Why has the USA's cesarean section rate climbed so high?

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A government-sponsored study of 230,000 births between 2002 and 2007 found that the C-section delivery rate was 30.5%.

• Among women who ended up with an unplanned C-section, failure for labour to progress was cited in nearly half the cases. • Fetal distress or non-reassuring fetal testing was listed as a reason for more than a quarter of unplanned C-sections. • Nearly half of all planned C-sections were scheduled because the woman had had a previous C-section.

Regarding failure to progress, the accepted rate of progress is deemed to be 1cm/hour. First baby or fifth baby, this is the rate that your labour is expected to progress at. This is despite that fact that first time labours do take longer than second and subsequent labours. There is research to support 0.5cm/hour as an acceptable rate of progress but this is largely ignored. I wonder what the caesarean rate for FTP would be if 0.5cm/hour was used instead of 1cm/hour?

So what happens to the woman whose labour doesn’t progress at 1cm/hour? Well, in the first instance, her waters are broken. This is done with the aim of speeding the labour. Generally, a vaginal examination will be performed 2 hours afterwards and if the woman has not progressed another 2cm in this time, a syntocinon infusion is commenced. This is part of a package, however, and the package includes continuous monitoring. Continuous monitoring is needed because the syntocinon drip causes unnaturally stronger, longer and more frequent contractions that can stress the baby.

Which leads to the next cause of caesareans, according to the article: fetal distress or non-reassuring fetal status. This accounts for around 25% unplanned caesareans.

And finally, about 50% planned caesareans occur as a result of a previous caesarean.

Are you joining the dots yet? That initial diagnosis of “failure to progress” often leads to augmenting the labour. If the augmentation is not successful – or if the baby becomes distressed in the process – the woman is taken down the corridor for a caesarean. Having had that first caesarean, there’s a good chance all her subsequent babies will be born in this way.

What can be done to avid this? There are a few keys: - continuity of midwifery care from pregnancy right through to 6 weeks after your baby is born - planning to birth at home - Ensuring that you have good support in labour from a loved one.

Melissa Maimann, Essential Birth Consulting 0400 418 448