World Health Organization Drops Recommendation To Cap C-Sections

AUTHOR’S NOTE: SINCE WRITING THIS I’VE LEARNED THAT THE ORIGINAL BBC REPORTING ON THE WHO STORY IS BASED ON FLAWED INFO.

The World Health Organization (WHO) has long recommended that the global cesarean rate be no higher than 10-15%. According to the BBC, their new position states that ”empirical evidence” is not sufficient to determine an “optimal percentage” for surgical births. The organization claims, “the optimum rate is unknown. What matters most is that all women who need Cesarean sections actually receive them.”

This is distressingly vague language: All WHO is really saying is that it’s hard to set a global “optimal” number. OK. Fair enough. (Maybe the optimal number is less than 10-15%?  It certainly could be for some populations.) But the interpretation of this statement is going to be far from neutral. Already a Fox News headline reads: “Pressure Off to Reduce Number of Cesarean Births.”

The WHO’s 10-15% cap was a strong tool for childbirth advocates fighting to lower the c-section rate and increase a woman’s chances of delivering vaginally. I completely agree that “all women who need” C-sections, get them.  And I wonder if this recommendation isn’t tied up with lack of emergency medical care in many parts of the developing world. In this country, I can’t imagine there is any woman not getting the c-section she needs. The national c-section rate is about 1 in 3 births. In some hospitals in New York, where I live, it’s closer to 1 in 2 births. Obesity has a big role in this, as recent studies have shown. But so does the over-use of induction of labor.

Taking “the pressure off to reduce” surgical births, means the pressure will be also be off to increase support for non-surgical births. In many parts of America, hospitals are not set up to accommodate unmedicated labor; tubs aren’t available, labor support is not provided, doctors tend to only be there for the pushing phase, nurses are neither trained nor available for assisting with massage, breath work, reassurance, gravity-friendly positions. This is not true for all regions, the Pacific Northwest has proven quite progressive on this front.

Women who are interested in trying for a “natural birth” are sometimes mocked for how wholeheartedly they embrace and work towards this goal. But from what I see going on around me in NYC, it does take some work to stake claim to this right. It might mean spending a lot of money on a doula, or making a big effort to learn all the kinds of drug-free coping strategies for labor.

The WHO change of policy comes via their Monitoring Emergency Obstetric Care handbook. I wonder what it says in their Supporting Normal Vaginal Birth handbook? Oh wait, there isn’t one.

Photo: Lars Plougmann/Flickr

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