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Why Are Nearly a Third of Childbirths Cesareans?

June 04, 2009 | 40,365 views

Cesarean, birthThe cesarean birth -- delivery via uterine incision -- was once reserved for cases in which the life of the baby or mother was in danger. But now it is a routine practice. It is in fact the most common operation in the United States; performed in 31 percent of births, up from a mere 4.5 percent in 1965.

 

With that surge has come an explosion in medical bills and an increase in complications. Now, the use of cesareans is being reconsidered. It is a major reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results, and may actually be doing more harm than good.

 

Childbirth is the number one cause of hospital admissions, and is a huge part of the nation's $2.4-trillion annual healthcare expenditure. Spending on the average uncomplicated cesarean runs from $4,500 to $13,000, much more than a comparable vaginal birth. And the cesarean rate in the U.S. is higher than in most other developed nations despite a standing government goal of reducing such deliveries.

 

The cesarean also exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

 

Dr. Mercola's Comments:

In the United States childbirth has been shifted to a conventional medical approach relying on drugs and surgeries as an alternative to the often superior traditional methods. According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent.

Well it's 2-300% higher with a  whopping 31 percent of births in the U.S. performed via cesarean (C-section). This is a rate that even The American College of Obstetricians and Gynecologists admits is worrisome. This is actually the highest rate ever reported in the United States, and a rate higher than in most other developed countries.

In some cases, of course, a cesarean section can save lives, such as in the event of a prolapsed umbilical cord (the umbilical cord slips through the cervix before the baby and may endanger the baby’s oxygen supply) or placenta previa, which occurs when the placenta grows in such a way that it blocks the baby’s exit through the cervix.

Other situations, including when the baby is in a transverse (sideways) position or if the mother is having an outbreak of genital herpes, may also call for a cesarean section. But in many low-risk pregnancies, C-section is far from the best childbirth option.

Unfortunately, I suspect a large part of this growing C-section rate has to do not with medical necessity but with convenience and doctors’ fears of liability (of not performing a cesarean and giving nature a chance to run its course, especially if someone requests the surgery).

There has also been an unfortunate shift in attitudes about pregnancy and birth, taking it from a natural life phase and turning it into a medical condition that needs to be “treated.” Gradually, however, I believe women in the United States are opting for more natural childbirths and choosing to listen to their bodies and give birth the way nature intended, instead of the way an obstetrician dictates.

According to data from the National Center for Health Statistics for 2006, the most recent year for which data is available, 8 percent of pregnant women in the U.S. gave birth with a midwife compared with just 4 percent in 1990.
Why a Midwife May be a Better Choice than an Obstetrician
Obstetricians are specially trained surgeons, taught from early on how to use surgical and other medical interventions to assist in childbirth. They certainly have their place in the medical field, as obstetricians excel at helping high-risk women deliver babies safely. But this is the minority of women.

More than 75 percent of women have normal pregnancies, meaning all of the surgical interventions obstetricians are trained to use are unnecessary. In these cases, a midwife, who is there to offer help, education and support during pregnancy, labor, delivery and after, is actually the safest, most qualified birth attendant.

Notice the word “attendant.” A midwife is there “attending” the birth, assisting in helping the woman’s body to do what it was designed to do naturally, give birth. A doula can also be immensely helpful for women during pregnancy and labor, as their role is to offer continuous emotional support, and assistance on topics such as breathing, relaxation and positioning.

This is the type of support that will help most women to deliver their babies in the safest and most comforting way. Unless there is a complication, medical interventions are typically unnecessary, and often do more harm than good.
Are Hospital Births Really Safer?
There is a misconception in the United States that having a hospital birth with an obstetrician is the safest way to give birth. There is not a single report in the scientific literature that shows obstetricians to be safer than midwives for low risk or normal pregnancy and birth.

Despite this, the American Medical Association recently passed a resolution saying "the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex…"

The reason for the resolution, according to AMA, was due to recent media attention given to homebirths. In other words, they were afraid more women would start to question whether a hospital really is the best option.

So let’s look at some facts.

Nearly all U.S. births (99 percent) occur in a hospital, yet the United States has one of the highest infant mortality rates of any developed country (6.3 deaths per 1,000 babies born). In the Netherlands, however, where one-third of deliveries occur in the home with the assistance of midwives, the infant death rate is lower (4.73 deaths per 1,000).

Cesarean rates are also typically lower among midwife-assisted births compared to obstetrician births, a benefit in and of itself.

One study in the British Medical Journal found that a woman’s risk of death during delivery is three to five times higher during cesarean than a natural delivery, her risk of hysterectomy four times higher, and her risk of being admitted to intensive care is two times higher.

Women who undergo cesareans are at an increased risk of many other complications compared with a natural birth as well. These include:
• Increased risk of mortality
• Infection to various organs including the uterus, bladder or kidneys
• Increased blood loss
• Increased risk of complications in future pregnancies
• Decreased bowel function

• Respiratory complications
• Longer hospital stay and recovery time
• Adverse reactions to anesthesia
• Risk of additional surgeries such as hysterectomy or bladder repair
Cesareans also have a psychological effect on women. As written in Having a Baby, Naturally, which is an excellent resource for all mothers-to-be, "Many women who have cesarean sections reported that the experience was traumatic." Women are also less able to care for the newborn immediately after childbirth and therefore may miss out on bonding opportunities.

There are other risks of hospital births to consider as well, such as drugs used to induce labor, which are also on the rise. If given too early, these drugs can result in the delivery of an infant who is too young to breathe on its own, and may also raise the risk of complications that lead to cesarean.

Early umbilical cord clamping, a practice that has been linked to difficulties breathing and brain damage in the newborn, is also common in hospitals but less so among midwife-attended births.
Excellent Resources for Natural Childbirth
The care you opt for during pregnancy and childbirth is highly personal, but if you are having a normal, healthy pregnancy I do suggest you explore all of your options, rather than simply defaulting to a typical hospital birth.

To start, if you are pregnant or planning to become pregnant I highly recommend watching the documentary The Business of Being Born. It explores the current U.S. maternity care system, including all of its faults, and interlaces the statistics with birth stories to give you a wide range of perspectives about childbirth. You can watch the trailer below right now.


Also, as I mentioned earlier the book Having a Baby, Naturally by Peggy O'Mara, the editor and publisher of Mothering magazine, is also highly recommended; it addresses common concerns and questions of pregnancy from conception through the first months of parenting.

Finally, my past article Natural Birth is Best has a variety of sources to help you make your pregnancy and childbirth as healthy and joyous as it possibly can be.
One of the MOST Important Duties for Pregnant Women
I am convinced that in the not too distant future it will be mandatory for women to receive regular vitamin D blood test levels.

It is absolutely imperative that pregnant women maintain a blood level of between 50 and 70 ng/ml of 25 hydroxy D as the newest evidence suggests that will radically reduce the risk of autism and virtually eliminate type 1 diabetes in the newborn.

There simply isn’t any excuse for not checking these levels and most women will require from 5,000 to 10,000 units of vitamin D per day to achieve these levels.

[+] Sources and References

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