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Are Mothers Driving Up the Cesarean Rate?

A report on Enterprisenews.com would have us all believe that the cesarean rate in the U.S. is being driven in some significant way by mothers demanding elective cesareans with hapless obstetricians following their orders.

 

But is this true?

 

While the Enterprise article cites the experiences of medical personnel in one Massachusetts city, researchers who have looked systematically at the (little) available scientific evidence say otherwise.

 

Eugene Declercq, principal investigator on the only nationally representative study to-date that directly surveyed mothers about their birth experiences, states that “far less than one-percent of mothers who had a first cesarean had requested it.”

 

Declercq goes on to say that “although there are undoubtedly some women who do seek elective caesareans, they are hardly enough to increase the number of caesareans by 400,000 nationally since 1996.” Such assertions about maternal request may make for sensational media coverage, but they hardly reflect the reality of cesarean sections in the U.S.

 

So, what is causing the rise in the c-section rate nationwide?

 

A number of factors are contributing to the rise, not the least of which is changes in obstetrical practice. Rather than simply following the wishes of their patients, it seems that how obstetricians practice medicine is a decisive factor. Says Declercq, the advent of group OB practices, concerns for malpractice suits, and the ease of scheduling cesareans all appear to be more significant factors in the rising cesarean rate than maternal choice.

 

The stakes in this trend are high. Overall, the risks of cesarean section are higher for mothers than vaginal birth. As ICAN’s statement on patient choice cesarean states,

 

“The International Cesarean Awareness Network opposes the use of cesarean section where there is no medical need. Birth is a normal, physiological process. Cesarean section is major abdominal surgery which exposes the mother to all the risks of major surgery, including a higher maternal mortality rate, infection, hemorrhage, complications of anesthesia, damage to internal organs, scar tissue, increased incidence of secondary infertility, longer recovery periods, increase in clinical postpartum depression, and complications in maternal-infant bonding and breastfeeding, as well as risks to the infant of respiratory distress, prematurity and injuries from the surgery.”