19 November 2004


Were you born by C-section or do you know anyone who was born this way?

A new study finds that, during the 1990s, there was a dramatic increase in Caesarean sections in the United States among women who faced NO real medical risks.

It's not clear why this is taking place, said the study, which appears in the Nov. 20 issue of the British Medical Journal.

In that decade, first-time C-sections in women at no increased risk increased by 67 percent, from 3.3 percent to 5.5 percent overall. The increase was gradual from 1991 to 1996, and then more rapid toward the end of the study period.

First-time mothers older than 34 were the most likely to have what the authors called a "no indicated risk" Caesarean, with almost one in five (19.5 percent) giving birth this way in 2001. More than 5 percent of mothers over 34 who had had previous vaginal births had "no indicated risk" Caesareans in 2001. And among mothers under 30 with no indicated risk, the first-time C-section rate grew by 58 percent, to 4.9 percent of all births in this age group.

In real numbers, the "no indicated risk" first-time Caesareans increased from 54,866 in 1996 to 80,028 in 2001.

[Forbes, Health]


Dr. Andrei Rebarber, an associate professor of obstetrics and gynecology and maternal-fetal medicine at New York University School of Medicine, gave a possible reason why:

"A lot of people want safe and effective maternity care, but they also want more control over care, and planning their birth is important. And what better way to plan it than to have a C-section?

"A lot of birth injury cases that have been magnified in the media have frightened people. We live in a culture of fear."

[Forbes, Health]

The "culture of fear" in the US is understandable, and might be associated with rising malpractice costs.

Here in the Philippines, where there's a scarcity of local data available, you will just have to take my word for it. Ob-Gynes here need not fear malpractice costs as the Medical Malpractice Bill is still hanging in Congress. But I think the same trend is happening here: there's also a rise in caesarean section rates among mothers giving birth.

There are two probable reasons I can think of. One of course, is to control maternity care as Dr. Rebarber said. It is more like, "playing it safe and sure." Second and silly as it may sound, is the Filipinos' probable desire to have it as some sort of "status symbol," and this makes the attending obstetrician happy as this ensures a safer delivery and promises a bigger professional fee.

Obstetrically speaking, these are the ONLY reasons why a C-section might be indicated:

Reasons related to the baby:

  • Developmental abnormalities of the fetus, such as hydrocephalus or spina bifida

  • Abnormal fetal heart rate pattern

  • Abnormal position of the baby within the uterus, such as crosswise (transverse) or buttocks-first (breech)

  • Multiple babies within the uterus (triplet and some twin pregnancies)

Reasons related to the mother:
  • Extreme maternal illness, such as heart disease, toxemia, pre-eclampsia or eclampsia

  • Active genital herpes infection

  • Maternal HIV infection

  • Previous surgery in the uterus, including myomectomy and previous C-sections

Problems with labor or delivery:
  • Prolonged or arrested labor

  • Very large baby (macrosomia)

  • Baby's head is too large to pass through mother's pelvis (cephalopelvic disproportion)

Problems with the placenta or unbilical cord:
  • Umbilical cord prolapse (the umbilical cord comes through the cervix)

  • Placenta attached in abnormal location (placenta previa) or prematurely separated from uterine wall (placenta abruptio)

[AllRefer, Health]

If you are an expectant mother, I advise you to read this informative article titled "How To Avoid an Unnessary Cesarean."

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