Ky. Voices: Doctors often push for risky births

OFTEn, C-Sections, labor inductions encouraged for their convenience

January 14, 2013 

  • At issue | Dec. 31 column by Dr. Elizabeth Case, "Caesarean section increasing, partly because some women want it"

In a recent column, Dr. Elizabeth Case of Lexington Women's Health at Central Baptist Hospital said the Caesarean rate is increasing "partly because some women want it."

Although Case is correct in that the C-section rate in the U.S. has reached an all-time high of 32 percent, her claim that women are to blame for this rise is false. In fact, only 0.4 percent of first-time C- sections are due to elective surgeries.

Then why do one in three women give birth by surgery?

Research shows the driving force behind our high C-section rate is the practice patterns of physicians, including routine labor induction and provider-imposed deadlines for labor.

An alarming 42 percent of first-time mothers have labor forced with medications, a procedure that doubles their risk of C-section. Furthermore, a substantial number of unplanned C-sections are done because physicians often mislabel women's labor as "failure to progress" — a diagnosis that research says is more accurately termed "failure to wait."

What happens in future pregnancies after birth by surgery?

It is a well-established fact that Caesareans increase the risk of short- and long-term complications for mothers and babies. These risks rise dramatically with each surgery. The National Institutes of Health says that giving birth vaginally after a prior C-section is safe, appropriate and carries less risk for the mother than a repeat C-section.

Most women (74 percent) who attempt a vaginal birth after Caesarean will be successful. However, more than half of women who want a vaginal birth are forced into repeat surgery because so few care providers and hospitals support this option. So, 92 percent of women who have a Caesarean will deliver subsequent babies by increasingly risky Caesareans.

How are we doing in Lexington?

The C-section rate at all three Lexington hospitals in 2011 was 34 percent to 35 percent. The rate of vaginal births after Caesarean ranges from 5 percent at Central Baptist Hospital to 8 percent at St. Joseph East to 17 percent at the University of Kentucky.

These rates are astonishingly low when we consider the 74 percent success rate that can happen when women are truly supported in giving birth vaginally after Caesarean.

So how can women in Lexington prevent a preventable C-section — and subsequent C-sections?

We can choose to say "no" to artificial labor induction when there is no true medical indication (suspected "big baby" or reaching 40 to 41 weeks are not valid medical reasons). We can remind our care providers our bodies are not on any deadlines and, unless there is a medical emergency, labor will begin and end on its own. We can choose providers and hospitals that actively support and encourage women to have VBACs.

Most importantly, childbearing women must educate themselves, understanding that we have the unequivocal human right to decide what is done to our bodies — and by extension, to our babies. With a one in three chance of giving birth by major surgery that might not be medically necessary, it's time we start really paying attention to our right to choose better and safer care.

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