternal age. The 1999 cesarean rate for mothers in their 30s and 40s is almost double that of teen-agers.

Cesarean rates throughout the '90s were highest in the South, and lowest in the Midwest and West. In addition, cesarean rates were higher for women having their first child than for women having a second or third birth.

The findings appear in the current National Vital Statistics Reports.

Cesareans can be the difference between life and death for many mothers and babies. Fetal distress, disorders that make labor risky for the mother, or a baby that is simply too big or badly positioned, are important reasons for cesarean deliveries, as are maternal conditions that make vaginal birth risky, such as high blood pressure and diabetes.

Nevertheless, avoiding unnecessary cesarean sections remains a priority, officials say. Women's risk of death, although small, is three to seven times higher with a cesarean section than during vaginal delivery, according to ACOG. The procedure can also lead to increased pain, longer hospital stays, higher medical costs and a higher risk of post-delivery infection.

The priority has even extended to women who have had a prior cesarean. ACOG now says a VBAC is preferred over repeat cesareans for women with small horizontal scars, and multiple previous cesareans do not rule out a VBAC.

However, Menacker says new research may explain the swing back to cesareans.

"Some of the newer research has challenged the view that cesarean sections entailed more risk to the mother than vaginal birth," she says. "The newer research has also challenged the safety of vaginal birth after cesarean delivery. What we think has happened is that doctors' attitudes have changed about cesareans, because the increase in the cesarean rate has been widespread -- for women of all ages, races and for nearly all the states."

What To Do: If you'd like to see a copy of the report on cesarean deliveries and VBACs, visit the National Center for Health Statistics. If you'd like to learn more about cesareans and vaginal birth after cesareans, check out Childbirth.org.

SOURCES: Interview with Fay Menacker, statistician, National Center for Health Statistics, Hyattsville, Md.; Dec. 27, 2001, "Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-99"
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