Cesarean Rate Jumps to Record High; 1 in 3 Pregnant Women Face Surgical Delivery

For Immediate Release

Cesarean Rate Jumps to Record High; 1 in 3 Pregnant Women Face Surgical Delivery

More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery

Release Highlights:
•    Cesarean rate continues at record high in the U.S.
•    ICAN’s survey of U.S. hospitals reveals that roughly 50% either formally or informally prohibit VBAC in their facility, contributing greatly to the rising cesarean rate.
•    March of Dimes releases report that elective inductions and cesareans are responsible for rising late term premature birth rate.
•    CDC releases report that states increases in non-medically indicated cesareans are driven by obstetrical practice and not maternal demand.

Louisville, KY, March 20, 2009 – The National Center for Health Statistics has reported that the cesarean rate has hit an all-time high of 31.8 percent.

In the state of the Kentucky, the rate is 34.6%, the seventh highest in the nation.
(see http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf, page 19 for state specific data)

“Every pregnant woman in Kentucky should be alarmed by this rate,” said Erin Vest, co-leader of the Louisville chapter of the International Cesarean Awareness Network (ICAN). “Otherwise healthy women and babies are being put at unnecessary risk, given that at least half of all cesareans are avoidable.”

For the third year in a row, ICAN has compiled a list of research from the past year that shows cesarean surgery should be used more judiciously and that VBAC should be used more routinely.  (See attached) Currently, more than 800 hospitals across the U.S. ban women from having a VBAC, with over 600 hospitals having no doctors on staff who will attend a VBAC, essentially coercing women into unnecessary surgery and feeding the growing rate of avoidable cesareans.  In the Commonwealth of Kentucky, at least seven hospitals refuse women the choice of VBAC.

The risks women assume when a cesarean is performed continue to be illustrated by reports of  maternal death, including Takea Harris, a mother in New Hampshire who left a behind a son and Tina Hagenbuch, a mother in Michigan who left behind 2 daughters and a son.  All 4 children were released in good health from the hospital.

In June, the March of Dimes published a report showing that the continuing increase in late term premature births in the U.S. is primarily explained by the continuing increase in elective cesareans.  http://www.marchofdimes.com/printableArticles/22684_30185.asp.  These infants have a greater risk of breathing problems, feeding difficulties, temperature instability (hypothermia), jaundice, delayed brain development and death than babies born at term.

“Mothers with elective primary cesareans are more likely to experience longer stays, generate more costs and are 2.3 times more likely to be re-hospitalized in the first 30 days after birth.” says Eugene Declercq, Ph.D., Professor of Maternal and Child Health at Boston University School of Public Health.  “The likelihood of neonatal death is small but significantly higher in elective cesareans.”

Another report released in June by The CDC Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics reported that increases in primary cesareans in cases of “no indicated risk” have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in “maternal request.” Several studies note an increased risk for neonatal and maternal mortality for medically elective cesareans compared with vaginal births.  http://www.ncbi.nlm.nih.gov/pubmed/18456070

“All pregnant women are faced with important choices in their pregnancies.  It is critical for women to understand what their options are, and learn to spot the red flags that can lead to an unnecessary or avoidable cesarean,” said Vest.

ICAN’s collection of research highlights from 2008 demonstrates the inherent risks of cesarean including higher risks of hemorrhage, hysterectomy and other complications, a higher chance of suffering from potentially fatal placental problems in subsequent pregnancies, and babies having a higher chance of developing asthma later in childhood.  Research from 2008 also shows that VBAC continues to be a reasonably safe birthing choice for mothers.

“The choice between VBAC and elective repeat cesarean isn’t a choice between risk and no risk.  It’s a choice between which set of risks you want to take on,” said Vest.

For women planning a VBAC, ICAN has available a searchable database providing information on the VBAC policies of every hospital in the United States that provides maternity care and a feature allowing for feedback from consumers.  The database can be found at http://ican-online.org/vbac-ban-info

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican-online.org for more information.  In addition to more than 110 chapters nationally and abroad, the group hosts active on-line forums and a discussion group that serve as a resource for mothers.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved.  Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations.  Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. http://ican-online.org/pregnancy/home

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean.  There are over 110 ICAN Chapters across North America and abroad, which hold educational and support meetings for people interested in cesarean prevention and recovery.

For women who have experienced a cesarean, who are working towards a VBAC, or simply want to know how to prevent a first cesarean, ICAN of Louisville is available to provide resources and support.  For more information on how to get involved, contact Erin Vest or Nina Berry at info@icanoflouisville.com or visit www.icanoflouisville.com.

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For Immediate Release

Rising Cesarean Rate Bad for Mothers and Babies

Top 12 Studies from 2008

1.     Asthma at 8 years of age in children born by cesarean section. (Roduit, et at., Thorax. Epub, 3 December)
Study Design: Researchers assessed the relationship between childhood respiratory disease and cesarean section.

Bottom Line:  Children born by cesarean section to non-allergic parents have a 2.14 times higher risk of asthma than those born by vaginal delivery.

2.    Cesarean birth in the United States:  epidemiology, trends and outcomes. (MacDorman, et al., Clin Perinatol. 35(2):293-307, June)
Study Design: Researchers analyzed data describing cesarean births.

Bottom Line:  Both primary and repeat cesareans have increased. Increases in non-medically indicated primary cesareans have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in “maternal request.”

