Are C-Sections Too Common?
March 10, 2010— -- Cesarean births are at an all-time high and fewer women who've had a C-section are opting for vaginal births on subsequent pregancies, according to the National Institutes of Health.
The trend has spurred the NIH to reassess current recommendations on birthing practices.
At this week's Consensus Development Conference on Vaginal Birth After Cesarean (VBAC), the NIH is seeking to provide better guidance to clinicians on this topic. The results of this meeting will be presented Wednesday afternoon in a consensus report.
"The rise in cesareans is disheartening," says Dr. Marjorie Greenfield, director of general obstetrics and gynecology at University Hospitals MacDonald Women's Hospital. "It is driven by many forces including economic incentives and malpractice fears, but also by our management of 'normal labor,'" she says, referring to a growing perception by mothers of the need to have "perfect outcomes" with deliveries despite the imperfect nature of the birthing process.
But experts were optimistic about the conference and felt that practice-changing recommendations may come out of this meeting.
"The mood at the conference," notes Dr. Lucky Jain, "has been overwhelmingly in favor of promoting VBAC, [especially] if we can improve our ability to identify those [rare] mothers that might have complications with VBAC."
Nearly one in three babies born today are delivered by C-section, according to the Centers for Disease Control and Prevention.
Though C-sections are associated with lower rates of birth injuries and are perceived as a lower-risk procedure in the face of a long and difficult labor, they are not without risks of their own.
In the short term, C-sections can result in longer hospital stays, higher risk for infection, and possible respiratory issues for the baby.
Jain says that cesarean delivery can interrupt the natural process through which newborns transition to breathing in an air environment.
His work has found that babies born from C-sections have higher rates of respiratory distress after birth, and a higher risk long term of developing asthma.
This, he says, is in large part because of babies' inability to clear lung fluid -- a process that is aided by certain hormones released during spontaneous labor.
The mother's health can also be compromised by C-section, especially after repeated cesareans.
Complications escalate with each C-section, Jain says. "This became clear at the meeting: that uterine rupture or the need for a hysterectomy after cesarean is much higher in mothers who will have multiple children."
"If you look at this country compared to any other industrialized country, we have one of the highest c-section rates of any," Nan Strauss of Amnesty International told "Good Morning America, "and along with the increase is coming an increase in very severe complications, and in deaths as well."
