Caesarean Sections on the Rise

W A S H I N G T O N, Aug. 29 -- Caesarean sections started dropping slowly inthe early 1990s after an outcry that American women undergo toomany — but now they’re on the rise again.

Most puzzling: Why C-sections are increasing in first-time moms,not just in women who previously had one. And where pregnant womenlive determines how likely they are to wind up on the operatingtable — C-sections are more common in the South than out West.

Now, with Caesareans inching back up to 22 percent of U.S.births, the nation’s leading obstetricians’ group is issuing newguidelines to reduce unnecessary C-sections and reserve the surgeryfor mothers and babies who truly need it.

There are many suspects in the C-section rise — state-by-statevariation particularly suggests doctors’ habits sometimes canovershadow medical need.

Are We Too Technical?

“Maybe we’ve become too technical,” says Dr. Jean Walker, anattending obstetrician at Chicago’s Rush-Presbyterian-St. Luke’sMedical Center, which is taking new steps to lower C-sections.“We’re going back to natural things like walking more often andbirthing balls and really encouraging natural descent of thefetus.”

To do that, Rush just began a nursing change — back to morecontinuous, hands-on care during early labor, especially forfirst-time moms whose labor takes longer, a big reason forC-sections. After all, studies show women who have continual carefrom nurses or midwives get fewer C-sections than when busy nursesjust pop by every so often to check how early labor is progressing.

Make no mistake: Caesareans can be a life- or health-saving procedure formany mothers and babies. Fetal distress, disorders that make laborrisky for the mother, a baby simply too big or wrongly positionedall are important reasons for C-sections — and hospitals thatspecialize in high-risk pregnancies will perform more.

But avoiding unnecessary C-sections also is important. Women’srisk of death, although still small, is three to seven times higherthan during vaginal delivery, says the American College ofObstetricians and Gynecologists. Not to mention increased pain,longer hospital stays and a higher risk of post-delivery infection.