(Continued from "The Rise of Repeat C-Sections: PART 1)
In 2006, Sakala’s organization published a survey by researchers at Boston University that found that out of 1600 women who had recently given birth by C-section, only one had requested a planned C-section for no medical reason.
Another study by the same group found that the rate of C-sections is increasing among all women, regardless of age, number or babies they are having, or the extend of their health problems.
The organization’s website instead suggests a fundamental shift in the standard of care, “a change in practice standards that reflects an increasing willingness on the part of professionals to follow the cesarean path under all conditions.”
Dr. John Thorp, professor of obstetrics and gynecology and director of the Women’s Primary Healthcare Division at the University of North Carolina School of Medicine argues that there are other, more scientific reasons behind the growing trend.
“The delaying of childbearing by women to accomplish career goals and the epidemic of obesity are both independent and often highly correlated risk factors for abdominal delivery,” says Thorp.
Earlier this year, Thorp and his colleagues published an article in the New England Journal of Medicine on the effects of elective, repeat C-sections on the babies of these women. The study showed that in babies delivered before the full 40 weeks of gestation, but still “at term” (that is, after 37-weeks, when fetal lungs should be mature enough to function), major complications like bacterial blood infections, respiratory distress and death can still arise.
These findings are particularly significant given that a large percentage of all C-sections are elective and that the majority of all elective procedures are repeats. The results suggest that the answer to why the C-section rate is climbing lies somewhere in the fact that very few women re-attempt birth the old fashioned way on their second go-around.
Vaginal birth after Cesarean (or VBAC) is a procedure that only 10 percent of all eligible women attempt, according to the American Pregnancy Association. One reason for this is a very rare but significant risk involved in the procedure called uterine rupture. Because the uterine wall is slightly weaker along the incision line of a previous C-section, continued pressure from pushing can cause the wall to burst in this area. The results can be fatal for both mother and baby.
This risk, however, is only 0.2% to 1.5%, meaning that the vast majority of all women who attempt a VBAC will deliver successfully.
The other and probably more influential reason why more women are not attemping VBACs is that many U.S. health insurance companies do not cover the procedure. This has led to a tripling since 2004 in the number of U.S. hospitals that now ban the procedure, according to a survey last month from the International Cesarean Awareness Network.
Whatever the reason for the rising rate of C-sections in this country—be it the refusal to offer the choice of VBAC, casual provider attitudes towards surgery, possible financial incentives, fear of litigation, or decreased patient awareness of the harms associated with C-sections, everyone agrees that the rate itself is far too high.
“An easy dodge and common assertion is cesareans are so much safer than before,” says Sakala. “True, but when compared to a vaginal birth, an unnecessary cesarean poses many more risks.”
And Thorp agrees. “We need to increase public awareness that C-sections are not as safe for mothers and babies as vaginal deliveries and have important downstream consequences,” he says.
Thorp says that if no action is taken, the number of C-sections will likely continue to rise and that this can have negative effects on women who want to deliver vaginally in the future.
For Hamilton, the concern is already there.
“I would definitely love to try a VBAC with my next child, but if it’s going to turn out to be a C-section again, why even try?”