THURSDAY, Jan. 23, 2014 (HealthDay News) -- Efforts to curb
cesarean birth rates in the United States might be working, with
health officials reporting a 2 percent decline in the number of
first-time surgical deliveries between 2009 and 2012.
Cesarean delivery rates in 19 states reporting to the U.S.
Centers for Disease Control and Prevention averaged 21.9 percent in
2012, the CDC said in a report released Thursday. This represented
a return to the rate last recorded for those states in 2006.
Report co-author Michelle Osterman, a statistician at the CDC's
National Center for Health Statistics, said the turnaround was
significant. "The rates had been going up every year, but in 2009
they either stabilized or started to come down," she said.
The real impact might be felt in the overall cesarean rate,
"Because primary cesareans are starting to decline, the overall cesarean rate will be impacted because there is only a 10 percent chance that a woman who has had a cesarean is going to have a vaginal birth afterward," she said. The overall rate has stabilized at about 33 percent of all births in the United States, Osterman said.
One expert said the report indicates slight progress.
"At least the rate stopped going up," said Dr. Mitchell Maiman, chairman of obstetrics and gynecology at Staten Island University Hospital in New York City. "After decades of climbing, there seems to be a hold to it. But we could do a lot better."
The risks to the mother and baby are much higher in a cesarean
birth than in a vaginal birth, Maiman said.
"Once you have the first cesarean, you're overwhelmingly likely to have repeat cesareans," he said, noting the odds for complications and death rise dramatically with each additional C-section. "It's also worse for the baby as multiple studies have proven."
Risks to the mother include infection, excessive bleeding and
blood clots traveling to the legs or lungs. Risks to the baby
include injury during delivery, breathing problems and the
potential need for intensive care.
"Vaginal delivery is the preferred method for having a baby," Maiman said. "Cesarean should only be resorted to when it's absolutely necessary."
Maiman said the cesarean rate is so high because doctors fear
"The pressure is on physician practices because it takes so much time and energy to stay with a patient for hours for a vaginal delivery, compared to the quickness of a cesarean," he said. "Most of the lawsuits are for the failure to do a cesarean in a timely fashion."
In a separate reporting region, the researchers found that in 28
states and New York City, the first-time cesarean rate dropped from
22.1 percent in 2009 to 21.5 percent in 2012.
Declines were reported in 16 of those 29 areas, while the
remaining states' rates remained the same, according to the
Some areas reported dramatic declines. C-sections in Delaware,
North Dakota, Oregon, New York State and New York City decreased by
5 percent to 10 percent from 2009 to 2012. In Utah, the rate fell
by 15 percent.
Cesarean rates also varied depending on the stage of pregnancy.
Each week from 37 weeks' gestation and beyond saw declines in
C-sections, with the biggest drop at 38 weeks, when the baby is
nearly ready to be born. Full term is usually considered 40
The researchers said these findings cannot be generalized to the
entire country, because the reporting states aren't a random sample
of U.S. births.
Putting financial pressure on hospitals could reduce the
cesarean rate further, Maiman said. "If you introduce financial
incentives or disincentives to hospitals for overall cesarean
rates, then they will pass that on to the physicians," he said.
Changes regarding medical malpractice laws could also make a
major impact on the cesarean rate, he said.
For more information on cesarean delivery, visit the
U.S. National Library of Medicine.
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