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Rise of unnecessary cesareans

MyHealthNewsDaily recently reported on the rising rate of cesareans, especially among first-time mothers.

“The most concerning problem is the high rate in first-time mothers,” said Dr. Jun Zhang, a medical researcher at the National Institutes of Health and co-author of a new report on cesarean delivery practices.

In his study, published in the American Journal of Obstetrics & Gynecology last month, Zhang looked at medical records of 228,668 women who had delivered babies in 19 hospitals across the country, to determine the factors involved in cesarean deliveries.

The study underscored a shift — one that has been in the making since the mid-twentieth century — in how hospitals approach the birth process. The shift is toward a more streamlined labor and delivery, and profoundly affects mothers-to-be.

In the case of rising C-sections, Zhang wrote in the report, this shift is not likely to reverse any time soon.

The study cites “failure to wait” as one medical practice impacting cesareans among first-time moms.

In Zhang’s study, however, he found that many patients weren’t given a sufficiently long time period to allow their labor to progress. In other words, doctors were calling it quits on waiting and opting for a C-section too soon — often before the patient’s cervix was dilated to 6 centimeters.

This was especially true in cases of induced labor, during which a woman is given the hormone oxytocin (also called by its brand name, Pitocin) to initiate labor: Almost half of the C-sections in these women occurred before they were 6 centimeters dilated, Zhang found.

Defensive medicine is also at work when it comes to VBAC.

Another factor contributing to the record-high cesarean rates is a drastic decline in vaginal births after cesarean (VBAC). Zhang found that 70 percent of women in his study who had previously undergone a cesarean delivery had C-sections with their subsequent pregnancies, without attempting vaginal delivery.

One reason for this is a fear of lawsuits. If a physician doesn’t perform a C-section, and something goes wrong with a patient who previously had a C-section, the law often does not protect the physician, said Dr. Daniel Roshan, an obstetrician and gynecologist (ob-gyn)  at New York University Langone Medical Center.

ICAN Education Director Krista Cornish Scott comments on ACOG’s revised VBAC guidelines:

“We’re hopeful that this statement will push hospitals to reverse their bans, but we haven’t seen significant change yet,” said Krista Cornish Scott, the education director of ICAN, who herself had two complication-free VBACs.

And again about the perils of the current medical model of birth and the need for change:

“It’s an intimidating system,” ICAN’s Scott said, “You almost need to bring a medical researcher and a lawyer with you to the hospital if you want to control how you give birth.”

“We’re fighting a cultural issue,” Scott said, that extends beyond C-sections.

She said, “We need to change the entire way we view birth and we have to be able to trust our caregivers. The alternative would be terrifying.”