The Tuba City Regional Health Care Corporation’s hospital, run by the Navajo Nation and financed partly by the Indian Health Service, prides itself on having a higher than average rate of vaginal births among women with a prior Caesarean, and a lower Caesarean rate over all.
The national Caesarean rate, 31.8 percent, has been rising steadily for the last 11 years and is fed by repeat patients. In Tuba City, the overall Caesarean rate is only 13.5 percent.
Changes in malpractice insurance might help the rest of the nation reach this goal. The hospital and doctors in Tuba City are insured by the federal government, and therefore insurance companies cannot threaten to increase their premiums or withdraw coverage if they allow vaginal births after Caesarean.
Critics say that doctors are performing too many Caesareans, needlessly exposing women and infants to surgical risks and running up several billion dollars a year in excess bills.
It used to be set in stone that once a woman had a Caesarean section for childbirth (delivery via uterine incision), she would have to have them for any future childbirths as well.
The rationale behind this outdated message was that the scar on the woman’s uterus could rupture during labor, leading to life-threatening complications for both mother and baby. But as this small Arizona hospital run by the Navajo Nation is quietly proving, it is often safer, not to mention less expensive, for women to have a vaginal birth after a Caesarean (VBAC).
In the United States, that national Caesarean rate is a dismal nearly 32 percent, which is so high in part because of women automatically having repeat Caesarean births (many obstetricians flat-out refuse to perform VBACs). At the Navajo Nation hospital, the rate is only 13.5 percent.
The Most Common Operation in the United States!
Caesarean section (C-section) is the most common operation performed in the United States, and accounts for nearly one-third of all births. This rate has risen drastically in recent decades, up from a mere 4.5 percent in 1965.
According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent.
The United States’ rate, at nearly 32 percent, is so high that even The American College of Obstetricians and Gynecologists admits it 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, profits 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."
Caesarean Section is Major Surgery
C-sections are so commonly performed in the United States that I think many women forget the fact that it is a major surgery. And with any major surgery come steep risks.
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 vaginal 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."
Babies born by C-section also do not receive the natural stimulation that comes from moving down the birth canal, and therefore must often be given oxygen or a rub down to help them breathe. They also miss out on the natural hormones that are released during vaginal birth to help the baby during his first moments of life.
Women are also less able to care for the newborn immediately after childbirth and therefore may miss out on bonding opportunities.
Getting a Midwife May Lower Your Chances of Having a Caesarean
In the United States, only 10 percent of vaginal births are attended by midwives, but at the Arizona hospital mentioned above, midwives deliver most babies born vaginally. This may be an important distinction as to why their caesarean rate is so low, as it’s well known that Cesarean rates are typically lower among midwife-assisted births compared to obstetrician births.
Obstetricians, which attend most births in the United States, 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. They are also less likely to try to induce a woman before her due date, which is linked to an increased risk of C-section.
A midwife offers 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.
Just look at the 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).
Are You Looking for Natural Childbirth Resources?
Gradually, I believe women in the United States are opting for more natural childbirths similar to those routinely performed at the Navajo hospital in Arizona, and choosing to listen to their bodies and give birth the way nature intended, instead of the way an obstetrician dictates.
If you’d like more information on natural childbirth, 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.