By Cynthia K. Buccini
Until about 1970, fewer than 5 percent of births in the United States were by cesarean section. By 1996, the rate was 20 percent, and in 2005 it was just over 30 percent.
“In cases of high-risk mothers or infants at risk, cesareans are usually appropriate,” says Eugene Declercq, a School of Public Health professor of maternal and child health. “The real point is that clearly 30 percent of the mothers and infants are not at high risk.”
Women face longer and more painful recovery times and longer hospitalizations after cesareans and greater risks of uterine rupture in future pregnancies, among other complications, according to Declercq.
The c-section rate has climbed for a variety of reasons, among them the fear of malpractice lawsuits. But don’t blame the moms. Declercq says it’s a myth that the rising cesarean rate is the result of maternal request.
Declercq was the lead author of the report “Listening to Mothers,” which surveyed 1,580 mothers in 2002 and 1,573 in 2006 on their childbearing experiences. Mothers who had had a cesarean were asked what the reason was, who made the decision, and when. Of 252 participants who had undergone a primary, or first, cesarean, only one reported that she had requested a cesarean with no medical reason. Other studies in the United States and abroad confirm those findings, Declercq says.
At the same time, he says, there is no evidence that the birth process is getting riskier or that there are more cases of fetal distress, breech births, or prolonged labor, which might account for the growing number of c-sections.
What has changed, says Declercq, is obstetrical practice. Cesareans have become safer as obstetricians have become more skilled in performing them and as anesthesiology has improved. On the other hand, as they do more c-sections, obstetricians may become less skilled at managing vaginal births. “If you have a provider who has never done a vaginal breech birth,” he says, “then of course you should have a cesarean if your baby is breech. So step by step, if you close off breech birth, then twin births, you start increasing the number of categories in which cesareans happen.”
Any efforts to reduce the number of c-sections performed in the United States will have to be led by women, says Declercq. In the 1960s and 1970s, women fought to bring their partners into the delivery room and for more pain-relief choices. “It’s a different set of issues now,” he says. “And the question is, will women get as involved in preventing unnecessary cesareans?”
