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New clues to unnecessary Caesareans

Federal health officials released some interesting data Monday aimed at trying to figure out why so many U.S. women are undergoing Caesarean sections to deliver their babies.

The rate at which women are having C-sections has soared in recent years. About one-third of all babies are delivered using the surgical procedure. C-sections are necessary sometimes to save the baby or the mother or both. But experts think they're being done far too frequently, putting both the woman and her baby at unnecessary risk, making the mother's recovery a lot harder and adding a lot of extra costs to the nation's health-care bill.

In the new analysis, published in the American Journal of Obstetrics & Gynecology, researchers at the National Institute of Child Health and Human Development analyzed data collected at 19 hospitals about 228,668 births that occurred between 2002 and 2008.

Overall, the researches found that about a third of the deliveries were by C-section. Surprisingly, however, that was even the case for women giving birth for the first time -- not because they had previously had a C-section, which can make trying regular labor riskier. Slightly more than one-third of first-time moms had C-sections. Also surprising was the fact that half of the women attempting regular births had their labor induced. And half of C-sections occurred in women who had been induced but had not even dilated 6 centimeters. That suggests that doctors may be jumping the gun and turning to a C-section too early. It also might support the idea that part of the problem might be that women and their doctors are scheduling their deliveries for convenience.

But none of this proves any of that. It could be that a lot of these C-sections are needed because of problem pregnancies. More women are giving birth at older ages, when complications are more common. More obese women are also giving birth. Obese women are more prone to complications.

About one-third of the C-sections were among women who had had a previous C-section. And among those who tried a C-section again even though they had already had one, they were successful in about 57 percent of the cases.

The researchers stress that the study can't determine exactly how many of the C-sections were really unnecessary and could have been avoided. But the study does provide new evidence that more could be done to avoid women getting C-sections the first time around, and more could at least try a regular birth even if they have had a previous C-section.

By Rob Stein  |  August 30, 2010; 3:05 PM ET
Categories:  Motherhood , Pregnancy , Women's Health  
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Comments

Hmm, could it have anything to do with malpractice lawyers??

Posted by: beegrace123 | August 30, 2010 3:37 PM | Report abuse

There appears to be a major typo here. It says "And among those who tried a C-section again even though they had already had one, they were successful in about 57 percent of the cases." That doesn't make sense -- there's no such thing as being unsuccessful at a C-section (what would that be? they take out your appendix instead of the baby?) I'm pretty sure the statistic should read "Among those who tried a vaginal delivery even though they had already had a C-section, they were successful in about 57 percent of the cases." Please EDIT and PROOF-READ!

Posted by: kmk27 | August 30, 2010 3:38 PM | Report abuse

There appears to be a major typo here. It says "And among those who tried a C-section again even though they had already had one, they were successful in about 57 percent of the cases." That doesn't make sense -- there's no such thing as being unsuccessful at a C-section (what would that be? they take out your appendix instead of the baby?)
**********
Agreed. The current wording suggests 43% of women either died or left the hospital with a baby still in their belly...what is going on with this paper?

Posted by: jennifermb98 | August 30, 2010 3:49 PM | Report abuse

"The fact that half of the women attempting regular births had their labor induced. And half of C-sections occurred in women who had been induced but had not even dilated 6 centimeters."

Isn't it possible that the woman's body was fighting the induction, by not dilating, to protect the baby who in the body's opinion wasn't ready for birth yet?

I wish more women would trust their bodies and go into labor naturally. Just because we can induce labor doesn't mean we should.

LoveSnow
Mom of 4

Posted by: LoveSnow | August 30, 2010 3:51 PM | Report abuse

It's quite simple: they can bill the insurance companies more for C-Sections.

Posted by: maurban | August 30, 2010 3:54 PM | Report abuse

Not that I was alive when this was the case, but obviously people don't remember that women used to DIE in childbirth at alarming rates! Are we seriously trying to go back in time?