3.    Increased risk of stroke in patients who undergo cesarean section delivery: a nationwide population-based study. (Lin, et al., Am J Obstet Gynecol. 198(4):391.e1-7, 14 Feb)
Study Design: Researchers examined population data to determine if cesarean sections increase the risk of stroke.
Bottom Line:  At 3, 6, and 12 months after delivery, rates of stroke among the mothers were 67 percent, 61 percent, and 49 percent higher, respectively, following cesarean rather than vaginal birth. Cesarean section delivery is an independent risk factor for stroke.
4.    Safety and efficacy of external cephalic version for women with a previous cesarean delivery. (Sela, et al., Eur J Obstet Gynecol Reprod Biol, Epub, 17 November)
Study Design: Researchers evaluated the success and complications after external cephalic version for breech position in women with one previous cesarean.

Bottom Line: The success rate was 74%, and 84% of women with successful versions delivered vaginally. There were no negative outcomes for any of the women or babies. Women with a breech baby and a previous cesarean should be informed about the success and safety of this procedure.

5.    Perinatal outcomes in the setting of active phase arrest of labor. (Henry, et al., Obstet Gynecol. 112(5):1109-15, November)
Study Design: Researchers compared outcomes of cesarean delivery vs. vaginal delivery in women with stalled labor.

Bottom Line: Cesarean delivery was associated with an increased risk of chorioamnionitis, endomyometritis, postpartum hemorrhage , and severe postpartum hemorrhage. There were no differences in complications with babies. Among women who delivered vaginally, women with a stalled labor had significantly increased odds of chorioamnionitis and shoulder dystocia.  However, there were no differences in the serious problems associated with these outcomes.  Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the baby.

6.    Physician financial incentives and cesarean delivery:   New conclusions from the healthcare cost and utilization project. (Grant, J Heath Econ. Epub 2 October)
Study Design:   Researcher analyzed the relationship between physician fees and the number of cesareans performed.

Bottom Line:  Analysis indicates that an increase of $1000 in the reimbursement for a cesarean section increases the rate of cesarean delivery by about 1%.

7.    Can a prediction model for vaginal birth after cesarean also predict the probability fo morbidity related to a trial of labor? (Grobman, et al., Am J Obstet Gynecol Epub 24 2008)
Study Design:  Researchers determined whether predicting the likelihood of a VBAC was effective in predicting the likelihood of morbidity associated with a trial of labor.

Bottom Line:  If the chance of a successful VBAC is estimated at 70% or better, then the likelihood of complications in the mother is the same as with an elective repeat cesarean.  The results were the same for the likelihood of complications in the baby as well.

8.    Maternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis.  (Rossi, Am J Obstet Bynecol. 199(3):224-31, September)
Study Design:  Researchers reviewed maternal complications following trial of labor after cesarean section, compared with elective repeat cesarean delivery.

Bottom Line:  VBAC was successful 73% of the time. Maternal morbidity, blood transfusion, and hysterectomy were similar in women planning VBAC or repeat cesarean.  Maternal morbidity, uterine rupture/dehiscence, blood transfusion and hysterectomy were more common after a failed trial of labor than after a successful VBAC or repeat cesarean but outcomes were more favorable after a successful VBAC than repeat cesarean. These findings show that a higher risk of uterine rupture/dehiscence in women planning VBAC is counterbalanced by a reduction of maternal morbidity, uterine rupture/dehiscence and hysterectomy when VBAC is successful.

9.    Suspected macrosomia? Better not tell. (Sadeh-Mestechkin, et al., Arch Gynecol Obstet. 287(3):225-30, September)
Study Design:  Researchers reviewed records of women with suspected macrosomia compared to all women who gave birth during the same time frame.

Bottom Line:  Induction of labor and cesarean delivery rates in the macrosomic pregnancies (actual birth weight >4,000 g) of the study group were significantly higher than the macrosomic pregnancies in the comparison group.  No significant difference was seen in maternal or infant complications when comparing non-macrosomic pregnancies to macrosomic pregnancies in the suspected macrosomia group.  The ability to predict macrosomia is poor. The management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome.

10.    Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. (Rosen, Clin Perinatol. 35(3):519-29, September)
Study Design:  Author reviewed theories on abnormal placentation.

Bottom Line:  The rising cesarean rate has resulted in an increase in placenta accreta and cesarean scar pregnancy which are associated with high rates of maternal morbidity and mortality.   Improvements in management and future research to reduce the incidence of the potentially devastating complication are necessary.

11.    Vaginal birth after cesarean delivery.  (Landon, Clin Perinatol. 35(3):491-504, September)
Study Design:  Author reviewed incidence of and complications associated with VBAC.

Bottom Line:  By 2004, only 9.2% of women in the United States with prior cesareans underwent a trial of labor, although nearly two thirds of these women were candidates for a trial of labor.  Women with prior cesarean deliveries are at risk for maternal and perinatal complications, whether undergoing a trial of labor or choosing elective repeat cesarean section. Complications of both procedures should be discussed and an attempt made to individualize the risks of repeat cesarean and the likelihood of successful VBAC for each woman.

12.    Cesarean delivery may affect the early biodiversity of intestinal bacteria. (Biasucci, J Nutr. 138(9):1796S-1800S, September)
Study Design:  Researchers evaluated the relationship between the intestinal bacteria of the newborn and mode of delivery.

Bottom Line:  The intestines of newborns are colonized immediately after birth with bacteria, mainly from the mother.  There is strong evidence suggesting that the type of bacteria plays an important role in the development of the immune system. The intestinal bacteria of infants delivered by cesarean delivery appear to be less diverse than the bacteria of vaginally delivered infants.  The mode of delivery has a deep impact on the composition of the intestinal bacteria at the very beginning of human life.