For many years, there has been criticism that the rates of cesarean births are too high because higher rates have not resulted in improvements in maternal or child health.
Many expectant moms feel strongly about having a natural vaginal birth, and want to do all they can to avoid a cesarean section. But for some, a C-section may seem like a good option for a range of reasons. And for others, a cesarean may be essential to protect the health — or life — of mom and baby.
In parts of the world where C-sections are not readily available, complications of vaginal birth often lead to serious consequences, including loss of life for mother and baby. In contrast, quick access to cesareans has its own problems. Over all, cesarean delivery is a very safe procedure. But it carries higher risks than vaginal delivery, including a three-fold higher rate of infection, hemorrhage, and organ damage. It also has a longer recovery period.
So how many cesareans we’re doing is a number worth paying attention to.
Finding the optimal C-section rate
As it turns out, there is a sweet spot — a certain “rate” of cesareans needed to prevent the terrible suffering and aftermath that can occur when a baby can’t move though the birth canal, or when there’s an emergency requiring immediate delivery.
Recently, a study from researchers at Harvard Medical School and the Stanford University School of Medicine found that the ideal rate of childbirth by C-section appears to be about 19% of all births. This number is higher than previous guidelines have recommended, but lower than the rate in most US hospitals — which can be as high as 70%.
How did the researchers come to this number? They looked at C-section rates from 194 countries and compared them to maternal and infant mortality rates. Their analysis suggests that babies and mothers don’t fare better when cesarean rates are above 19%. Cesarean rates below 19% were associated with more birth-related complications and poorer outcomes.
This research also suggests that some of the reasons commonly cited for high C-section rates — moms who are older or obese, or who’ve had multiple previous births, along with doctors’ fear of being sued — may be only a small part of the bigger picture. In particular, these examples don’t account for why some doctors and hospitals simply do more (or fewer) C-sections than others do.
Dr. Neel Shah is one of the co-authors of the study and an obstetrician in my department at Harvard-affiliated Beth Israel Deaconess Medical Center. Dr. Shah has uncovered some previously unrecognized factors that help explain the variation in C-section rates. For example, his research suggests that time pressures in some hospitals may lead to more C-sections, since in comparison, vaginal birth can take a great deal of time and staff resources. Providing the clinical team with access to better data and technology can help them make better decisions based on patient volume, staffing, and the overall resources needed to support safe care.
What this means for expectant parents
If you are a healthy woman and have a low-risk pregnancy, the hospital you plan to use may determine the likelihood you’ll have a C-section more than any other factor. So find out the C-section rate at the hospital where you plan to deliver your baby. Talk to your doctor about this as well. If you are early in your pregnancy, you might opt to choose your doctor based on where he or she practices.
Finally, it’s important to remember that there are times when a C-section is the only safe way to deliver a baby. When that happens, a woman may feel a sense of loss for the birth experience she had hoped to have. But doing your homework about quality of care can help assure you that your method of delivery was determined for the right reasons.