Our ‘Appalling’ Rate of C-Sections

This is not 'minor surgery.' Moms, be sure you're on board.

Ashley Wallis of Nashville, Tennessee, recently delivered her first child by Cesarean section. It wasn’t the birth experience she had been planning on.

“Six days past my due date, the ultrasound tech estimated my son’s weight at over 11 pounds. I was admitted two hours later to be induced. After 26 hours of labor that never successfully progressed, my baby’s heart rate dropped and my obstetrician ordered an emergency C-section.”

Her doctor and his practice partner both had urged her to have her labor induced more than a week before her due date, since her doctor was going on vacation; she refused. Even after waiting almost a week past her due date, she regrets the decision to go ahead with the induction at that point. She felt it left her with no option other than a C-section to deliver her baby safely.

“C-section is not a choice I would have considered if both our lives hadn’t been in jeopardy,” said Wallis. “This experience has been life-altering in many ways. It is not an experience I am willing to go through again.”

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More C-sections are performed than any other type of surgery. So when a group of doctors and researchers decide to gather statistics on the availability of surgical treatments around the world, it makes sense they first look at the data on C-sections.

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One such study, from Ariadne Labs and Stanford University School of Medicine, was published in the Journal of the American Medical Association on December 1, 2015. The study looked at C-sections performed in 2012 in member countries of the World Health Organization, or a total of 194 countries. The resulting data provides an interesting look into both the positive and negative sides of the use of C-sections, not only in the U.S. but around the world.

According to the study, the optimal rate of C-sections per 100 live births is about 19 percent. It is important to note that the study only compared C-section rates with childbirth mortality rates in these countries.

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So countries with C-section rates lower than 15 to 19 percent had an increased loss of life during childbirth. On the other side of the coin, countries whose C-section rate was higher than 19 percent did not see further improvement on their mortality rates. The U.S., showing a C-section rate of 32 percent in 2012, had a similar mortality rate to those countries that only had a 20 percent C-section rate.

Dr. Alex Haynes, of Ariadne Labs in Boston, Massachusetts, was one of the authors of the study. He said the study does not in any way address the variety of non-life-threatening complications that may result from a Caesarian section, such as infection of the wound, hernias, tears in the abdominal walls and other effects later in life.

“This study is not about whether there should be more C-sections or less C-sections,” Dr. Haynes told LifeZette. “It is about how health care systems can provide good outcomes to mothers and babies, or others, for that matter.”

Dr. Lanalee Sam, of Elite Obstetrics in Broward County, Florida, applauds the WHO for recognizing the need in many countries to improve access to the training, resources, personnel and facilities necessary to provide that optimal 19 percent rate. At the same time, as a surgeon herself, she has been appalled at the high rate of C-sections performed in U.S. hospitals, higher than 50 percent in some cases.

“It is not uncommon for the on-call physician in a public hospital to perform 10 to 12 C-sections in one shift,” said Dr. Sam. “I advocate that patients pick their physicians carefully and never dismiss C-sections as minor surgery. Moreover, I think the hospitals should be required to provide the C-section rates of the obstetricians delivering at their hospitals to help the public better select their providers with hard data and not hearsay.”

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Many different factors can enter into the decision to choose a C-section delivery.

Lynnea Aponte of Eugene, Oregon, also delivered her first child by C-section in 2015. The experience was far from the natural home-birth she had envisioned with her midwife. Still, she had very positive things to say about the hospital staff and how they handled the situation.

“I had an excellent team. I made every decision in my process and was fully empowered every step of the way,” said Aponte. “My care was excellent. If C-section wasn’t an option, one or both of us would not have survived. I’m sure of that.”

Aponte, like Wallis, was past her due date, having reached 43 weeks. She too wished she had taken a different approach in her induction. In the end, both women are thrilled to be mothers of healthy, beautiful babies in spite of unexpected birth scenarios and the much more difficult recovery they have experienced after their surgery.

C-sections performed by excellent surgeons with the right resources can save the lives of mothers and children that might otherwise be lost — but they are not without risk and can include many negative consequences for the mother.

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