Soaring C-Section Rate Troubles Doctors

FRIDAY, July 13 (HealthDay) -- Convenience has become a fixture in American society. As life grows more fast-paced, people look for more corners to cut and ways to save time.

But should the desire for convenience extend to one of the most fundamental natural functions -- the act of childbirth?

A growing number of mothers and physicians apparently think so. The rate of women who deliver their babies via Caesarean section stands at a record high in the United States, accounting for more than 29 percent of all births in 2004.

While the procedure is sometimes medically necessary for preserving the lives of mother and child, many health experts believe a desire for convenience has driven the Caesarean section rate to its current heights.

And, as the use of Caesarean section has grown, so have concerns that the desire for convenience is creating unnecessary health risks.

"Caesarean section is major abdominal surgery, and, as with all major abdominal surgery, it carries major risks," said Dr. Marsden Wagner, a former director of women's and children's health for the World Health Organization. "As you do more and more Caesareans, the chance you are making things better gets less and less."

U.S. health officials are trying to cut the Caesarean delivery rate in half, bringing it down to 15 percent by 2010.

That case runs counter to some fairly strong trends.

The use of Caesarean-section surgery has increased by 38 percent since 1997. About one of every five babies was delivered through C-section then; now, the rate is more than one of every four babies.

Patient preference is one reason why the rate of C-sections is growing. Rather than waiting in suspense for labor to begin, women can schedule to the hour when they will deliver their child.

"If the woman has been told it's just as safe as vaginal childbirth, there's that temptation to schedule it when grandma's going to be in town," Wagner said.

Caesarean section also saves time for harried obstetricians who find themselves stretched too thin, he added.

"A Caesarean takes 20 minutes. A birth takes 12 hours," Wagner said. "It's a godsend for an obstetrician to do a Caesarean."

However, a mounting body of evidence is showing that C-sections are less safe than normal vaginal childbirth.

As such, the increased use of Caesarean section runs counter to a basic rule of medicine, said Dr. John Zweifler, chief of the Family and Community Medicine Department at the University of California, San Francisco-Fresno.

That rule? First, do no harm.

"At a fundamental level, it's an intervention," Zweifler said. "We should only be intervening if we're sure we're providing additional service. We don't do operations unless we know there's a good reason for it."

In a C-section, the physician cuts into a woman's abdomen to remove the baby. Infection, increased blood loss and decreased bowel function are among the risks.

There are valid reasons for having a C-section, Zweifler said. They include: The baby is in breech -- or feet first -- position in the womb; twins in the womb aren't lined up head first; or there's evidence of fetal distress or maternal hemorrhaging.

International studies have found that the optimal Caesarean rate for a country is between 10 percent and 15 percent, Wagner said. "If the rate is below 10 percent, maternal mortality goes up," he said. "If it's over 15 percent, maternal mortality goes up."

The risk of death is also is dramatically higher for C-sections than natural births, Wagner added, even when one takes into account those times when the procedure is medically necessary.

"There's a doubled risk the woman will die even if it's an elective Caesarean she's requested with no medical emergency," Wagner said.

Studies also have shown that women are three times as likely to experience severe complications during a planned C-section compared with a planned vaginal birth and are highly likely to experience complications during subsequent births.

The risk does not end with the mother. Wagner said babies born through Caesarean section are more likely to suffer respiratory distress, because vaginal childbirth acts to squeeze liquid from the child's lungs.

"Without that squeezing, the air tries to go in but is blocked by the fluid that's still in the lungs," Warner said.

Zweifler added that he's concerned that the skyrocketing Caesarean section rate will have consequences down the line that cannot be predicted.

"Sometimes, we don't appreciate all the effects of our interventions until years later," Zweifler said. "You're getting into uncharted territories here."

To combat the C-section rate, doctors are urging women to become more aware of the risks associated with the procedure.

"I don't believe there's a woman who would agree to it if they felt they were putting themselves or their baby at risk," Wagner said.

Women who've already had a C-section birth are being asked to consider a VBAC, or vaginal birth after C-section, for their next pregnancy.

Studies show that not only is it possible to have a vaginal birth following a previous C-section, but that the risks are roughly the same, Zweifler said.

"There is no difference in outcomes," he said.

More information

To learn more, visit the International Cesarean Awareness Network.

SOURCES: Marsden Wagner, M.D., former director of women's and children's health for the World Health Organization; John Zweifler, M.D., M.P.H., chief of the Family and Community Medicine Department, University of California, San Francisco-Fresno