This is the first part of a paper I wrote for one of my classes on the public health benefits of reducing cesareans. Please feel free to quote from this as long as you give proper attribution to me and the authors of the cited sources of this paper. Thanks and enjoy!
The cesarean section is now the most common surgical procedure in the United States and accounts for 32.8 percent of all deliveries as of 2011 (Kozhimnnil, Law, and Virnig, 2013). This is a substantial increase from what it was decades ago. As Dr. W. Lawrence Warner stated in a 2013 article for the American College of Obstetrics and Gynecology, “When I began medical school in 1970, the overall cesarean delivery rate was 5.5%… I practice in Utah, where the rate is 22.2%, the lowest in the country. In New Jersey, the rate is 38.3%, the highest in the country. There are some individual hospitals with rates well over 50%.”
There are many factors that have been cited as driving the increase in cesarean rates, including an increase in multiple gestations due to fertility treatments, rising rates of maternal obesity and conditions such as gestational diabetes and preeclampsia. However, other issues that are not related to the actual health of the mother or baby also come into play, such as convenience and doctors’ concerns about liability and malpractice (Kozhimnnil, Law, and Virnig, 2013).
Cesarean sections play a vital role in maternal and child health. There are situations which absolutely indicate the use of a cesarean, such as transverse lie, preeclampsia or other hypertensive disorders of pregnancy that have progressed to a life-threatening stage, cord prolapse and placenta previa. However, these cases account for only a small number of c-sections performed, which means that many c-sections are not actually a medical necessity. This has important implications from both a cost and health perspective for mothers, babies, hospitals, insurance companies and Medicaid. C-sections are more costly than vaginal births and also carry increased risks for both mothers and newborns. Lowering the overall rate of cesarean surgery could mean reduced healthcare costs as well as important gains for maternal and child health.
Though cesarean surgery has become extremely common, it is actually a procedure which entails more risks for both mothers and babies than a vaginal birth. Intraoperative damage to internal organs such as the bowels, bladder, urinary tract and unintentional damage to the uterus or cervix are relatively common, occurring in approximately 12 percent of cesarean sections. Other maternal complications include an increased occurrence of placenta abnormalities in subsequent pregnancies, admission to the intensive care unit, blood transfusion, infection, blood clots, hysterectomy and death, with the chances of these complications increasing with each subsequent cesarean (Dodd and Grivell, 2011).
Kozhimnnil, Law and Virnig (2003) found that even among women who fit the American College of Obstetrician-Gynecologists’ (ACOG) definition for low-risk pregnancy, cesarean rates are still very high and that clinical factors alone could not explain the increase in cesarean surgery. They theorize that rising cesarean rates might be explained by physicians’ practice patterns and hospital policies along with a failure to educate women about the real instead of perceived benefits and risks of cesarean and vaginal delivery.