Posted by: forgetthis | August 30, 2010 3:57 PM | Report abuse

Another correction: as of 8/30/2010 this paper has not yet been published. It is in press.

Posted by: a440 | August 30, 2010 3:57 PM | Report abuse

I'm curious if I'm reading the next to last paragraph right. Does that say that only 57% of second-time c-sections are successful? What does "unsuccessful" in this case mean?

Posted by: gtrain82 | August 30, 2010 4:00 PM | Report abuse

I'm not sure why this even needs to be studied. Having had two babies, it was pretty clear to me that obstetricians see inductions and Csections as the norm, and "regular" deliveries as abnormal. The rules they set are just crazy. For my first birth, the ob kept insisting that if I didn't deliver within 8 hours, he would do a Csection. Talk about pressure to produce!

Posted by: bkmny | August 30, 2010 4:17 PM | Report abuse

A lot of this has to do with OB/GYN's trying to control perceived higher-risk pregnancies.

A friend of mine just had her first baby at 39, and she has some associated medical issues that would have made the pregnancy risky if she had been 29. She wasn't out of her first trimester and her doctor was scheduling a C-section for her, which she kept resisting.

She ultimately had the C-section - but that was because she had developed HELLP syndrome at 7 1/2 months. So necessary, but it wasn't something she wanted and was fighting every step of the way before the emergency arose.

My SIL - who had her first pregnancy at 39 - was on track with a natural childbirth, but ended up having an emergency C-section. The umbilical cord had wrapped around my niece's neck in the last week, and every push was tightening the cord. So necessary.

But on the flip side, I have a friend who had both of her kids - born in her early 30's while she was in excellent health - by C-section. Because she was convinced that having kids was going to make her incontinent. She changed OB/GYN's because her original doctor wouldn't do a C-section because it wasn't indicated. (Among our friends, we all thought she was afraid of labor, because she admitted no one in her family was incontinent and certainly none of her friends were.)

I think it's a combination of older women having babies (and multiples caused by fertility treatments, as well), and some women who are scheduling their childbirths. Why you would willingly want abdominal surgery, I don't know.

Posted by: Chasmosaur1 | August 30, 2010 4:18 PM | Report abuse

To forgetthis:

You'd be surprised at how poor the U.S. infant and maternal mortality rates are. For all our high tech births, we are 20-something in the world for mothers and babies surviving childbirth.

Why aren't we #1? Why don't we have the most mothers and babies surviving birth? The countries at the top of the list are the Scandinavian countries. They treat childbirth as a natural event (not a medical event.) A surgeon (an obstetrician) only gets involved when deemed necessary.

We should be looking at ways to improve the survival of moms and babies at childbirth by studying what the countries that have better survival rates than we do are doing.

It's not "going back in time" to try to reduce the number of elective c-sections. A Caesarean is major abdominal surgery, and is inherently riskier than normal, vaginal birth.

Posted by: LoveSnow | August 30, 2010 4:18 PM | Report abuse

Considering that prior to advances in Western medicine, ONE out of THREE women were expected to die in or shortly after childbirth, the rate of sections does not seem all that high to me.

Of course, without a section, I would have been the one of three. Often, there is a d^mn good reason a section is performed. Thanks to good doctors and access to a C-section, my child and I are healthy and thriving.

BTW, I know women who have delivered "naturally" and almost lost their lives (one woman did die) because of hemorrage. Yes, this is a natural process, but nature isn't always a happy ending.

Posted by: dahozho | August 30, 2010 4:21 PM | Report abuse

Easy answer: Because physicians push (no pun intended) for c-sections as opposed to natural birth.

We have two children. Prior to both births, the doctor wanted to schedule C-sections for no reason other than to expedite the delivery.

