On the anniversary of my c-section.... how fitting....
C-sections on the Rise in New Jersey
When her doctor said it was time for a C-section, Jaime Rowlyk of Woolwich, mom of now-2-year-old Alden, tried to negotiate. “Can you give me five minutes to think about it?” she asked. The doctor gave her just one. After 12 hours of labor with virtually no dilation and soaring blood pressure, Jaime’s body was beginning to break down; there wasn’t time for back and forth. In retrospect, Jaime believes the C-section saved her life.
While cesareans obviously are useful in preventing potentially serious complications for mother and baby, the World Health Organization recommends they be performed in no more than 15 percent of all births.
But in 2006, the U.S. cesarean birth rate was 31.1 percent, according to the National Institute for Health Statistics. (It was 20.7 in 1996.) Delaware and Pennsylvania had numbers in line with the national rate, at 30.7 and 29.7 percent, respectively, but New Jersey led all 50 states with a C-section birth rate of 37.4 percent.
This disparity between the recommended and actual frequency of surgical births has people asking: why are so many C-sections done in the U.S., and why do the numbers continue to rise?
Risks and complications
There’s no doubt that a C-section is major abdominal surgery. It carries risks—such as bleeding and infection—and requires a longer recovery time than vaginal childbirth. There’s also a chance of injury to surrounding organs, such as the bowel or bladder. The risks increase with each successive C-section.
But the consequences are relatively small in comparison to complications that can arise during pregnancy and delivery. A first, or primary, C-section may be performed because of:
- Malpresentation of the fetus (if the baby faces any way but down);
- Fetal distress (if monitors indicate the baby isn’t tolerating labor);
- Failure to progress in labor (if dilation stops, or pushing is unproductive);
- Health conditions of the mother, such as diabetes or high blood pressure;
- The baby’s size (if he’s estimated to be too large to fit through the mother’s pelvis—generally more than 11 pounds).
Pam Udy, president of the International Cesarean Awareness Network (ICAN), an organization that aims to prevent unnecessary cesareans through education, says, “C-sections have become the end-all cure-all to every pregnancy complaint and labor complication.” She herself had a C-section after she got indigestion 38 weeks into her pregnancy. No other remedy was suggested.
Due to the high number of lawsuits from complications during vaginal births, doctors seem to order C-sections more quickly than they used to. They tend to err on the side of caution if fetal monitor tracings or anything else is abnormal during labor. Says Dr. Sindu Srinivas, a clinical fellow at the Hospital of the University of Pennsylvania and a member of the Committee for Professional Liability at the American College of Obstetricians and Gynecologists: “the liability issue definitely plays some role” in climbing C-section rates.
On the agenda
According to Dr. Gordon Ostrum, Jr., acting chair of the OB-GYN Department at the Christiana Care Health System in Delaware, “Repeat cesareans are the other large driving force,” in rising U.S. C-section rates.
Because research has shown a small but increased risk of uterine rupture during vaginal births after cesareans (VBACs), some moms and doctors avoid them for fear of potentially dangerous complications. Also, some moms are less receptive to going through labor if they’ve had a prior C-section. Today, most women who’ve had a C-section will likely have another for subsequent births.
While most physicians discourage purely elective C-sections, they are becoming more common. “Our society is very convenience oriented,” says Dr. Ostrum. “People wish to be delivered on a schedule.”
Since labor is unpredictable, making an appointment for surgery removes the guesswork about when a baby will be born. Both physicians and mothers have plans to make and agendas to keep; scheduling delivery offers the option of knowing an exact due date.
Still, an elective C-section remains controversial. Many say babies should simply arrive when they’re ready. Potential physical risks to the baby include low birth weight, prematurity, respiratory problems, and lacerations, according to the ICAN website. Potential risks to women include hemorrhage, placental abnormalities in future pregnancies, and an increased percentage of maternal death, says ICAN-online. In addition, the New York Times reported a finding in June that a history of a cesarean can mean higher health insurance premiums for a woman—even if she is in good health.
Pam Udy of ICAN suggests women ask their doctors: “What’s the medical justification for this procedure?” before agreeing to a C-section. If a C-section is recommended, Udy suggests asking for a second doctor’s opinion if there’s time.
International Cesarean Awareness Network: ican-online.net
Hospital C-section rates in NJ: starledger.com/str/indexpage/default.htm (link from Health and Environment)
Suzanne Koup-Larsen is a freelance writer from Pennsylvania. Her second baby is due in September.