A government report released this week shows that the number of babies born by cesarean section was up in 1999 for the third year in a row. In addition, the American College of Obstetricians and Gynecologists (ACOG) released a set of recommendations on Thursday aimed at helping doctors and hospitals to review and, where appropriate, reduce their rate of cesarean deliveries.
The organization devised a formula that permits hospitals and doctors to determine their rates of cesarean section. The calculation would be based on adjusting the total number of procedures performed to reflect a mix of cases.
Approximately 22% of all live births in 1999 were done by c-section, whereas the US Department of Health and Human Services set a target rate of 15%, as part of their "Healthy People 2000" goals.
The ACOG document, entitled "Evaluation of Cesarean Delivery" -- also tackles other issues relating to cesarean rates, including residency and post-residency training in vaginal operative technique (forceps deliveries), and whether "the continuous presence of nurses or other trained individuals who provide comfort and support to women in labor may lead to lower rates."
American College of Obstetricians and Gynecologists Position Statement August 9, 2000
One of the complications that is hardly ever addressed is the problem that the surgical scar has on the mother. It frequently blocks the proper flow of energy through the autonomic nervous system and seriously impairs her ability to stay healthy. Fortunately, this is relatively easily repaired with a simple injection of procaine into the scar, but very few physicians are aware of this issue and never check for it.
Another issue as far as the proposition of ACOG, is that they would like individual hospitals and doctors to compute their c-section rates. This may not be such a great idea, as some of them might be apt to artificially lower the c-section rates, if too high.
Interestingly, another article in this week's newsletter deals with a published list of doctors who have had disciplinary action taken against them. In a similar manner, it would be great to be able to obtain the c-section rate for individual OB/GYNs, as they vary greatly.
Besides using a midwife and having a home-birth if possible, there are several thing that women can do in order to lower their chances of needing a c-section:
Get a Doula - Also known as a 'labor assistant' or 'montrice' they have been shown in published studies to lower c-section rates, as well as provide other benefits as well (Abstract 1, Abstract 2). Doulas of North America (DONA) is a good organization and can help you find one.
Make a Birth Plan - This is a document that states the expectant mother's or couple's interests or desires for their birth experience. It is not a legal document, but simply a good way of letting the doctors and hospital staff know of your wishes. Many interventions (e.g., epidurals, pitocin, etc.) can be avoided, simply by making clear your desires, and many of these interventions can lead to an increased chances of c-sections.
Talk to your OB/GYN - Be sure to talk to your doctor early in the pregnancy, or even before hand, about different issues, including c-sections. For example, you can ask what their c-section rate is.
Avoid epidural/pitocin if possible - These will increase your chances of needing a c-section (Abstract)
Interesting Links:
Birthing the Future - Website of Suzanne Arms, author of many books and active in the natural birthing movement. The Bradley Method - The American Academy of Husband-Coached Childbirth, founded by Robert A. Bradley, MD and Marjie & Jay Hathaway for the purpose of making childbirth education information available. They are much more naturally-oriented than the more popular Lamaze method. List of instructors available. Or call 1-800-4-A-BIRTH. Birth Centers Online Childbirth.org Waterbirth Information
Birthing the Future - Website of Suzanne Arms, author of many books and active in the natural birthing movement.
The Bradley Method - The American Academy of Husband-Coached Childbirth, founded by Robert A. Bradley, MD and Marjie & Jay Hathaway for the purpose of making childbirth education information available. They are much more naturally-oriented than the more popular Lamaze method. List of instructors available. Or call 1-800-4-A-BIRTH.
Birth Centers Online
Childbirth.org
Waterbirth Information
Related Articles:
LINK BETWEEN HISTORY OF C-SECTION AND RISK OF PLACENTA PREVIA FEDERAL PUSH TO REDUCE C-SECTIONS QUESTIONED
LINK BETWEEN HISTORY OF C-SECTION AND RISK OF PLACENTA PREVIA
FEDERAL PUSH TO REDUCE C-SECTIONS QUESTIONED