Posted by: sloppyawn | August 30, 2010 4:22 PM | Report abuse

Do they really need a "study?" Doctors earn more with caesarians; doctors and patients can "schedule" the delivery to avoid "inconvenience;" patients have come to expect perfect deliveries and doctors are loathe to test their malpractice coverage; and, yes, as the median age at delivery has creeped upward the percentage of c-sections goes with it. But I agree; I keep my mouth shut but it used to be that people at least waited to go into labor, tried vaginal delivery and then at a reasonable point threw in the towel and moved onto a c-section. Today, everyone I know has their "birth days" all picked out well in advance. Weird...

Posted by: Omyobama | August 30, 2010 4:24 PM | Report abuse

@ lovesnow. Did you know that how "infant mortality" rates are calculated in other countries is NOT the same as the US? The EU's rates seem especially low because infants born alive but not considered "viable" ARE. NOT. COUNTED. Look into it. The way the stats are calculated are important.

BTW, yeah, my obs did speak glowingly of natural childbirth until they finally realized the child was not going to fit through my pelvis (a grandmother had the same problem and lost two children before sections were available in her rural state).

We are very lucky to have such low rates of maternal mortality and access to treatment for neonatal medical issues. I agree that the elective section rate is too high (I've known women who've done that), but don't condemn the procedure entirely.

Posted by: dahozho | August 30, 2010 4:29 PM | Report abuse

I have been delivering babies for the past 10 years. I found this article to be disingenuous. The cesarean section rate is certainly too high, but the only one taking any risk in the delivery room is the obstetrician. It doesnt matter if the mom abused tobacco, alcohol, illicit drugs, if the baby has complications at birth the obstetrician can and most likely will be sued. These lawsuits can be career ending if your insurance drops you. What risk is the malpractice attorney or patient taking? Absolutely none.

Posted by: jg520 | August 30, 2010 4:31 PM | Report abuse

@ lovesnow. Did you know that how "infant mortality" rates are calculated in other countries is NOT the same as the US? The EU's rates seem especially low because infants born alive but not considered "viable" ARE. NOT. COUNTED. Look into it. The way the stats are calculated are important.

Posted by: dahozho

**********************************

Where is that written? Can you actually back that up? What do you mean by 'viable'? Please cite and clarify.

Regardless, that still says something about the USA's birth rate. Apparently, European nations are coming out with healthier, "more viable" babies than we are. They must be doing something right.

Posted by: jromaniello | August 30, 2010 4:47 PM | Report abuse

People like LoveSnow like to, in their minds, "Charitably" insist 99% of women should not have c-sections. Its the same ignorant mentality of women in the 50's "Charitably" insisting on formula instead of breastfeeding, the same idiot statements of German-Nazi heritage Giselle Bundchen insisting all woman should be forced to breastfeed, the same narrow minded ignoramuses who believe that any human with a handicap, whether Autism or Spinal Bifida or Downs or BiPolar, should be institutionalized or better yet aborted. How many times have I been in a Doctors office when a happily pregnant older mom, is pressured to take or not take a test, falsely thinking that the baby inside of her will not be "viable" if a test is or isn't taken?
LoveSnow, people like *you* have an abortive, anti-life attitude. Would Mary not have Jesus if she decided or had to C-Section and not breastfeed?
Isn't it more important that a Mom get all the info *she* wants on the child inside of her, then make the decisions best for her and the baby?
Its good to research properly why the C-section rate is high as compared to historical info (Women have been having children outside of the home for just 100 years). Its evil to take any life filled option away from a soon to be Mom, especially a stressed young one who may not have the support of family or a boyfriend. I support all females, women and girls, who have their children,and make many many sacrifices to bring these children in the world.

Posted by: lee3333 | August 30, 2010 4:51 PM | Report abuse

"Among our friends, we all thought she was afraid of labor"

I don't blame her. A scheduled C-section lets you plan for a delivery with humane levels of pain relief. I was in hard labor for about six hours before I was dilated enough to be admitted to the hospital, and it was another two hours before an anesthesiologist was available for an epidural. I'd have gotten better pain relief if I'd come in with a broken arm. For women who don't want natural childbirth, there has to be a middle ground between scheduling a C-section and "suck it up and deal until you're 3cm dilated," or you're going to get a lot more C-sections than are medically necessary.

