Tori's Blog

The U.S. Cesarean Section Rate tops 32%

Thursday, April 29th, 2010

YouTube Preview ImageAs April is coming to a close I learned that this is national Cesarean Section Awareness month. I hadn’t heard of this so I did a little research on how this came about. This awareness month was created by a grass roots organization called  ICAN (International Cesarean Awareness Network).

They are an advocacy group that strives to provide information on cesarean statistics, as well as how to advocate for a VBAC (vaginal birth after cesarean).

Yes, yes, yes- we should be screaming that our C/section rate in the U.S.  is out of control. But it is not only in the U.S., it is worldwide. The increase is based on a couple of things. Not only is the increase in women having their first baby, but also is significantly increased in women who have had a prior C/section.

In the 1990’s – VBAC’s were highly encouraged. Insurance companies would not authorize payment of a c/section for many situations, prior to a trial of labor. And physicians solidly encouraged women to VBAC. In my experience, depending on the reasons for the first c/section, the successful VBAC rate was about 70% , at that time.

In the late 90’s, studies were released that showed that 1/200 women who attempted a VBAC, had a uterine rupture. This is a life-threatening situation for both mom and baby and it was at that time that standards began to shift. Although, still unlikely, the risk was great enough for many physicians to become more comfortable with scheduling repeat c/sections.

As time went on, insurance companies began paying for repeat c/sections and the push for VBAC’s decreased. Today, there are hospitals and physicians who refuse to do VBAC’s. This is primarily in less urban areas and the chief reason is lack of 24 hr. anesthesia coverage at the birth hospital.

The larger issue today is with scheduled cesarean sections with a first baby, for either  “quasi” medical reasons, or electively, for no medical reason. I work at a hospital that has a “first-baby” cesarean section rate of 17%, which is below the national average. But we can do better. And we cannot forget that a cesarean section is a vital, life-saving surgery that should be reserved for the times when it is medically indicated.

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