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Doctors Look at Rising C-Section Rates

csectionmomAlmost one-third of all US births are by Cesarean section, the highest rate ever. Doctors are expressing concern about why this is happening, and some researchers are studying techniques that could help lower the rate of c-section births.

C-sections are one of those topics that can get people scrambling to their battle sections in seconds, so the balanced, well-researched tone of this excellent Detroit Free Press article is very welcome. Reporter Patricia Anstett lays out the reasons doctors believe C-section rates are climbing, including the fear of getting sued, fetal heart monitors which give bad data about a baby’s heart rate, labor-inducing drugs which can restrict a baby’s movement, and lack of good evidence about who might benefit more from a c-section (such as an older mother, or someone with high blood pressure or gestational diabetes).

Also, the article states, younger doctors rarely learn techniques to deliver a baby who’s in breech position. One doctor called such knowledge a lost art.

I think one of the bigger factors is the 2004 American College of Obstetricians and Gynecologists report which recommended that women not be allowed to try to give birth vaginally after a c-section unless their hospital had anesthesiologists and obstetricians available around the clock (not simply on-call). Most small and medium-size hospitals now forbid VBACs.

However, as this sidebar to the story says, a major NIH conference starting Monday is going to look again at the VBAC recommendations and is expected to issue new guidelines.

Dr. Ted Jones, interim chief of obstetrics and gynecology at Wayne State University, said the choice should be a product of a discussion between women and their doctors. “We wouldn’t want patients to feel they failed themselves or their child if they have to have a c-section. None of us particularly want the pendulum to swing the other way, so that women feel a c-section and a vaginal delivery are so essentially equivalent that women wouldn’t try a vaginal birth.”

Photo: Patricia Beck, Detroit Free Press

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