Birth and C-section rates

While working on a story about doulas , I looked up some statistics on Cesarean delivery rates. (According to doulas and their advocates, having a trained doula at birth can decrease the chances of having a C-section.)

Nationwide, the Cesarean delivery rate rose to more than 30 percent of all births in 2005, according to the Centers for Disease Control’s 2007 National Vital Statistics Report . That percentage set a new U.S. record and reflected a 4 percent increase from the 2004 figure. According to the CDC, the C-section rate fell sharply between 1989 and 1996 but has since risen by 46 percent. The 2007 report also noted that the rate of labor induction rose 5 percent in 2005 to 22.3 percent – a level that has more than doubled since 1990.

The increase in C-sections, however, is due to several factors.

Lori Schneider, director of women’s and children’s services at Kootenai Medical Center , passed along an article on this subject that was published last year in the New England Journal of Medicine.

“Critics decry the cesarean numbers and argue that obstetricians have been too quick to abandon possible vaginal deliveries for reasons related to profit or their own convenience,” wrote the authors, both obstetricians at Massachussetts General Hospital in Boston and professors of obstetrics, gynecology and reproductive biology at Harvard Medical School. “A more dispassionate analysis, however, reveals that the trend is widespread, crossing state and national boundaries, and suggests that multiple, convergent factors are responsible, including changes in patients and their pregnancies, in options and recommendations for delivery, and in patients’ and providers’ expectations and evaluation of risk.”

The article points out several changes in the last few years that have been associated with an increased risk of cesarean delivery:
• Mothers, generally, weigh more now than they did in previous decades;
• They’re also older (since 1990, births to women 35 to 39 years of age and 40 to 44 years of age have increased by 43 percent and 62 percent, respectively);
• The number of premature and low birth-weight babies also has increased, “in part as a function of the increasing number of multiple gestations, many of which have resulted, in turn, from the use of assisted reproductive technology” wrote the authors.

The focus of my story was the work of doulas, so I didn’t really get a chance to explore how this issue played out in our region.
Local journalist Rocky Wilson, however, wrote about this in detail in a 2006 Journal of Business story : “C-section deliveries on rise: Reasons include perceived lower risk to baby, desire to set own date, avoid pain.”

I realize that birth has become a rather politicized and touchy subject for some women. But I think it’s always worth talking about – especially as we learn from each other’s experiences. And regardless of how we give birth – whether at home or in the hospital, with a doctor or midwife, with drugs or without – having the support of other women including doulas can make a big difference.