labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, August 1, 2007

Rising C-Section Rates

The American College of Nurse Midwives (ACNM) brought to my attention an article on the rising cesarean rates in our country. Here is the link to the Childbirth Connection’s page on c-sections. Go read it then come back and finish this post. I’ll wait for you.

………..ok…… what stuck out for me was the myth of maternal requested c-section. I have to say I wouldn’t have called it a myth. With many famous women having such surgeries and hearing about this trend in the media I assumed that this was in fact part of why so many women now have surgical birth. If just 1 in 16,000 women surveyed by Childbirth Connection (I’m assuming via their Listening to Mothers II survey) requested and had a c-section for non-medical reasons, then why has this been portrayed as a major cause of the rising c-section rates?

I have two theories. As I’ve mentioned, celebrities are having c-sections just because they want them. One of the most notorious of them is Britney Spears. She had c-sections because she didn’t want to experience the pain of childbirth. (What a dope! Surgical pain for days, if not weeks, is a better alternative?) Then there is Too Posh To Push, aka Victoria Beckham, Kate Hudson, and Elizabeth Hurley to name just a few. I'm sure we'll be adding Nicole Ritchie to this list because, frankly, she'd need to eat in order to have enough strength for a vaginal birth. Because these famous women chose surgical birth the media hypes it as the “in thing”. Just like Botox.

My other theory is that it is being propagated by obstetricians. I’m certainly not saying that all obstetricians support or perform maternal requested c-sections but if there is an internal dialogue movement within their profession then word will get out. The American College of Obstetrics and Gynecology (ACOG) is a powerful organization, and if they place this on their agenda you can bet more obstetricians will open their practice to mom’s wanting surgical birth for non-medical reasons. This topic is quite popular among our residents and attendings right now, and it appears as though it’s a 50/50 split.

I am very worried about the climbing c-section rate. When I first began working in this field seven years ago 1 in 5 women had a c-section. Now it is 1 in 3. Firstly, I believe that we perform too many unnecessary surgeries created out of our own doing. As the Childbirth Connection article mentions, some labor interventions have been linked with higher c-sections rates. Secondly, I don’t think we are going to see a stabilization of this rate any time soon. More and more obstetricians are denying women the VBAC option and there is worsening litigious practice underlying medical decisions. Thirdly, I have a personal fear that I will be one of the three women giving birth by c-section. There are some obstetricians who would consider me a c-section waiting to happen….I’m obese, short, have PCOS (a nice set up for gestational diabetes), and will likely be advanced maternal age (35 and older) when I do have children.


Alias Mother said...

I also was interested in learning that the requested C-section rate is so low. I've certainly been led to believe that it was much more of a trend from the coverage it's been getting. My ranting feminist side can't help but wonder if the media has been engaging in their usual "Oh, those silly vain women! Look what they are doing now" tactic.

What also interests me in this is that doctors seem to be less willing to work with women in less-than-textbook birth situations. My mother gave birth to three children, all vaginally and without problem. She was an older mother. The first two babies were twins that were nearly three weeks overdue. The third child was breech. These days, she wouldn't even be given a choice but would be shunted right off to the OR.


Labor Nurse said...

Alias Mother, I recently had a discussion with a woman who was pregnant with her second child. She called the obstetrician who she was with during her first pregnancy. This doctor told her to go elsewhere because she was too high risk. She was 39, had chronic hypertension that was controlled, and overweight. Other than her age, nothing had changed since her first child. Her first childbirth was an uneventful vaginal birth. Interesting, huh?

Anonymous said...

Some days I think I'd rather have a nice tidy surgical scar than have to deal with the pain the episiotomy causes me... and the huge hemorrhoids that I got while pushing.

Awesome Mom said...

I am one of those forced into c-sections. If I had wanted to try for a VBAC with #2 I would have needed to go to a far away hospital and change OBs. I opted not to do it because I also had a feeling that he would be another large child like his older brother. It is frustrating though that I could not have at least tried with an OB that I was comfortable with and near my own home.

Anonymous said...

I had a vaginal delivery followed by a c-section for a much larger baby. We knew our family was complete but it would have been a hard decision to make to VBAC or not if more kids had been planned.

In the long run the c-section probably wasn't anymore painful than my vaginal delivery. I'm an L+D nurse and many of my collegues agree that have also had sections.

We have had elective primary sections in patients concerned about maintaining the integrity of their perineal floor. I work in a university town. In some countries, laboring is a sign of the working class. The elite have c-sections.

