With nearly one in three babies born by Cesarean … doctors and natural birth proponents are concerned that factors such as a woman’s preference to schedule birth on a particular day and a doctor’s fear of malpractice are, in part, driving the increase.

There’s worry, too, that fetal heart monitors, which often raise false alarms about the condition of a baby, or drugs used to induce labor might be leading to unnecessary C-sections and subsequent problems, such as a rupture of the uterus, which can lead to a hysterectomy.

“The C-section rate is probably higher than it should be,” … “We have to figure out which ones are medically necessary.”

An initiative at 60 Michigan hospitals hopes to make a dent in at least first-time C-sections by encouraging natural delivery techniques. The hospitals also are encouraging women to postpone scheduled C-sections until the 39th week of a pregnancy, when a baby’s lungs are healthier, and use labor-inducing drugs less often.

Safety a big concern

After a lengthy, dangerous labor that eventually ended in an emergency C-section, Kelly Morphew of New Baltimore wanted to play it safe this time. She scheduled a Cesarean delivery for her second baby.

Her daughter, Madison, was among 16 babies born Feb. 8 at the [hospital] … Four others also were C-section deliveries …

While safety was her biggest concern, Morphew was happy to get a Tuesday afternoon appointment that allowed her to get to the hospital of her choice and arrange a baby-sitter for her 2- 1/2 -year-old daughter.

“For me, C-section was the best way to go,” … Everything was planned. Nothing was scary.”

“We agree the C-section rate is too high, but we can’t just look at the rate alone,” … “We have to look at why women are having C-sections.”

Besides a woman’s preference, other leading reasons include:

• Doctors’ fear of lawsuits. Obstetricians … are sued the most and pay some of the biggest insurance premiums, as much as $200,000 a year. Reluctant to have a labor go wrong, many doctors perform C-sections for more defensive reasons, rather than good medical ones …
• Policy changes at small- and medium-size hospitals against natural delivery of a baby after a prior C-section …
• Technology. Fetal heart monitors, which often can be wrong, pushing too many women along a path to C-section.
• Labor-inducing drugs restrict the baby’s movement, often leading to a C-section.
• Lack of good evidence about which women with possible medical issues like older age, gestational diabetes or high blood pressure
would benefit more from a C-section.
• Fewer training opportunities for doctors to learn how to deliver babies in difficult circumstances [such as] breech …

C-sections, like other surgeries, can have major risks, including infection in the mother, profuse bleeding requiring blood transfusion and, in rare cases, death. They also carry a small risk of uterine rupture, a serious complication that occurs when the uterus tears open, sometimes leading to hysterectomy.

With safety a major focus in medicine, a Michigan campaign at 60 hospitals hopes to reduce childbirth complications. The campaign is encouraging safe birthing practices; lowered use of labor-inducing drugs … and postponement of elective C-sections until the 39th week of pregnancy …