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Cesarean Prevention Information
News Release - C-section rates are rising! But, why?
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Specialist says number of births
by C section needs to be reduced
"Certainly patience is a virtue in obstetrics," said Dr. Robert DeMott, who practices "low-intervention obstetrics" in Green Bay, Wis., and is a veteran of 2,044 deliveries in 14 years. "Just because things are progressing slowly, and two hours have passed, doesn't mean you wheel her off to the OR."
DeMott spoke to a meeting in Missoula of the Statewide Task Force on Caesarean Reduction, which drew about 75 labor and delivery nurses, physicians and related providers to the Holiday Inn Parkside. Started by Western Montana Clinic and Blue Cross and Blue Shield of Montana, it has been meeting several times a year since the fall of 1999. Its goal is to lower the incidence of births by Caesarean section, called for short "C section," in Montana and promote standard vaginal deliveries when possible.
In 1972, 6.5 percent of U.S. births were Caesarean; in 2001, 23 of 100 babies were C section babies, born by abdominal surgery on their mothers. That was more than 1.2 million babies born surgically - without necessarily better outcomes for mothers or babies, said Lynne Evans, a registered nurse who works as quality care manager at Western Montana Clinic and is coordinator of the task force.
"It's the most common surgery performed," she said before the conference. "But it's estimated 25 to 50 percent of those are unnecessary."
In Montana, the rate of C section births last year was 19.1 percent; births in Missoula at Community Medical Center last year matched that percentage. The national health goal set in 2000 is 15 percent.
Last year, Montana was only one of two states that did not have a rise in C section rates, said Missoula physician Eric Hughson, who is director of the task force.
"Of course," he said, "we're happy to take credit for that."
In the short few years the task force has been working, it has attracted a fair number of doctors who will listen, he said. However, it's too soon to be sure the work is affecting doctors' practices.
Caesarean births carry a death rate for mothers that's three to seven times greater than vaginal births, differing among studies.
"It is my opinion that Caesarean section is absolutely more dangerous to women than a vaginal delivery," said DeMott.
As surgeries, C sections carry
with them the risks associated with
For the baby, C sections bring more frequent cases of abnormally fast breathing and of hemorrhages in the brain and between the brain and the skull.
There may be more effects, DeMott said.
"I think there's things we do not know about the benefits of vaginal birth," he said.
C section delivery is also expensive, costing about twice as much.
In some cases - for instance, when a fetus is crosswise or sometimes in a breech position, or in cases where mother or fetus would die without surgical intervention - a surgical birth is necessary. But they are often chosen for the wrong reasons, said DeMott, whose own rate of Caesarean births is 6.2 percent and whose success rate in vaginal births after a first C section is 97 percent.
In DeMott's study in Green Bay
of births at three hospitals from 1986
They were less likely to artificially rupture membranes to move labor along and less likely to induce labor with drugs.
In his own practice, DeMott favors focusing on a due month, not a specific date. He also uses therapeutic rest during labor, in which the mother is allowed to sleep for a few hours. He never tells women their pelvises are too small. He never estimates the weight of a fetus, as studies show that women with large babies are treated differently and are more likely to be rushed into surgery. At DeMott's hospital, Bellin Memorial, 2.5 percent of babies weigh more than 4,500 grams, or about 10 pounds, which is twice the national average.
"That's why we have such a good football team," he joked. "It's beer, cheese and bratwurst."
The main reason given for C sections
in U.S. hospitals is "failure to
A disturbing trend that is a growing concern on both U.S. coasts but has yet to come to the heartland is elective C sections, in which a woman demands birth by surgery to avoid labor or to be able to schedule a birth, DeMott said.
Studies in London and in Israel
found that significant percentages of
"Is there a right to choose a more harmful route of delivery?" he said.
"Is it ethical to even offer the
choice?" he said. "Or is it ethical to be
DeMott reminded his audience that pregnancy, labor and vaginal delivery are normal physiologic processes.
"Why have we turned it into a disease?" he said. "We've turned our labor and delivery units into intensive care units. I think we should get back to a more normal method."
Reporter Ginny Merriam can be
reached at 523-5251 or at
The National Women's Health Alliance (NWHA) is dedicated to providing women with important information about their health care. Its purpose is to enable women to make meaningful choices on medical procedures and devices, over-the-counter medications, prescription drugs, physicians and health care providers.
Almost one in four women who gave
birth last year had a Caesarean
C-sections had dropped in the early 1990s after an outcry that American women were getting too many. But in 1997, they started inching back up again. Last year brought the biggest jump yet, a 7 percent increase that "was certainly a surprise," said Joyce Martin, co-author of the Centers for Disease Control and Prevention (news - web sites) birth report that was released Thursday.
That made C-sections account for
24.4 percent of U.S. births last year, the CDC found. The nation's
high was 25 percent in 1988. The annual birth report also found:
Caesareans can be life- or health-saving for many mothers and babies. But a C-section is major abdominal surgery so avoiding unnecessary ones also is important.
Women's risk of death, although
small, is three to seven times higher
Almost 17 percent of first-time mothers had a Caesarean last year, a 5 percent jump, the CDC reported.
Part of the reason is that more women are opting for a Caesarean even though they are healthy enough to avoid one. There is no data on exactly how often this happens, although "patient-choice Caesareans" are being done around the country.
Some obstetricians say it is wrong to operate without a medical reason while others say it is paternalistic not to let women choose.
But most Caesareans are repeats.
Women who had one C-section are very likely to give birth that way
again. Last year, the number of
Studies at teaching hospitals
sparked the trend of "vaginal birth after
There is a 1 percent risk of a
uterine rupture during VBAC, but the few
But by the late 1990s, more women who had had Caesareans were having their subsequent deliveries at community hospitals, which are less prepared to offer emergency surgery, he said.
With the growing crisis of affordable
malpractice insurance an
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