Posted by: sisina | August 30, 2010 4:52 PM | Report abuse

It's not just doctors pushing C-Sections, but savvy mothers whose company benefits encourage them. My company pays out maternity leave through a short term disability policy. The policy allows a mother 6 weeks paid leave if she delivers vaginally. If she delivers by C-section, she gets 13 weeks paid. I think most women at my company would go ahead and schedule the surgery just to ensure that they will have sufficient time to bond with their child and recover.

Posted by: clunman | August 30, 2010 4:56 PM | Report abuse

Awww, cmon, we know it doesnt take a doctor or a scientist to figure why this rate has increased. It is either one or two reason for 95% of the C sections and ladies, YOU know who YOU are,.....one reason is some dont want the VA JJ to get too loose, the most common reason is HSV or HPV...which has been running around down there since their Sophomore Year in college....and way before baby was even conceived.

Posted by: Fred23 | August 30, 2010 5:23 PM | Report abuse

Awww, cmon, we know it doesnt take a doctor or a scientist to figure why this rate has increased. It is either one or two reason for 95% of the C sections and ladies, YOU know who YOU are,.....one reason is some dont want the VA JJ to get too loose, the most common reason is HSV or HPV...which has been running around down there since their Sophomore Year in college....and way before baby was even conceived.

Posted by: Fred23 | August 30, 2010 5:24 PM | Report abuse

Hospitals make more money from C-sections, you get a nice OR fee, surgeon's fee, anesthsia fee etc., plus the patient is there for the ideal lentgh of time, not too short, but not too long.

My wife was induced, the drug she was given causes very strong contractions which are very close together meaning the pain was unbearable, then they broke her water, then had to get the epidural to manage the pain (nice fees in that), all those powerful and close contractions stress the baby's heart and exhaust the patient, meaning there is no choice but a c-section. The interventions push you to the ultimate outcome which just happens to make more money for the hospital.

Posted by: scmtneer | August 30, 2010 5:25 PM | Report abuse

I wonder about sick leave bank policies that will give you paid time off to recover from surgery (C-section) but no paid time off for natural child birth. Probably not the deciding factor, but I wonder how much it influences people's choices. I have worked at two different places (fed and local gov't) where you can qualify for paid time off for a c-section but not for natural birth.

Posted by: elwarn | August 30, 2010 5:31 PM | Report abuse

Responding to clunman:
Wow, your company's policy is bizarre. A normal vaginal birth certainly doesn't entirely "disable" a woman for 6 weeks! And an extra 7 weeks of total disability because it's a c-section? What a bunch of nonsense!

What new mothers REALLY need from their employers is 3 DAYS of total disability, followed by 6 MONTHS of reduced working hours, gradually ramping back up to 40. Believe it or not, most new mothers are quickly ready to go back to work -- for a few hours per day -- after only a few days off. In fact, they'd welcome the opportunity, if employers would be open-minded enough. But stupid American employers are usually locked into the mindset that employees are only useful if they are physically present at work for a full 40-hour work week.

Posted by: dmm1 | August 30, 2010 5:47 PM | Report abuse

Honestly, if you are a fit woman, it is not hard to bounce back from a c-section. I am 35 and had one a year ago. I was out of bed and walking around the next day. I was out on a mile walk within a week. The healthier we all are the easier it is to bounce back from things.

Posted by: thought4 | August 30, 2010 5:57 PM | Report abuse

Did jg520 just say that the ONLY person in the delivery room taking any risk is the physician? How about the woman whose belly you're slicing open, Doctor?

