C-section increase may heighten risks for both mother and child

Cesarean Awareness Month

C-section increase may heighten risks for both mother and child

By Dennis Thompson
HealthDay Reporter

(HealthDay News) -- The number of births by cesarean section has surged in recent years in the United States , and evidence is piling up that these surgical births are threatening the lives of both mother and child.

Doctors used C-sections in more than 30 percent of all births in the United States in 2005, according to the U.S. Centers for Disease Control and Prevention. C-section rates have undergone a decade-long steady increase since the mid-1990s, when they hovered at about 21 percent of all live births.

"You don't want too many C-sections, and you don't want too few, and we're in a situation now where experts agree we're doing too many to be good for the health of the mother and her baby," said Debra Bingham, executive director of the California Maternal Quality Care Collaborative. "We need the right dose of cesarean sections in this country."

April has been designated Cesarean Awareness Month, and medical experts concerned about the effects of the increase in C-sections are taking the opportunity to share their findings and fears with expectant couples.

The World Health Organization has put the ideal rate of cesarean sections at 10 percent to 15 percent of all live births in any one country, says Dr. Marsden Wagner, a former director of women's and children's health for the organization.

"If the C-section rate is under 10 percent, the number of women dying goes up, because some women who need it aren't getting it," Wagner said. "But if countries have rates over 15 percent, the death rates also go up, because then you're doing them when they're not necessary."

No one is absolutely certain why the C-section rate continues to increase in the United States . Some believe the answer hinges on data showing that more women who are not at risk of losing their unborn child are undergoing C-sections. That seems to indicate that either doctors are undertaking or mothers are requesting unnecessary C-sections, possibly because the surgery is more conveniently timed than natural delivery.

However, that explanation was put in doubt by a CDC study published in January that found that the rate of unnecessary C-sections was not the 60 percent first thought but rather was closer to 4 percent. The study was published in Obstetrics and Gynecology .

Bingham suspects that there are two main reasons for the increased use of C-section. Women who have had a C-section often are not allowed to pursue vaginal delivery of subsequent children, "which means more C-sections," she said. And she said that births are managed differently in hospitals today.

There are more induced labors, which increases the risk of complications, she said. "It could be related to the doctor's schedule, it could be related to the mother's schedule." Also, Bingham said, mothers are more likely to be kept at the hospital, in bed, during the early stages of labor. "We used to send women home who were in early labor and let them walk around," she said. "There wasn't any pressure to be kept in the hospital, which affects how labor progresses. Labor may go on and off for a few days. It's well described as a normal part of labor."

Whatever the reason, solid data now show that the high C-section rate has had an effect on the health of newborns overall.

A study released last spring by the CDC, the March of Dimes and the Albert Einstein College of Medicine found that the number of single-baby preterm births in the United States grew by about 60,000 from 1996 to 2004, with the vast majority of that increase -- 92 percent -- delivered by cesarean.

Babies born preterm, or before 37 weeks of gestation, face a higher risk of death and also tend to suffer a wide range of health problems.

"Respiratory distress syndrome is far, far more likely if you do a cesarean," Wagner said. "When the baby goes through the birth canal and out the vagina, it squeezes the baby -- squeezes the lungs and squeezes all of the fluid out of the lungs. When the baby's head comes out and takes a breath, air comes in and fills up the now-empty lungs."

But babies born by cesarean still have lungs full of fluid. "The baby takes a breath, and the air can't go in because of the fluid," Wagner explained.

Other health concerns for preterm babies include feeding problems, jaundice and delayed brain development.

The mother also faces risks during a cesarean delivery. "You don't do major abdominal surgery on anybody without risk that you're going to nick the aorta or there will be some sort of problem leading to massive hemorrhaging," Wagner said. "There's also a huge risk of infection."

And the risk posed by a C-section extends into the mother's next pregnancy. Bingham cited research that found that the placenta of women who've had an earlier C-section has problems adhering properly to the uterus because of the surgical scar.

A woman undergoing her first vaginal labor has a 1 in 300,000 chance of needing a hysterectomy because of hemorrhaging after birth, Bingham said, but a woman undergoing her first birth via cesarean has a 1 in 1,700 chance of needing a hysterectomy and will face a 1 in 1,300 chance with her next pregnancy. Women with two or more C-sections in their medical history face a 1 in 220 chance of needing a hysterectomy.

Bingham said she believes the best way to protect mother and child is to step back and let the process of labor occur on its own timetable, interceding only when necessary.

"Nature knows better when a baby is due than we do," she said. "With all our technology, it's better to rely on a mother's body."

On the Web

The Patient Education Institute of the U.S. National Library of Medicine has more on C-section at http://www.nlm.nih.gov/medlineplus/tutorials/csection/htm/index.htm.