It seems to be a general rule of thumb that if someone doesn’t need surgery, you don’t give it to them. The exception to that rule, for modern doctors, appears to be the cesarean section. About 30% of babies in the United States are born by C-section, although a 5% to 10% rate is best for mothers and babies. The fact that cesarean section is serious surgery does not seem to concern doctors, who are often reluctant to perform vaginal births after cesarean sections (VBACs), or simply see a cesarean section as an uncomplicated alternative to natural labor. The procedure seems safer when it’s medical and preferably surgical, hence opposition to midwives and home birth.
However, the prevalence of birth by cesarean section, as well as rising obesity in pregnant mothers, seems to have very real consequences. According to the San Francisco Chronicle, “The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade.” This is the most significant spike in pregnancy-related deaths since the 1930s. The number of deaths is relatively small, but the rate is larger than that of Kuwait or Bosnia.
This problem may be occurring nationwide as well. Doctors have been asked to consider “morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors to deaths.” But the principal investigator for the taskforce, Dr. Elliott Main, says that demographic changes like obese mothers, older mothers and fertility treatments cannot fully account for this dramatic rise in the incidence of maternal death.
And, as Dr. Main observes, it’s hard to ignore the fact that the c-section rate has increased 50 percent over the past decade. Dr. David Lagrew, a doctor in Orange County, CA, noticed that in his hospital, “many women were having their labor induced before term without a medical reason. He knew that having an induction doubled the chances of a C-section. So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.”
This meant a dip in revenue for the hospital – a C-section typically brings in twice as much money as a vaginal birth. It is also the single most common surgical procedure in the U.S. But Lagrew’s limits on C-sections were clearly much better for the patients, indicating (once again) that this sometimes elective and often unnecessary surgery should not be a common procedure.
Photo courtesy of Erik Langner's Flickr photostream.