Posted by: jerkhoff | August 30, 2010 6:18 PM | Report abuse

thought4: You're using faulty logic based on your anecdotal experience to argue that C-sections aren't so bad. Just because you had a quick recovery doesn't mean that C-sections aren't riskier than vaginal deliveries (FYI - I also recovered fairly quickly after my C-section). A C-section involves all the risks of other abdominal surgery - anesthesia reaction, infection, blood clot, etc, and those are just the risks to the mother. There are also risks to the baby. There is no question that some C-sections are necessary - I had an emergency C-section that probably saved my daughter's life - but I wonder how women who do it electively deal with the negative consequences to their babies.

I think one way to decrease the number of elective C-sections and inductions that lead to C-sections is for insurance companies to stop paying for them. Absent documented medical reasons (preeclampsia, placenta previa), insurance companies should just stop paying. When it has to come out of pocket, women will be less likely to opt for an elective C-section.

Posted by: JMFCO | August 30, 2010 6:45 PM | Report abuse

@Chasmosaur1
You said:
My SIL - who had her first pregnancy at 39 - was on track with a natural childbirth, but ended up having an emergency C-section. The umbilical cord had wrapped around my niece's neck in the last week, and every push was tightening the cord. So necessary.

Thirty three years ago, I gave birth to my first child, a daughter, at age 32. I had planned and practiced for natural childbirth, but the cord was wrapped around her neck, and every time I had a contraction, her heart rate was affected as the cord tightened. She was delivered vaginally, through high forceps intervention.
So NOT necessary to have a C-section.
Result: She was fine, 7 lbs. 11 oz and an Apgar score of 9. I was fine, although a bit sore from the forceps. And 21 months later, her younger sister was born with natural childbirth.

Posted by: Lamentations | August 30, 2010 6:45 PM | Report abuse

Don't Get Pregnant, Is Only true Way to Stay Healthy. first Birth Is Futile, As Endless Succession of Baby Switching, so your own never made out to corridor.TOTAL LOSS AT bAPTISM IN QUick Switch & Elementary School Do Same. from there even more grabbing of name, numbers & benifits thru endless cruel switching of People.

Next, at birth, womans genitile organs are removed, leaving greatly reduced health. If Person Insists, Give Home Birth, at least Save YourSelf.
Use As Many Birth control devices as you can get. Patch, Pill,Grinder, Spermacide & diaphram, ALL at Same Time. Hormones will help keep sterate mass strong & others to prevent insemination. yet, even with ALL, Even Grinder wears, eventually pregency will occur, if mechanical blades are still in womb, bad luck, if came out, on road to lot of work for same crocked indusrty.

Signed:PHYSICIAN THOMAS STEWART von DRASHEK M.D.

Posted by: thomasxstewart1 | August 30, 2010 6:49 PM | Report abuse

An obstetrician friend of mine put it bluntly. "In twenty years of practice, I have never regretted performing a Csection. There have been a few that I regretted not doing". He was perfectly candid and completely unapologetic that many of his decisions were motivated by defensive medicine.

Posted by: arson152 | August 30, 2010 7:27 PM | Report abuse

It's easier - that's why. Are the "experts" still trying to figure it out?

Posted by: fleeciewool | August 30, 2010 8:21 PM | Report abuse

@Lamentations:

That's great and you're lucky everything came out okay. But OB's don't generally do high forceps interventions anymore, due to a high risk of trauma (to mother and child - see the post by the OB a few above yours, re: malpractice law suits).

So while high forceps was used 33 years ago, it's not now. When this happens now, they do the C-section.

Posted by: Chasmosaur1 | August 30, 2010 8:41 PM | Report abuse

lee3333:

FYI - I am strongly pro-life. I support c-sections when medically necessary. I don't know where the 99% came from, that's not from my post. I talked only of reducing elective c-sections.

Posted by: LoveSnow | August 30, 2010 8:49 PM | Report abuse

I won't get too deep on this one, but where I live (Hong Kong), almost 80% of deliveries are C-sections.

