Efforts to Reduce Unnecessary C-Sections

The REDUCE campaign of the American College of Nurse-Midwives and allies seeks to call attention to the rising C-section rate in America, and explains that its primary aim is "to compel the United States Congress to scrutinize this issue and examine the various factors underlying the rise in Cesareans in this country. Congress should be concerned about the direct and indirect costs associated with Cesarean section (one of the most frequently performed medical procedures in this country), the impact the increased rate of surgery having on publicly financed health care systems such as Medicaid, and the long-term health implications for mothers and babies."

The campaign's frequently asked questions document (PDF) further explains the issue, and provides the following info:

"1.2 million cesarean sections are done each year and cost $14.6 billion in 2003.1 Cesarean section is the number one most common hospital procedure performed in this country, according to the Agency for Healthcare Research and Quality."

“The cesarean delivery rate rose 6 percent in 2004 to 29.1 percent of all births, the highest rate ever reported in the United States. The rate has increased by over 40 percent since 1996. For 2003–04 the primary cesarean rate rose 8 percent, and the rate of vaginal birth after cesarean delivery (VBAC) dropped 13 percent. The primary rate has climbed 41 percent and the VBAC rate has fallen 67 percent since 1996, according to the National Center for Health Statistics."

"No research has been done to quantify the risk of elective (no medical indication) primary cesarean section compared to the risk of normal vaginal birth. Thus, providers must refrain from claiming that cesarean sections are as safe as or better than normal vaginal births."

Additional information is available on the REDUCE site, including risks of C-section, resources for local advocacy, and consumer-friendly information.

ACNM's partners in the REDUCE campaign include the American Association of Birth Centers, Citizens for Midwifery, the Coalition for Improving Maternity Services, the International Cesarean Awareness Network, and Lamaze International.

Childbirth Connection recently released preliminary results from a survey of over 1,000 US women who gave birth in 2005. Among the findings, as reported in this press release (PDF):

"Eight-one percent of mothers stated that before consenting to a cesarean section, it is necessary to know every possible complication, and 17% felt it necessary to know most complications."

"Close to half of survey participants (42% to 45%) were "not sure" about how to reply to four statements about complications of cesareans, and 21% to 33% responded incorrectly."
(It's not clear whether these results are only among the women who had c-sections, which would make a difference in the interpretation of the results.)

"Just 12% of women with a previous cesarean had a VBAC. Of the remaining women who had a repeat cesarean, 45% were interested in the option of VBAC, but more than half (56%) of them were denied this option, primarily because their caregiver (45%) or hospital (23%) was unwilling to do a VBAC."
(It's not clear how many of these women should legitimately have been denied VBAC, which makes a difference in what these results mean as well.)

The results of the survey are being interpreted as indicating that many women are not in fact choosing elective c-section, but may be persuaded to have them when there is insufficient evidence that they are needed and women may perhaps not be fully informed of the risk. More information on the survey is available here, and Kaiser network coverage is online here.

Additional Resources:
Cesarean Section - MedlinePlus
What You Need to Know About Cesarean Birth - March of Dimes Foundation
Vaginal Birth After C-Section - MayoClinic.com
Fastats A-Z: Obstetrical Procedures - National Center for Health Statistics
Cesarean Section: A Brief History - online exhibit from the National Library of Medicine

Thanks go to Tim Clarke Jr, who is certainly doing his job as Associate Director of Communications for the American College of Nurse-Midwives, for pointing me to the REDUCE information.

Technorati Tags: c-section; cesarean section; childbirth
MeSH Tags: Cesarean Section/statistics and numerical data; Cesarean Section, Repeat/statistics and numerical data; Vaginal Birth After Cesarean