Did you know that the percentage of Cesarean Section births in the US is about 33%? And it's not because women are opting for them; it's because our capitalist medical system does not promote health.
Reasons for the High Cesarean Section Rate
The following interconnected factors appear to contribute to the high cesarean rate.
Low priority of enhancing women's own abilities to give birth
Care that supports physiologic labor, such as providing the midwifery model of care, doula care providing continuous support during labor, and using hands-to-belly movements to turn a breech (buttocks- or feet-first) baby to a head-first position, reduces the likelihood of a cesarean section. Quite a few cesareans are carried out because the fetus seems large, even though this estimate is often wrong and a cesarean has not been shown to offer benefits in this situation. The decision to switch to cesarean is often made during labor when caregivers could use watchful waiting, positioning and movement, comfort measures, oral nourishment and other approaches to facilitate comfort, rest, and labor progress. Providing more women with such care would lower the cesarean section rate.
Side effects of common labor interventions
Current research suggests that some labor interventions make a c-section more likely. For example, labor induction among first-time mothers and/or when the cervix is not soft and ready to open appears to increase the likelihood of cesarean birth. Continuous electronic fetal monitoring has been associated with greater likelihood of a cesarean. Having an epidural early in labor or without a high-dose boost of synthetic oxytocin ("Pitocin") seems to increase the likelihood of a c-section, and epidural analgesia appears to increase the likelihood of cesareans performed in response to "fetal distress."
Refusal to offer the informed choice of vaginal birth
Many health professionals and/or hospitals are unwilling to offer the informed choice of vaginal birth to women in certain circumstances. The Listening to Mothers survey found that many women with a previous cesarean would have liked the option of a vaginal birth after cesarean (VBAC) but did not have it because health professionals and/or hospitals were unwilling (Declercq et al. 2013). More than nine out of ten women with a previous cesarean section are having repeat cesareans in the United States. Similarly, few women with a fetus in a breech position have the option to plan a vaginal birth, and twins are increasingly born via planned cesarean section.
Casual attitudes about surgery and variation in professional practice style
Our society is more tolerant than ever of surgical procedures, even when not medically needed. This is reflected in the comfort level that many health professionals, insurance plans, hospital administrators and women themselves have with cesarean trends. Further, the cesarean rate varies quite a bit across states and areas of the country, hospitals, and maternity professionals. Most of this variation is due to "practice style" rather than differences in the needs and preferences of childbearing women (Baicker et al. 2006, Clark et al. 2007).
Limited awareness of harms that are more likely with cesarean section
Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. Short-term harms for mothers include increased risk of unintended surgical cuts, infection, blood clots, emergency hysterectomy, going back into the hospital, a challenging recovery, and death. Babies born by cesarean section are more likely to have breathing problems and to develop several chronic diseases: childhood-onset diabetes, allergies with cold-like symptoms, and asthma in childhood and beyond. Perhaps due to the common surgical side effect of scarring and "adhesion" formation, cesarean mothers are more likely to have ongoing pelvic pain and to have infertility in the future. Of special concern after cesarean are various serious conditions for mothers and babies that are more likely in future pregnancies. For mothers, these include ectopic pregnancy, placenta previa, placenta accreta, placental abruption, emergency hysterectomy, and uterine rupture. Babies in future pregnancies are more likely to need breathing help and have extended hospital stays. Preliminary research suggests that many other harms are more likely with cesarean section, and more studies are needed (Childbirth Connection 2012).
Incentives to practice in a manner that is efficient for providers
Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. Even when payment is similar for both, a planned cesarean section is an especially efficient way for professionals to organize their hospital work, office work and personal life. Average hospital payments are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit.