U.S., Southern California C-Section Rates Up

The United States' "ambitious, decade-long" campaign to reduce the number of caesarean sections has come to an "apparent end," as the number of women who undergo the procedure is "rising rapidly," the Los Angeles Times reports. While California does not compile official statewide data on c-section rates, the Times reviewed data from the state Healthcare Information Resource Center and found that c-section rates increased at 31 of 38 Southern California hospitals between the end of 1997 and June 1999. Some observers predict that within the next year or two, as many as 30% of all deliveries in the United States will be c-sections. One explanation for the rising rate is the "growing belief" among obstetricians that c-sections are "as safe as vaginal births," the Times reports. Dr. T. Murphy Goodwin, chief of maternal-fetal medicine at the University of Southern California's Keck School of Medicine, said, "There is a real question as to whether a c-section is a reasonable option, because a number of complications of vaginal delivery are eliminated if you [perform one]." In addition, delivery by c-section "can be more predictable and convenient" for women who "may be less tolerant of undergoing ... long, unpredictable and painful labors." Women giving birth today are also more likely to be older and more likely to deliver bigger babies -- two factors that can "increase the difficulties" of vaginal birth and lead doctors to perform c-sections. Vaginal births also are associated with "often overlooked" risks, such as urinary or fecal incontinence, sexual dysfunction or prolapse or a slipping of the uterus that could require a hysterectomy, Goodwin said. C-sections are on the rise in other areas of the world as well, and a growing number of women in Brazil and the United Kingdom are opting for the procedure.

Not all physicians and health officials are enthusiastic about c-sections, and most doctors do not support the procedure when patients do not demonstrate an "immediate medical need." Over the last decade, insurers and public health officials have launched a campaign to reduce the frequency of the procedure. Beginning in the late 1980s, physicians "encouraged" women who had delivered by c-section to deliver their next child by vaginal birth, a strategy touted as a way to cut both c-section rates and health care costs. But research has shown that a vaginal birth after caesarean (VBAC) carries some health risks for women; for example, 1% of women who attempt VBAC experience a ruptured uterus, a sometimes fatal complication. As a result, VBAC rates have fallen 17% since 1996. Some physicians, however, remain reluctant to endorse c-sections, saying that the procedure "mainly benefits obstetricians by limiting their exposure to malpractice lawsuits" and reducing the number of "middle-of-the-night deliveries." Dr. Robin Richman, a medical director for the Tufts Health Plan, said, "The No. 1 reason for the lawsuits against OB/GYNs is failure to perform a timely c-section. They feel the best way to protect themselves from a lawsuit is to go to a caesarean sooner rather than later." Other critics of c-sections say that supporters of the practice are describing vaginal delivery as "more dangerous than it really is" in order to "frighte[n]" women into undergoing the procedure (Roan, Los Angeles Times, 1/29).