Lately I've noticed articles about childbirth popping up in mainstream news websites. What's surprising about these articles is not so much them covering birth per say, but they way they're doing it-- bringing attention to the ever-rising c-section rate (and that it might not necessarily be a good thing), treating home birth as a viable option and exploring the risks and benefits in a fairly unbiased manner.
This is exciting. It's nice to see someone like TIME asking the questions many of us feel like outsiders for trying to bring up. ; )
Too Many C-sections: Docs Re-Think Induced Labor (TIME)
High c-section rate may have something to do with impatience (LA Times)
Should American Women Learn to Give Birth at Home? (TIME) (BTW, I kind of hate that title. I feel it's misleading to what the article itself is about. But, the article is good, so am linking it regardless)
The thing is, it's not that hospitals, doctors, or nurses are evil, or that c-sections, inductions, or epidurals are bad (we've been very grateful for hospitals and good doctors and nurses when we've had to take D in for an illness, and been satisfied with the care we got). But a look at our ever-rising national c-section rate* (32.3% of all births as of 2008, up from 5.5% in 1970), and the fact that our infant and maternal mortality rates are among the highest of any developed nation (and in some cases are actually rising instead of falling) should be a wake-up call that something is not right with the way we currently handle birth.
Personally, I think all these numbers would look much better if we could find ways to provide all women with a safe and comfortable environment for giving birth (whether that's in a hospital, birthing center, or at home; with an epidural, other pain medication, or none; on dry land or in water; etc) and limit interventions to when they are truly medically necessary (as opposed to turning to them for convenience, or fear of litigation). But that's just me. ; )
* If you're curious, The Unnecesarean has compiled stats and numbers for the c-section rates of 16 different states within the US (broken down by hospitals within each state), along with comparisons of the rates of other countries around the world. The numbers are quite interesting.
I couldn't agree more with what you say. And it's really important you keep saying it.
ReplyDeleteI agree with your overall sentiment: when medical spending is through the roof but life expectancy rates aren't any higher, when women are choosing a highly medicalized birth but their babies aren't faring any better, then something is amiss.
ReplyDeleteBut I also want to point out that data indicates that a high c-section rate may not be entirely to blame. There are many countries out there with a higher cesarean rate than the US: Brazil,Italy, Ecuador are a few, and China is the heavy hitter of the group, with the world's highest cesarean rate at nearly half of all births.
http://blogs.babble.com/strollerderby/2010/01/12/worlds-highest-c-section-rate-is-where/
http://www.msnbc.msn.com/id/34826186/
But studies in China comparing their cesarean rates and their neonatal outcomes seem to indicate that infant trauma is lowered in China even as more cesareans are performed.
http://cesareandebate.blogspot.com/2010/01/chinas-cesarean-rate-high-but-birth.html
Perhaps the trends seen in the US (high infant/maternal mortality) are due to something else about the way we handle birth, something other than the cesarean rate. Or perhaps it is more a reflection of our overall health as Americans than a fault of our maternal care. After all, we are collectively possibly the least healthy nation in the world as far as obesity, type 2 diabetes, heart disease, etc...
That said, I agree with your entire last paragraph of this post, the one that begins "Personally, I think all these numbers would look much better if..." Amen to that.
Laura-- I agree. C-sections are not the sole cause. Both of the articles I linked to about our high infant and maternal mortality rate suggested that a huge reason why our rates are so high is all our low-income mothers who lack health care and thus get no prenatal care (I believe that, depending on the group, between 1 in 5 and 1 in 3 women didn't get prenatal care), which leads to worse outcomes.
ReplyDeleteBut, even on low-risk mothers a c-section carries a 2-4 times higher risk of death for the mother than vaginal birth (at least in the US). I hadn't heard about China having so many c-section with such good outcomes... Maybe we need to take a look at what they may do differently in their c-sections (prep, the surgery itself, aftercare) that's different from us, since there are so many studies done in the US and western world showing higher risks for complications and bad outcomes for both moms and babies after a c-section birth.
http://www.americanpregnancy.org/labornbirth/cesareanrisks.html
http://www.webmd.com/baby/tc/cesarean-section-risks-and-complications
I also wonder if part of this may be related to the number of births each woman has. In China, most women only give birth once, right? A single, first-time c-section is relatively simple. Where some of the more dangerous complications come in is with the pregnancies and births that follow that first c-section (more complicated surgery due to scar tissue, placenta previa/accreta/increta/percreta, uterine rupture, breathing problems and NICU stay for baby, etc).
Laura-- Ok, so I was reading over the blog post you linked to about China's c-section rates compared to infant outcomes and noticed it didn't say anything about mortality rates. So I looked it up... and their death rates are WAY higher than ours.
ReplyDeleteHere's a list of the WHO/UNICEF estimates of maternal mortality of different countries as of 2005. The US is listed as having 11 deaths per 100,000 births. China's rate is 45 per 100,000.
http://www.childinfo.org/maternal_mortality_countrydata.php
Here's a list of infant mortality rates by country (estimated foe 2010)-- the US has a rate of about 6.2 deaths per 1,000 births, China's rate is 20.5 per 1,000.
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
I also looked up the study that showed the decrease in birth trauma in China, and read this from the abstract (emphasis my own):
"There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre-study period... The instrumental delivery rate decreased during the study period. The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period"
It sounds like they were only looking at trauma directly related to "instrumental deliveries" (which they seem to be separate from c-sections). It then only makes sense that if the number of instrumental deliveries goes down, the trauma/complications FROM those kinds of deliveries would also go down. Maybe I'm confused, but it doesn't look like those studies even looked at complications from c-sections themselves...?
I don't blame c-sections alone for our problems in obstetric care. But, I do think they are a big part of the problem (and a big symptom of bigger overall problems in philosophy and quality of care).
This is slightly terrifying as my husband and I prepare to try for our first. It did make me think though, so much so that I went and looked up the hospital near us statistics. So much MORE to consider, but glad I know now rather than later!
ReplyDelete