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Understanding Rising Cesarean Birth Rates
More babies are being born by Cesarean section in the 2020’s than in the 1990’s. Detailed statistics describe the increase of Cesarean section from 1996 to 2021 from 20.7% to 32.1%. There are several reasons why this is happening:
Advancing Maternal Fetal Medicine High risk pregnancies are managed by improved technology and advancing maternal fetal medical care processes. Medically indicated Cesarean sections can help protect women and their babies.
Increased Demographic Risks Delayed pregnancies into late 30’s and 40’s bring higher risks for women and babies. Increasing prevalence of obesity in childbearing age women also increases the risks of cesarean sections.
Increased Use of Labor Inductions Women who have an induction of labor with their first delivery are at higher risk to deliver by unplanned cesarean birth than women laboring spontaneously. Some inductions are medically indicated by a maternal condition like hypertension or diabetes or a fetal condition. Women sometimes request an elective induction of labor for social or personal preference reasons.
A New Social Trend for Elective Cesarean Birth Women occasionally request elective Cesarean birth for social or personal preference reasons.
How is the Decision for Cesarean Section Made?
The decision for Cesarean Section is made jointly between you and your health care provider. Your health care provider is evaluating the health risks to you and your baby while providing your prenatal care. If your health risks are high your provider can refer you to a perinatologist for closer management of your pregnancy. Your health care provider continues to manage your care with the additional consultation of the perinatologist.
Indications for Cesarean section found during pregnancy
Indications during pregnancy may include:
Health conditions like hypertension that worsen during the pregnancy or active genital herpes near the time of delivery.
Cephalopelvic disproportion, a term for a condition where the baby is too large to be delivered through your pelvis or the internal diameter of your pelvis is too small to deliver your baby.
Previous Cesarean birth is an indication. Vaginal birth after a Cesarean (VBAC) can be considered with two or fewer previous Cesarean births and a low transverse uterine incision used in previous Cesarean births. Your health care provider can discuss the risks of uterine rupture with you if you are considering VBAC.
Placenta previa, a finding that the placenta extends over your cervix and blocks your baby’s delivery.
Breech or transverse lie, a finding that your baby is not in the safe head down position for labor and delivery. Your baby may be bottom-first, breech or sideways, transverse. Your health care provider may discuss with you the option of a version, a procedure where your provider manually helps your baby turn to a head down position.
Indications for Cesarean Section found during labor
Indications found during labor may include:
Prolonged labor or failed labor induction, a finding that your cervix stops thinning and opening or that your baby stops moving down the birth canal for an extended time.
Umbilical cord prolapse, a finding that the umbilical cord has moved ahead of your baby’s head. This is a risk until your baby’s head has descended into your pelvis.
Fetal intolerance of labor, a finding that your baby’s heart rate during and after contractions show that your baby can no longer tolerate labor.
Placental abruption, a finding of excessive bleeding indicating that your placenta has started to separate from your uterine wall to early in labor.
Risks and Benefits of Cesarean Section
The benefits of Cesarean birth are directly related to the medical indication for your surgery. Your healthcare provider will discuss individualized risk-benefits in your immediate situation.
There are some long-term public health implications of our rising Cesarean birth rates that are worth your attention. Increasing Cesarean birth rates are associated with an increasing frequency of noncommunicable diseases for babies including:
Asthma
Food allergies
Type 1 diabetes
Obesity
Long-term maternal risks in subsequent deliveries include:
Hemorrhage
Uterine rupture
Placenta previa
Placentia accreta, a condition that occurs when the placenta grows too deeply into the uterine tissue. This condition can necessitate hysterectomy if the placenta is too deeply imbedded.
Intrauterine adhesions, a condition that complicates further surgeries
Will your baby be born by Cesarean Section?
The answer is yes for one of three women who are pregnant today. That is why it is important for you to know how the decision for Cesarean is made and some of the long-term risks of our rising Cesarean birth rates.
Important discussions to have with your health care provider include:
Risks and benefits for Cesarean birth when indications are found during your prenatal care or during labor,
Possibility of VBAC if you have had a prior Cesarean birth,
Risks and benefits of an induction, especially if this is your first baby,
Possibility of a version procedure if your baby is breech or transverse lie.
References:
NVSS Vital Statistics Rapid Release, Report No. 21, July 2022, Michelle J.K. Osterman, MHS
NCHS Data Brief, No. 360, February 2020, Craig M. Hales, MD, Margaret D. Carroll, MSPH, Cheryl D. Fryar, MSPH, and Cynthia L. Ogden, PhD.
The Brink, Boston University, November 30, 2015, Lisa Chedekel
National Library of Medicine, 2017 March 21, Kristen H. Kjerulff, PhD, MA, Laura B. Attanasio, PhD, Joyce K. Edmonds, PhD, MPH, RN, Katy B. Kozhimannil, PhD, MPA, and John T. Repke, MD.
National Library of Medicine, 2004 March 2, CMAJ, JAMC, Mary E. Hannah.
NHS Inform, Public Health Scotland, 19 December 2023.
National Library of Medicine, Health Science Reports, v.6(5); 2023 May, Cornel M. Angolile, Baraka L. Max, Justice Mushemba, and Harold L. Mashaur.
ACOG, Expert View, Dr. Angela Glover.
Assessed and Endorsed by the MedReport Medical Review Board