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The Myths of the C-Section

October 7, 2011

The feminist community has been debating the pros and cons of Caesarean sections for a while now, but somehow the myths and misinformation surrounding the procedure have refused to go away. Given the continually rising rate of C-sections in the U.S., feminists need to wonder if this is yet another example of the medical establishment taking choice away from women.

New data shows that rates of c-sections have risen to unprecedented levels: HealthGrades, an independent source of physician information and hospital quality outcomes, released a new report in July stating that,

Between 2002 and 2009 the C-section, or Cesarean section, rate in the U.S. rose from 27 percent of all single births to 34 percent, an all-time high … The highest rate of C-section was found in Florida, (38.6 percent) and New Jersey (38.0 percent). The lowest rate was found in Utah (22.4 percent).

Miami-area hospitals are reporting rates of greater than 50 percent.

The World Health Organization recommends optimal C-section rates of 5 percent to 10 percent. In 1965, just 4.5 percent of U.S. births were C-sections. But as technological advances in electronic fetal monitoring and improved neonatal care have made C-sections safer, the numbers have risen dramatically. C-sections are often performed because of health concerns: the mother is hemorrhaging, the baby is not getting enough oxygen, or the pregnancy itself is threatening the mother’s or the child’s health. But many of the C-sections being performed today are not medically necessary; they are performed under pressure from doctors and as a result of a lack of information. Returning the choice of how to give birth to women may depend, at least partly, upon rebutting the myths of the C-section, both in terms of the risks they carry and the reasons they are commonly performed.

1) Vaginal Births Can Cause Health Problems. For a time, people believed that cerebral palsy was caused by traumatic vaginal births, so doctors began performing C-sections to keep themselves safe from law suits. As Dr. Robert Yelverton, a Tampa physician and board member of the Florida Obstetric and Gynecologic Society, told the St. Petersberg Times, “Obstetricians tend to opt for the method of childbirth most likely to withstand a legal challenge.” But according to the American College of Obstetricians and Gynecologists, the maternal mortality rate for C-sections is actually three to seven times greater than for vaginal deliveries. According to HealthGrades [PDF], other risks associated with C-sections include blood clots, increased risk of certain conditions in future pregnancies, and an increased risk of neonatal mortality. Childbirth Connection also reports that C-sections lead to less early contact with the baby, which the World Health Organization has shown leads to difficulty forming maternal/infant bonds and breastfeeding. In the absence of complications, C-sections are not the less risky option.

2) An Aging and Less Healthy Maternal Population Requires More C-sections. Older women with more medical conditions are having more children, and while age-related diseases like diabetes and hypertension can put women and their babies at risk, a recent Childbirth Connection survey found that,

Cesarean section rates are going up for all groups of birthing women, regardless of age, the number of babies they are having, the extent of health problems, their race/ethnicity, or other breakdowns.

Clearly something else is afoot.

3) Once a C-Section, Always a C-Section. Though most doctors insist that women who have had one C-section have them again for any additional births, Dr. Patrick Duff, a professor at the University of Florida’s Department of Obstetrics and Gynecology told the St. Petersberg Times that the risk of complications from a vaginal birth after a caesarean with a low transverse incision is less than 1 percent. Approximately 70 percent of women who have had a Ceasarean are candidates for a safe VBAC (vaginal birth after C-section.)

4) Doctors Make Money Off of C-Sections. Not anymore. As Dr. Aaron Elkin, a board-certified obstetrician and gynecologist, told The Florida Independent,

While C-sections require the cost of surgery, vaginal births rack up costs in the long monitoring process. The equipment and the presence of nurses for such a long period of time, Elkin explains, disproves the assertion the C-sections make more money for hospitals. While it may have been different in the past, he says it is no longer the case.

5) Women Want C-Sections. NPR recently ran a story claiming,

The increase wasn’t because of emergencies, says Jay Iams, a specialist in maternal fetal medicine at Ohio State University, but rather because women and doctors began scheduling deliveries for convenience — “convenience for the mother, for the family, for the physician,” says Iams. Sometimes, Iams says, it’s because patients say to themselves, ” ‘I want only my doctor to be there. I don’t want the person who’s on call.’ “

The New York Times reported similar anecdotal evidence last year. However, the Childbirth Connection Listening to Mothers survey found that,

Despite a lot of talk about “maternal request” cesareans, few women appear to be taking this step. Childbirth Connection’s national Listening to Mothers survey of women who gave birth in hospitals in 2005 was the first study to poll women about these decisions in the United States. When we asked mothers who had had a cesarean why they had it and who had initiated it, just one woman among nearly 1600 survey participants reported that she had had a planned first c-section with no medical reason at her own request. … In fact, one quarter of the Listening to Mothers survey participants who had cesareans reported that they had experienced pressure from a health professional to have a cesarean.

6) Scheduling an Early Birth is No Big Deal. Though full-term pregnancies are 40 weeks long, “elective” C-sections are usually planned for as early as the 37th week, often because a woman’s estimated due date can be off by as much as two weeks. However, babies born even one week early are at greater risk for learning disabilities, autism and deafness than those born later. Luckily, not all ob-gyns are taking this trend lying down. According to NPR, Jay Iams, a specialist in maternal fetal medicine at Ohio State University, and pediatrician Ed Donovan of Cincinnati Children’s Hospital, are spearheading an effort to reduce the number of deliveries scheduled before 39 weeks:

In addition to helping doctors … educate pregnant women, Iams and Donavan asked doctors at the 20 largest hospitals in the state to document a medical reason every time a woman was scheduled to deliver before 39 weeks. And much to their surprise, Iams says in under 15 months the rates of those deliveries dropped from 15 percent to under 5 percent. And more important, the number of babies admitted to neonatal intensive care also decreased.

Clearly, increasing doctors’ awareness of the tendency to do C-sections without good reason decreases the number of times they do so. Increasing women’s awareness of the facts will also better enable them to make the right choices for their births and to counter pressure from doctors to do otherwise. This certainly wouldn’t be the first time in history that women have gotten pressure to have a surgical procedure they don’t need. Unnecessary hysterectomies are also on the rise, and new anti-choice laws in Texas and Oklahoma require women seeking an abortion to have unnecessary ultrasounds. When a C-section is medically necessary, a mother should feel no qualms about scheduling one. But all women should be informed of all of their options and all of the risks.

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