Caesarean deliveries have doubled since 1996 and now account for one-third of all births in the United States. A new study suggests that a big dose of patience on the part of women and their health care providers during delivery might help to lower the rate substantially.
The study, released Monday by the Eunice Kennedy Shriver National Institute of Child Health & Human Development, found C-section rates were twice as high after induction of labor compared with women undergoing spontaneous labor. Labor is often induced to speed up labor and delivery.
"Our study cannot directly say induction causes C-section, but it does provide some clue that either people may not be patient enough or something is going on that we're not really sure about," said the lead author, Dr. Jun Zhang.
The study showed, not surprisingly, that the major reason for undergoing a Caesarean was due to the woman having a previous C-section.
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Still, almost half of the Caesareans that took place after labor had started were due to "failure to progress," and the study suggests that doctors aren't acknowledging that labor takes time and doesn't follow a predictable pattern in women, especially first-time mothers. A high proportion of these C-sections were performed before the women's cervixes had dilated to 6 centimeters, which is still considered an early stage of labor, and among women who had been in active labor for only two or three hours.
"As long as the maternal and fetal health are doing well in labor, they can wait longer and perhaps decrease the Caesarean rate," said Dr. S. Katherine Laughon, a co-author of the study.
The study, on 230,000 deliveries at 19 hospitals across the United States, also found that women who tried to have vaginal births after Caesarean succeeded only 57 percent of the time. That number is lower than the estimated success rate of 60 percent to 80 percent found in other studies.
The study implies that the high C-section rate is not being driven by women who are "too posh to push." Researchers found that "truly elective" Caesarean delivery accounted for 9.6 percent of all scheduled C-section and 2.1 percent of Caesareans that occurred after labor had begun.
Doctors and women aren't giving labor enough time, but it's clear that labor patterns have changed from several generations ago because women today tend to be older, have a larger average body mass index and have bigger babies. Most experts say Caesarean rates of 30 percent or higher are unacceptable, but no one really knows what constitutes a reasonable rate based on medical criteria.
For C-section rates to fall, more first-time mothers need to deliver vaginally, Zhang said, and more patients should undergo a trial of labor for vaginal birth after Caesarian, as was recommended recently by the American College of Obstetricians and Gynecologists.
More information also is needed on why doctors are making decisions to induce labor and not allowing more time for a woman to labor naturally.
The study is published online in the American Journal of Obstetrics & Gynecology.