C-section rates hit an all-time high
Just as fashion and health trends change, so do the options for delivering your baby. What is in vogue is often dictated by the type of births mothers want, which for the last 15 years or so has been more C-sections.
C-section (Caesarian section) deliveries have increased to a high of more than 30% in the United States. In 2013 there were 3.93 million births in the U.S .and, of those, 1.3 million (32.7%) were C-section deliveries, according to the World Health Organization (WHO).
Although medically there are many reasons for the increase in C-sections, one contributing factor was that women began to request them and became less invested in vaginal deliveries.
“In early 2000, it became fashionable and reasonable to have an elective C-section,” said William Agel, MD, an obstetrician at Cape Cod Hospital. “It was happening in other countries and there was a desire for it here.”
Although this trend contributed to the increase, one of the main reasons was the decrease in the number of VBACs (vaginal birth after C-section), Dr. Agel said. It was thought that VBACs were not as safe as having a repeat C-section and in 2000, the American College of Obstetricians and Gynecologists (ACOG) published stricter VBAC guidelines.
A domino effect occurred. Smaller hospitals stopped doing them and obstetricians started to pull away from the procedure as well, said Dr. Agel. The VBAC rate dropped from a high of 28% in 1996 to a low of 8.5% in 2006, according to ACOG.
Other medical reasons for doing C-sections include multiple gestations, delayed childbearing, failure to progress with labor, a compromised oxygen supply to the baby, changes in the baby’s heart rate, a mother’s complex health problems, or an infection such as genital herpes or HIV that could be passed on to the baby with a vaginal delivery.
Although diabetes, high blood pressure and other chronic illnesses contribute to an increased C-section rate, they are not an overwhelming cause, Dr. Agel said. And women who have chronic diseases can, with the right care, deliver healthy babies, he added.
In 2010, ACOG took another look at VBACs and developed new guidelines that included a trial of labor after a C-section (TOLAC) to give women the opportunity to proceed to a VBAC. It stated that 60-80% of candidates who meet the criteria of the guidelines will successfully deliver vaginally.
Preparation for childbirth includes knowing the delivery options, but no matter the type of delivery, moms need to live a healthy lifestyle to have the most successful birth possible, according to Dr. Agel. This includes eating a good diet and exercising, as well as avoiding smoking and alcohol.
Dr. Agel said he and his staff do everything they can to support and educate their patients to be informed and prepared for their experience. He strongly recommends that all pregnant women take the prenatal classes offered at Cape Cod Hospital.