Too Many C-Sections: Docs Rethink Induced Labor

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The rise in cesarean-section deliveries in recent years has been characterized by some as a key indication of the overmedicalization of childbirth. While the procedure undoubtedly saves lives and leads to better health outcomes for mothers and infants who face problems during pregnancy and labor, many experts say the procedure is being performed too often, and in many cases for nonmedical reasons, putting healthy women and babies at undue risk of complications of major surgery.

The rate of C-sections has reached more than 31% in the U.S., a historical high ...

The rate of caesareans is the same in Australia. Our Government is making moves to cut this rate.

The reasons for the increase are many and have been widely discussed: the rising rate of multiple births, more obesity in pregnant women, the older age of women giving birth. In fact, C-sections have become so common that many women may have an inflated sense of safety about them. "For the most part, moms and babies go through the process healthy and come out healthy, so maybe there's this sense that we're invincible," ...

But C-section carries all the attendant risks of major surgery; and data show that compared with vaginal birth, cesarean delivery increases the odds that a mother will end up back in the hospital after birth with complications ...

Now obstetrics experts are actively seeking ways to drive down the number of C-sections ... the ACOG issued new guidelines recommending that hospitals allow most mothers who desire vaginal birth after cesarean ... to attempt a trial of labor, including ... mothers who are carrying twins or have had two prior C-sections. Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits.

Another factor contributing to high C-section rates is the increase in induced labor, especially between 37 weeks and 38 weeks ... The use of labor induction in the U.S. has risen from less than 10% of deliveries to more than 22%, between 1990 and 2006 ... research suggests that induced labor results in C-sections more often than natural labor ... those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.

... previous studies had come to the same conclusion. In her study of ... mothers delivering before 41 weeks' gestation ... 44% of women had their labor induced.

... after 41 weeks' gestation, at which point it is standard policy to induce labor, it may lower the risk of medical complications for mother and baby — including the risk of stillbirth — and even decrease the likelihood of C-section delivery, but those same effects are not seen in women who induce labor before the 41-week mark.

... Among the women whose labor was induced in Ehrenthal's study, nearly 40% of cases were categorized as elective. In other words, there was no pressing medical indication for induction. Extrapolating from the study findings, Ehrenthal suggests reducing the use of elective labor induction could lower the national C-section rate by as much as 20%.

Several hospitals have already begun reducing medically unnecessary induction as a way to lower the rate of cesareans ...

... under the new policy the overall induction rate dropped 33% and the rate of elective inductions fell by roughly the same amount ... the total number of C-sections among first-time mothers who underwent elective induction dropped 60% ...

If a relatively simple policy shift based on medical evidence can successfully cut the rate of induced labor and C-sections at a single hospital, experts say similar changes applied broadly may help lower the rate of C-sections on a national level.

But as with the new guidelines regarding VBACs, decisions about labor induction and other issues surrounding childbirth must be shared by women. Patients should be informed and included in the decisionmaking process, Ehrenthal says. "Unlike the decision to do an emergency C-section where there's no time to talk, usually there is time to have a discussion about induction," she says.

Melissa Maimann, Essential Birth Consulting 0400 418 448