Wednesday, December 05, 2007

2006 US Cesarean Rate

The CDC just released its preliminary birth data for 2006. For yet another year, the US cesarean rate has hit a record high at 31.1%. This is a 50% rise over the past decade, and almost a six-fold increase since 1970, when 5.5% of women gave birth via cesarean section.

A 31.1% cesarean rate translates into 1,326,725 surgeries. 1,326,725 women recovering from major abdominal surgery while taking care of a newborn baby.

Let's imagine for a moment that we had a radically different maternity care system that put the basic needs of laboring women first. Even if most women continued to give birth in hospitals, we could do things very differently. What if hospitals implemented changes similar to Michel Odent's maternity clinic in Pithiviers Hospital. These changes were inexpensive and low-tech, including:

  • soft, large mattresses--no delivery tables
  • large, deep birthing pools
  • birthing chairs
  • cozy and private rooms
  • extremely limited use of Pitocin (around 1%) and pain medications
  • low-profile midwives overseeing births and consulting obstetricians for complicated cases
  • mothers encouraged to labor and birth in whatever positions felt most comfortable to them.
  • emphasis on creating a private, warm, and safe environment for the mother to labor in

Odent's hospital was able to achieve a 6-7% cesarean rate while at the time having one of the lowest neonatal mortality rates in the world. Other hospitals were only able to achieve such low mortality rates via a very high cesarean rate. The Pithiviers clinic served an unselected population; in other words, it didn't weed out unhealthy or "high risk" women and send them to a larger facility. Read more about Odent's clinic in Birth Reborn (pictures below are from the book).

If our country had a 7% cesarean rate, we would only have 298,620 cesarean sections performed each year. More than a million women and babies would avoid major surgery with all of its physical and emotional costs.

A typical French delivery room
Pithivier's new birth rooms
Midwife and laboring woman
Upright, physiological birth
(Michel Odent is supporting the woman's weight
while the midwife waits for the baby to emerge)


  1. Any idea whether this is a "true" C/S rate, or if it's altered a la the California data as you posted before? (and apologies for the lack of accent on my "a")

  2. Michel Odent is a true pioneer.

    We know too much about the human physiological and emotional condition to go back to 'traditional' times. We must all rise above the idea that somehow 'how it was back then' was ideal -

    (of course the cesarean rate was low, which is good, but so many other tragedies faced mothers and babies)

    I fundamentally believe that we need to look forward to birth. That midwives need to let go of the term "traditional midwife" - what is "traditional" about having this incredible awareness about the human body, emotional state and baby's transition to life? What is "traditional" about having access to labwork, collaborative care with medical fields, etc?

    We are way beyond traditional. We need to grab this bull by the horns and ride it forward, bucking!

  3. and I have to add, I have no idea where that tangent came from. It wasn't really in response so much to your post. Guess I feel something more coming in my awareness. :)

  4. Go Pamela and I too feel very strongly that Michel should be named Man of the Year or century or something on some big list really soon if he hasnt already.

    Wonderful, wonderful stuff.

  5. It was the hospital's overall cesarean rate--included all moms, all levels of "risk" (although I don't think he uses that terminology).

  6. Oh sorry, thought you were asking about Michel Odent's. As far as I know, this is the "true" C/S rate nationwide for all births, not the way CA reports theirs.

  7. Hooray for Pam's tangent!!
    I always thought this is a wonderful time to be a birthing mother. We have a chance to go into labor with more confidence than ever before in history that we will come out alive. We can use this freedom from fear as an opportunity to marvel as the perfect physiology of our births unfold. Unhindered birth is revolutionary, not a regression to some pristine past. We are on the verge of a Golden Age for birth; it never has been better, and the potential is awesome (with the obvious necessary improvements).

  8. Yes, Judit, I agree! Thing is--why so much fear and anxiety about childbirth? From all of the historical research I've done into childbirth during my PhD years, we have far more fear about it now than women did a few hundred years ago. In general, of course. And women seem far more scared of the pain of childbirth today than they were when narcotics and anesthesia were not available.

  9. Oooh, nice. I wanna give birth there. :)

  10. my father-in-law is very frustrating. his belief is that all births should be in a hospital. and if we were to change things and have more home births, they'd turn into businesses that turn out babies like hospitals do. if that makes any sense. "because we all have to make money."

    he's useless to have a conversation with about such things because he has to be right. otherwise i'd mention there's a different MINDSET when it comes to home birthing.

  11. Judit, I'm not so sure about the historical lack of fear - I'm a medievalist, and women were not trekking to various saints' shrines praying for safe labour and delivery because they thought it would be a cakewalk. In fact, sources suggest that childbirth was a source of anxiety. Take St Margaret, the (virgin!) patron saint of childbirth; legend has it that she went into the belly of a dragon, and yet survived the experience. As a metaphor for childbirth, being devoured and spat out by a dragon isn't exactly the most positive of imagery.