Reason - the mother can regain her figure quicker.

Who'da thought?

Posted by: thetroubleboys | August 30, 2010 9:32 PM | Report abuse

Lawsuits. Lawsuits. Lawsuits. And more lawsuits.....

In 1980 there was a huge effort from the medical community to decrease the number of "repeat" C-sections and encourage VBACs (vag birth after cesarian) ... and in the 80s we saw a significant increase in the number of VBACs. Then in the 90s there was a decrease in VBACs for one simple reason....

Lawsuits.

Posted by: Hmmmmm3 | August 30, 2010 10:02 PM | Report abuse

I wish my doctor would have done C-Section two weeks before, and not letting me have the baby at the end of the 42nd week, a huge baby (more than 10 pounds) that risked brain damage because my fluid was reduced and he had low sugar. I think it is absurd to see all these women going that far in their pregnancies and deliver huge babies...I actually did not meet so many women that had c-section, only dangerous inductions that caused problems to their babies. Women used to die years ago during delivery, and I think we are going back to that stage.

Posted by: myself4 | August 30, 2010 10:12 PM | Report abuse

The answer is doctor's fear of malpractice suits.

Posted by: janye1 | August 30, 2010 10:26 PM | Report abuse

Another reason: doctors are trained to perform medical procedures. A pregnant women is viewed as a person with a medical condition, so a medical procedure is performed.

Posted by: Nemo5 | August 30, 2010 10:49 PM | Report abuse

This finding brings to mind my own suspicions that I had a generation ago...performing what appear to be questionable surgery -- that's what a C-section is in essence.

When my daughter's OB (the hospital OB, who not her regular OB/GYN) decided that my daughter needed a C-section at 18 years old, I was immediately suspicious. I questioned on the medical necessity of a C-section since I've never known my daughter's doctor indicate complications during her pregnancy. We're talking about an 18 year old here who was giving birth to her first child.

I suspect that the real reason was this had more to do with the convenience of the hospital financial, rather than a necessity to address a medical need. I suspected this because the OB was quick to decide early after one meeting that my daughter needed a C-section. I discussed this with my own husband and explained to him several things: insurance companies had changed the discharge policy from what it used to be when I had my daughter. My daughter (who is a an only child BTW) was born using the vaginal birth method. Although I refused drugs for dealing with pain, the nurses and doctors were working it to convince me otherwise) and 3 days in the hospital. My daughter's case was the opposite -- C-section with anything to make the pain go away and 5 days in the hospital. And...I learned that most insurance companies nowadays will pay only for one day (no more than two days) for vaginal births. So yes...I think this is more about increasing the income for the hospital, not a credible medical need in some cases for the mother...not to mention that hospitals try to convince mothers to work within their convenience because there's something in it for everyone. And yes...I remember when I was right there with my daughter giving birth the doctor even told her that the pain medicine was "required." I glared at the doctor and rolled my eyes. After my grandson was born, we saw that doctor maybe once or twice afterward, and never saw her again. Perhaps that doctor didn't like my interfering with questions, questions, and more questions? How many ways ways can you spell profit and cheaper malpractice insurance?

Doctors need to unlearn that giving birth is NOT a medical condition that requires a surgical procedure. That's putting the hospital's needs before the mother. It's one thing to do the C-section if there's documented medical condition that warrants it, and another thing that hospitals use this birth to take advantage of opportunities to boost income. I say that my daughter's case was the latter, since she was covered by a commercial health insurance policy, not a public medical benefit such as Medicaid. At woman who is 18 years old and giving her first birth (and a repeat for the second birth) should not be subjected to whims of medical institutions trying to use her condition milk greater profits out of insurance companies just because insurance companies won't pay for more than what's necessary.

Posted by: ldsw | August 31, 2010 1:33 AM | Report abuse

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