A c-section is not the end of the world.

Tonyia said...

I work in the OR of a small (37 bed) hospital within 40 minutes of several large metro hospitals. In 2006 our hospital had 429 births. We have only one group of three OB/GYNs, and seveal family practice docs doing deliveries. The OB/GYNs are in favor of offering primary C-births by maternal choice. In fact, one OB just had her firt baby by elective C-section. One of her arguments in favor was that she took care of so many women in their 40s with rectoceles/cystoceles from childbirth, and she didn't want to be one of them.

If this is occurring in our small hospital, I would have to argue that the elective C-birth rates will be climbing rapidly, soon.

I did L&D in another small hospital from 88 to 94, (yes, a whole lifetime ago, I know) and we were very proud of our low section rate. We also had very few labor epidurals. We spent alot of time working with our laboring moms. Today, I'm afraid that staffing levels lead many nurses to suggest a labor epidural as a way to quiet their pt - they just don't have the time they need to spend coaching their pts

Anonymous said...

Hmmm, your last sentence has me wondering. I'm 5'5", about 200#. I have PCOS and have been going through ART to try to get pregnant. IF next week's FET works, what do you recommend I do to make sure that any OB's thoughts on doing a c-section are governed by necessity, rather than convenience? Obviously if I NEEDED a c-section, I'd do it, but we've worked to hard at this that I'd like a real chance at a vaginal birth.

Labor Nurse said...

anonymous, I say do your homework. Research, research, research. This includes asking your OB their c/s rate, their philosophy of birth, and the reasons they do c/s. Keep in mind that the "suspected large baby" argument for c/s is not recommended UNLESS the ultrasound estimates a full term baby over 4500gm. And even then it can be off.

I would like to think I would be exercising regularly and watching what I eat (cuz I'm not doing this now) while pregnant to decrease my risk for gestational diabetes, and therefore decrease the chances for labor interventions that can ultimately lead to a c/s.

(: Amanda :) said...

Hello! I'm Amanda, a new student nurse very interested in L&D. Do you mind if I link to your blog?
(: Amanda :)

geena said...

This is a bit off-topic, but having gestational diabetes was the best thing that could have happened to me.

I had no idea (even as a nurse!) how to watch carbs and what was an appropriate amount to eat for meals/snacks until I went through the GD class. Ended up 10 lbs under my pre-pregnancy weight, too, by the time I came home from the hospital.

Not that I stayed that way :) But still - the knowledge I gained was helpful, and I had no complications from the GD itself.

RehabNurse said...

Yes, I think elective C-sections are a bit ridiculous, but I had no choice but a C for my delivery. Kid with cord around neck, left arm and 9lbs. 11oz. to boot. Head circumference really large, too.

He is healthy as a horse and I am so happy. I told my doc beforehand what happened to my mom (lost first baby --stillbirth--over 11 lbs. via vaginal delivery--she nearly died) I thank God every day he listened. I was able to go home with a live, little fella due to technology, when my mother did not.

If I have to be sectioned again, I'll do it. Yes, the side effects do suck. Can't imagine anyone doing it on purpose for time constraints, etc., more than once!

Julia said...

I was very disappointed by my C-section, but kiddo was breech and refused all efforts to turn him. I think I was a victim of nurses' pregnancy "luck!" Even in this crunchy part of the country, I don't think anyone would do a vaginal breech delivery, esp on a primip, and I know the research seems to show that it is safer to deliver by section the case of a breech. I did not enjoy the C-section, and could not imagine someone choosing major surgery just for convenience. Hopefully, I will have the VBAC option the next time around. I'm all for allowing women as much choice as possible for birthing their babies, but it does seem that the "choices" seem to get fewer and fewer for those of use who want to avoid sections.

Anonymous said...

I am at 35 weeks now, but a week ago my OB thought my baby could be transverse (and by that I mean the head was down, but next to the cervix not right on and the bottom under my right breast). I have a low anterior placenta and am a grand multipara, so I have a loose uterus and a baby trying to find a comfy spot with that big placenta in the way. She ordered a sonogram to see if baby needed to be turned and immediately spoke of a c-section, although the transverse lie was at a 29 week sonogram. I mentioned that I've had 5 babies, and my uterus has been well tested. I believe my pelvis can handle a breech. Her comment, "breech deliveries are frowned upon now." Last sonogram shows vertex baby, however, baby moves around a lot. If I'm breech, as long as it's a "good" kind, I almost want to go in complete so I can push that baby on is just frustrating that they won't even try anymore.