March 23, 2010 — Cesarean deliveries have reached an all-time high in theU.S., with nearly one in three babies now delivered by C-section compared toone in five just a decade ago, new government figures reveal.
Roughly 1.4 million newborns were delivered surgically in 2007 — a 53%increase from the mid-1990s, when rates started to climb after remaining steadyfor several years.
Rates rose for both older and younger mothers across all racial groups andall regions of the U.S., making cesarean delivery the most commonly performedsurgery in the nation.
The C-section rate increased by annually between 1996 and 2007, from a lowof 21% to 32%.
“Every state has seen an increase in cesarean sections over the last decadeand rates continue to climb,” National Center for Health Statistics (NCHS)statistician Fay Menacker, DrPH, tells WebMD.
The new figures were published today by the NCHS, which is a division of theCDC.
Vaginal Birth After Cesarean
The NCHS report did not address the reasons for the decade-long rise inC-section deliveries, but an expert panel convened by the National Institutesof Health weighed in on the issue a few weeks ago.
The panel looked at why so few women in the U.S. who have had C-sections arehaving nonsurgical deliveries for subsequent births.
The practice, known as vaginal birth after cesarean, or VBAC, was common inthe mid-1990s. But today, fewer than one in 10 women who have had a previousC-section attempt labor.
Studies suggest that 75% of women who labor with a pregnancy that follows aC-section delivery successfully have a vaginal birth, and outcomes are alsogood in the vast majority of cases where VBACs are unsuccessful and surgicaldelivery is required.
But in slightly less than 1% of cases, VBACs lead to uterine rupture, apotentially catastrophic complication for both mother and baby, panel chairmanF. Gary Cunningham, MD, tells WebMD.
Several leading medical groups now call for a surgeon and anesthesiologistto be available when a woman who has had a previous C-section attempts labor,and this guideline has led many hospitals to stop offering VBACs, he says.
In recent surveys, about 30% of hospital administrators said their hospitalsstopped performing VBACs because they could not comply with the guideline.
Uterine rupture often leads to fetal death or brain damage. When thishappens, hospitals and ob-gyns are often sued and massive settlements are notuncommon.
“Their position is understandable. You can’t make a hospital offer VBACs,”Cunningham says. “But on the other hand, there is a growing voice out there ofwomen who would like a trial of labor, but it is not available to them.”
The panel concluded that VBAC is a safe alternative to C-section for mostlow-risk women who have had just one prior surgical birth, Cunningham says.Panel members also called for ob-gyns to discuss VBACs with appropriatepatients and honor their patients’ delivery preferences whenever possible.
Primary C-Sections on the Rise
Maureen Corry, who is executive director of the birth research and advocacygroup Childbirth Connection, applauds the panel’s action.
But she tells WebMD that lack of access to VBAC is just one of severalfactors driving the steady increase in C-section deliveries in the U.S.
“There has also been a big increase in the number of first-time cesareansections over the last decade,” she says.
Women who are older and those delivering more than one baby are more likelyto have C-sections.
Corry says older maternal age and rising multiple birth rates may be factorsin the rising rate of surgical deliveries, but they are not driving thetrend.
Likewise, few women are demanding medically unnecessary surgical births,even though so-called “C-section on demand” has received much attention in themedia, she says.
In a 2005 survey conducted for Childbirth Connection, just one in 1,600women reported having a planned, first C-section for no medical reason at herown request.
Economics and litigation fears play a big part in this, she says. Surgicalbirths are more lucrative for hospitals and doctors.
“From the doctor’s point of view, a scheduled 45-minute surgery would haveto be preferable to getting up in the middle of the night to attend to a womanwho might labor for many hours,” she says.
And while hospitals and ob-gyns are often sued when labor goes wrong, thisis not the case with surgical deliveries, Northwestern Memorial Hospital ob-gynLauren Streicher, MD, tells WebMD.
Streicher is an assistant professor of obstetrics and gynecology atNorthwestern’s Feinberg School of Medicine.
She tells the story of a patient who delivered a severely brain damagedchild following an uncomplicated pregnancy and scheduled C-section.
“She is still a patient, and she tells me people often ask her how much shesued for,” Streicher says. “Her response is that she didn’t sue because no onedid anything wrong. But had she labored, there would have been no way to knowthat the delivery didn’t cause the brain damage.”