There is a crisis in maternity care: a spiraling rise in C-sections—along with resulting risks to maternal and infant health.  In 2005 the Cesarean section rate was 30 percent—a six-fold increase from the 1965 rate of only 5 percent. Experts estimate the rate will not slow down or decrease, but instead increase each year. What has happened?  Multiple factors now contribute to the fact that the Cesarean section rate has increased so dramatically. These include:

Repeat C-sections: Once a woman has her first Cesarean, most care providers do not offer the option of VBAC (vaginal birth after cesarean), but rather do repeat C-sections.

Breech: Many physicians aren't trained or comfortable delivering babies that are not head down.

Fear: Rising use of invasive medical practices may increase the risk of C-section. These include induction of labor, inhibiting a woman's ability to move in labor, withholding nourishment, early epidural anesthesia and, most importantly, leading women to believe that birth is fraught with danger and they are incapable of laboring and giving birth without medical intervention.

Dystocia: This somewhat vague term denotes that the uterus isn't working efficiently or there is not a good fit between the maternal bony pelvis and the baby's head (also called CPD).  This occurs almost twice as often when women are induced.

Fetal distress: Continuously monitoring the fetus during labor (as opposed to intermittently listening) has increased the C-section rate without improving overall infant survival. The vast majority of infants delivered by C-section for fetal distress are completely healthy with no indication of distress.

Medical-legal concerns:  Physicians are concerned with being sued and, indeed, do get sued significantly more often with vaginal births than Cesareans.  Thus, they perform C-sections to decrease liability.

Primary elective Cesarean section: A small minority of women request Cesarean section for their first pregnancy without medical indication. However, these numbers are extremely small and, when examined further, are more the result of physician pressure rather than maternal request.

Obesity: Obesity significantly increases the risk of a Cesarean for reasons that are not thoroughly understood.

Why is this such a problem? Why aren't women making their own choices and getting the birth experiences they want? In a recent “Listening to Mothers” survey, Childbirth Connection (childbirthconnection.org) queried thousands of women who had hospital births in 2005. Over 50 percent of the women said they felt that birth was a normal process and shouldn't be interfered with unless medically necessary. However, of that group, the induction rate was 40%, the epidural rate was 76%, the continuous electronic fetal monitoring rate was 76%, and only 60% of the women surveyed had spontaneous vaginal births. Interestingly, two out of three women had scores that indicated some degree of depressive symptoms (postpartum) in the two weeks before being surveyed, perhaps related to their birth experiences. 

The World Health Organization recommends that the optimal Cesarean section rate be below 15 percent. The best outcomes for mothers and babies occur when the C-section rates are around 10 percent. Anything less than 5 percent increases the risk for babies, and anything over 15 percent increases the risk for both moms and babies.  Clearly, there are medical indications for C-section, and it can be a valuable life-saving tool for mother and baby when indicated. However, as the United States edges ever closer to a 35 % C-section rate, we have to ask ourselves if this is really in the best interest of women, families, and babies. C-sections are roughly three times more costly than vaginal birth, which places an enormous burden on our already overextended healthcare system. More importantly, though, women are losing confidence in the ability of their bodies to do what is normal and natural. Normal childbirth can not only enhance a woman's self-esteem, but also provide the optimal start for parenting: a position of strength and confidence. 

Helpful Resources: The Official Lamaze Guide: Giving Birth with Confidence by Judith Lothian and Charlotte DeVries (Meadowbrook, 2005)  Websites: www.birthcenters.org www.childbirthconnection.org www.acnm.org www.lamaze.org

So, what can you do to avoid an unnecessary C-section?  Familiarize yourself with the issue (see Helpful Resources.) Learn about the medical practices that increase the likelihood of unnecessary intervention.  But most importantly, find a healthcare provider who has a low C-section rate—for a physician, that should be around 18%, or a midwife with less than 10%.  If a provider won’t tell you his or her rate, or say they don’t know: keep looking.  You deserve to have a happy, healthy baby, and the birth experience you want!

Barbara Norton is a Certified Nurse Midwife practicing midwifery at Midwifery & Women’s Health Care at Geneva Woods.  She and her partners attend births at Geneva Woods Birth Center and Providence Hospital.  For more information:  www.midwivesatgenevawoods.net.