    Anyway, I have to say that I have wondered (as a Brit) why so much of the birth debate in the US seems to be polarised between hospital and home. Why not revolutionise the hospital? Even if homebirth is one's first goal, there are enough high-risk women who need to deliver in the hospital; why not change the hospitals for them? It's a bit like the homeschooling debate; if your local schools are awful, consider changing them rather than just ditching them!

    The British system isn't perfect, but when I delivered in hospital two months ago, I got a big, dark room with a huge birthing pool at the centre of it, quiet music playing, and intermittent monitoring. There were monitors in the room, but they were all hidden behind a curtain; I didn't know they were there until I ran into trouble in the second stage and needed them. Ditto the consultant; I saw only midwives until things went awry. I don't honestly think that things would've gone differently if I'd been at home in a birthing pool; I'd just have been stuck with a forty-minute ambulance ride at the end of it.

  12. ps--I was the one who commented about the historical lack of fear--or rather, what seems like an unusually elevated level of fear today given the extremely high likelihood that all will go well.

  13. Tamsyn,
    respectfully, but saying "Change the schools!" doesnt do anything for the parents of a child who is about to turn 5. Saying "change the hospitals"! Doesnt do anything for a pregnant woman.

    Of course we are all for social change, but it is slow, and in the meantime, we are having our own ral live children with whome we have only one chance to give them the best birth, the best education, and yeah, for me, I already know that most of my ability to be very politically active will come when my little ones are grown.

    Your British hospital birth sounds groovy--but what does that do for us here in the States? What is the point of saying "I had this great hospital birth" -- how does that help anyone here? Although I was really glad to hear that Europe is much more enlightened in regards to maternity care, we already knew that.

    I will never subscribe to the idea that choosing homebirth and homeschool is "hurting" the big businesses. Because A) my body and my children are not up as pawns in their experiment and B) it isnt true. Revolution always starts by a small group of thoughful individuals who were willing to make personal change in order to hopefully someday create largescale change.

    IF enough people DID "give their money" to midwives instead of OB's, and homeschooling instead of public schooling, these big institutions would HAVE to look at what it was that was "taking business away from them" and then possibly begin to emulate and really look at what it is that consumers want.

    Money talks, and big business listens. Look at how the organic food industry has gone from this fringey hippie thing to WalMart in less than 15 years. Same with so many other things.

  14. I have really enjoyed this conversation, and I have to agree with Housefairy here.

    Joy, you were right on the money (pun intended) when you stated that as more people make choices outside of the mainstream, the mainstream will want to know why they are losing customers, and will eventually change to accomodate them. It is simply how supply and demand works in a capitalist economy.

    Now, the problem comes with the timing. It may take many years, and I'm not willing to become a casualty of that, or let my children be either.

    Michel Odent's hospital looks wonderful, and I sincerely hope we can get something like that in our hospitals soon. In the meantime, I will birth at home. Hey, I've got a nice, soft, BIG mattress, and a deep tub in the corner of the room, too! :)

  15. Tamryn!
    So you are a medievalist, and I am married to one! :)

    I actually said that we have less to fear than ever. I know women used to anticipate childbirth as a life-or-death ordeal. From this point of view, the availability of comparatively safe surgical interventions is truly liberating. I can only agree with Rixa that fear in the 21st century is disproportionate to the *actual* risks involving a normal, physiological birth. But why worry? Most American (Western?) women don't have to undergo unmanaged birth, so I'd say our abstract fear of physiological birth is irrelevant for the majority of actual mothers. Same with labor pain. Medicine conquered pain. Those who would otherwise be afraid of the pain have anesthesia, and no worries. Typical modern women are not afraid of typical modern births. They are afraid of out-of-hospital, unmanaged, especially unattended! "natural" birth though, like Rixa says.

  16. Oh, one more thing, Kelley: I wouldn't count on supply and demand, there is no free market in US maternity care. It's an oligopoly of the healthcare industry, the AMA/ACOG and the insurance industry. They lobby for licensing and other laws, and conspire to set barriers to enter the maternity care market. Why is malpractice insurance prohibitively expensive, why are home births rarely covered by health plans, why do so few midwives have hospital privileges, and why are they prosecuted as felons for practicing medicine without a license? It's not a simple matter of you and me taking our business elsewhere. It's big business and those guys make sure they won't have to compete on a level playing field.

  17. Unfortunately, Judit, you are right. I guess I'm just thinking idealistically because I just read "Born in the USA." I really like what Dr. Wagner proposes as changes to the American maternity world. Perhaps I'm getting a little ahead of myself. Hopefully we will see these changes made in the future.

  18. Oooh good for you I wanna read that too! So many books... I like that nice doctor with that Santa Claus face :)


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