Thursday, March 19, 2009

2007 C-Section Rate Hits Record High

The 2007 U.S. cesarean rate has hit yet another record high: 31.8% of all births. The CDC has just released the preliminary birth data for 2007 (PDF download). From the report:
The preliminary cesarean delivery rate rose 2 percent in 2007, to 31.8 percent of all births, marking the 11th consecutive year of increase and another record high for the United States. This rate has climbed by more than 50 percent over the last decade (20.7 percent in 1996). Increases between 2006 and 2007 in the percentage of births delivered by cesarean were reported for most age groups (data not shown), and for the three largest race and Hispanic origin groups: non-Hispanic white (32.0 percent in 2007), non-Hispanic black (33.8 percent) and Hispanic (30.4 percent). The rise in the total cesarean delivery rate in recent years has been shown to result from higher rates of both first and repeat cesareans.
What are you going to do about it?


  1. Frankly, I'm disgusted, and I'm excited to have a successful VBAC in July!

  2. I just gave birth in December. I had a "what if" conversation with my OB at an appointment a couple of weeks before my due date. I feel like she and I have a closer than normal relationship due to seeing her during years of infertility so she was pretty candid with me. She said she generally doesn't like to induce since the liklihood of a c-section is so great. She will only induce in the event that fluid is low and the placenta has aged or if there is an emergency that doesn't warrent an immediate c-section. She told me that I would be shocked to know the number of women she sees that request to be induced just to make things more convenient for them. The reasons vary from "Our insurance is changing so I need to have the baby before the new plan goes into effect" to "My husband likes to hunt and so he would like the baby to be born before hunting season!" Craziness!!! My OB is wise and always tells them that she will abide by the baby's schedule, not the parents. I just can't imagine choosing to have the baby yanked from you before the due date just so you don't have to change your plans!


  3. Anon: cherish that relationship with your OB.

    I attended a friend's birth in January (her husband's in the military, and in Germany right now); I watched her OB's attitude toward her patient go from 'best friend' to 'induction' - discarding 9 months of natural birth promises in an instant. Frightening.

    Even more ridiculous - the cursed belly-strap monitors (which they force you to wear if you're induced), to which mom was hooked-up before they brought in her pitocin drip, showed that she was having contractions every 7 minutes or so.

    *head shaking*

    It's difficult to spread the good word about natural birth when everyone around me is so staunchly convinced that 'at least everyone is okay' is justification for unnecessary iatrogenesis.

  4. Good point. Women are asking to be induced!!! Women are refusing to push and tell me, "Just give me a c-section."

    I don't actually have a problem with inducing women for a good reason. I also don't have a problem with inducing women with pitocin or cervidil. I do have a problem with Doc's rupturing membranes. Why? Because if you are being induced and it does not take, you can call it a day and take out the IV, go home rest and perhaps come back into the hospital in labor. The pitocin might kick your body into labor action. But if they rupture the membranes, you are stuck in the hospital until you have the baby and it is more uncomfortable. So women who were doing fine with labor might get their membranes ruptured and then whig out from the pain. Also it increases the possibility of infection.

  5. I don't think it's fair to blame women for their C-sections. I'm really sure that the vast majority of women, even the ill-informed, want to have a vaginal birth.

    Their sources of trusted information (OB's) are the ones unsupportive of the natural order of things in the extreme, with inductions left and right, and no information on the actual process of birth as something a woman DOES and can be EMPOWERED by . . .

    I'd like to see actual surveys and numbers before I'm willing to commit to the belief that "many" women ask for C-sections.

    Lack of information, and the illusion that it's safe might cause women to ask for inductions (sadly), but again, I'd love to see actual numbers.

  6. I agree that most women want to have a vaginal birth. However, I am seeing more and more clients who request cesarean sections and more and more clients who request induction for what I would call social reasons. Also, so many physicians practice differently from me, that even when I explain the risks of induction, I don't think most clients believe me. They all know that their friend was able to pick a date after 38 1/2 weeks and plan their childcare arrangements and their husband's time off and have the baby when they want. I do explain all the risks of induction and strongly encourage women to wait - but I'm finding more and more clients who are insistent, even to the point of threatening to just go to another doctor if I'm not willing to schedule an induction (and some have gone ahead and left me for another doc and good riddance) I recently had a client at her first prenatal visit at 9 weeks tell me if I wasn't willing to plan her induction date NOW, she'd just go elsewhere. So far she's coming back to me despite no date in the books, but sheesh.
    As a healthcare provider, I'm trying my to reduce the cesarean rate by avoiding induction, avoiding rupturing membranes (which is early labor often commits folks to a long difficult labor), using intermittent monitoring, and especially by encouraging upright and freely mobile positions for my clients. It mostly works - until 2009 by cesarean rate including repeats has been consistently around 11%. 2009 so far has been awful - 31%, the highest shortterm rate I've ever had. 5/16. 1 failure to progress, 1 repeat who also had severe pre-eclampsia and severe IUGR, 1 transverse lie, 1 failure to descend with a big posterior stargazing baby, and 1 primary breech. The 2 primary cesareans during labor were not for lack of trying - both had well over 24 hours of labor, and every trick in the bag prior to their cesareans. The transverse lie failed an external version and has a uterine anomaly. The repeat may well have not needed her 2 previous cesareans, but this one was needed as this little IUGR baby needed to be born urgently and was having distress wihtout any labor. the primary breech - well, lot of obvious debate on that one!
    It's discouraging to me to see the cesarean rate rise and rise and to see the docs around me practice more and more defensively. Also, the way obstetrics is practiced in most places - you see a group of docs and get whoever is on call, who manages your labor from home or the office and just swoops in to catch the baby or do the surgery - this is not the way to encourage a lower operative rate. My pipe dream is that every woman would have care with the provider who will attend their birth, and the provider attends them throughout active labor. I am convinced that the entire reason my cesarean rate is low is because of those 2 factors.

  7. doctorJen, yep, they get pissed at we L&D nurses, too when they come in as LD checks and "we" send them home because they aren't in labor/ and we won't induce. There are some patients that I *dread* giving the news to, that they are going to go home & come back another day to have the baby, because I know they are going to be so nasty and angry about it.

    And yes, I have LOTS of labor patients who (albeit usually in the course of labor pains) say "can't I just have a c-sections??!?!?!?!"
    Just by guessing, I would say that at least 80+% of them are probably dead serious & would really go do it if we said "ok".

    I have a few patients who have educated themselves on birth, who have an idea about the induction/c- section issues, but they are fairly UNusual... the patients I mention above are extremely *common*, *average* patients on my unit. Most of my patients are induced, either because of a medical indication (preeclampsia, diabetes, oligo, etc.), or, commonly "elective" inductions on request (insistence?) of the patient.

    Anyway, doctorjen, I know what you're saying... and by the way, it sounds like you're doing great to me... wanna come work on my unit???

    PS... and pinky, amen about the membranes!!!!!!!!!!!!!!!!

  8. Lady Leslie,

    I have had 2 women in the last week tell me to "just section me" after they pushed for 30 minutes. As you can see the other health care providers concur with what I am saying.

    Many mainstream women are getting their birth information from a baby story. Folks are not going to childbirth class the way they used to. So there is a lot of misinformation out there. And folks want control over something they really have no control over.


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