Cesarean Rates Hit at an All-Time High

Yes, lives can be saved by cesarean sections and the majority of women will not be permanently harmed by this procedure. But, a national cesarean section rate of 24 percent, and climbing, cannot be justified. It is particularly alarming as we once again are told that "once a cesarean section, always a cesarean section." Even worse, women are being told that a cesarean section will save them from future problems with incontinence. Unfortunately, there are many examples of surgical procedures that have been promoted in the name of prevention and have fallen far short of their goal. Women have been told that they should have an episiotomy to prevent incontinence -- wrong; that radical breast removal can prevent cancer in those whose DNA suggests they are at high risk for breast cancer -- wrong; and that their children should all have tonsillectomies for improved health -- wrong! Similarly, the evidence being used to suggest that cesarean section can prevent incontinence is weak and cannot be generalized to all women.

While each woman and each pregnancy deserves careful evaluation as to the safest approach for delivery, a woman must not be denied the full information she needs to make a potentially life-threatening decision. A woman wants to trust that her health care professional is placing her welfare and that of her baby above fear of litigation, monetary gain and convenience. This recent rush to downplay the risks of surgical birth, in favor of promoting a surgical cure for a nonexistent problem paired with unproven promises for the future, is guaranteed to erode that trust.

These are confusing times, and perhaps some of the blame can be attributed to the ethos of contemporary America. Have we become a nation so obsessed with expediency and control that we are willing to relinquish our humanity to technology? Are we truly willing to sacrifice our health and future childbearing for the lure of "birth by appointment"? Are our demands for perfection OR compensation forcing unnecessary interventions?

Calling for a return to common sense, it is our recommendation that all obstetric providers acknowledge the scientifically proven fact that the majority of women are healthy and capable of delivering healthy babies with a minimum of intervention. Professional health care organizations must ensure that their members are qualified to differentiate between those women who need watchful waiting and those who need proactive interventions.

Most importantly, health care must be guided by evidence-based outcomes. Fear of litigation must not negate the evidence or unduly influence decisions made by health care professionals. Women need unbiased, individualized information, a safe environment in which to birth and supportive, ethical health care professionals. A cesarean should be the last resort, not merely an option based on convenience or defensive practice.

These are the words of Deanne Williams, Executive Director, and Mary Ann Shah, President of the American College of Nurse-Midwives, in response to the preliminary data just released from the National Center for Health Statistics, which show the 2001 cesarean section rate reached an all-time high of 24.4 percent and the number of women having a vaginal delivery after a previous C-section dropped to an all-time low of 16.4 percent.

Source: American College of Nurse-Midwives Press Release, January 2003

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