MONDAY, Aug. 30 (HealthDay News) -- The rate of cesarean
delivery in the United States continues to rise and steps are
needed to reverse the trend, a new study finds.
From 1996 to 2007 the rate of cesarean delivery climbed by more
than 50 percent, and "one in three first-time mothers are now being
delivered by cesarean delivery," lead researcher Dr. Jun Zhang, of
the Eunice Kennedy Shriver National Institute of Child Health and
Human Development, said during a press conference Monday.
In addition, more women than ever before are having repeat
C-section deliveries and the rate of medically induced deliveries
"We found that 44 percent of women who attempt vaginal delivery have their labor induced," said Zhang, who is a senior investigator in the institute's Division of Epidemiology, Statistics and Prevention Research. "In this [induced] group the C-section rate is twice as high as women who have spontaneous labor."
He also noted that many cesarean deliveries were done at an
early stage of labor, before the women even had a chance to
The report is published in the Aug. 30 issue of the
American Journal of Obstetrics and Gynecology.
Like any surgery, C-section comes with risks, explained Dr.
Salih Yasin, an associate professor of obstetrics and gynecology at
the University of Miami Miller School of Medicine.
"First, cesarean section is not just having a baby; it is having a baby through major surgery. So there is a chance of bleeding, infections and longer healing and recovery," said Yasin, who was not involved in the new study. There are also the long-term effects of repeated cesareans on the uterus. "You end up having many more cases of cesarean-related hysterectomies and transfusion and maternal death," he said.
While these consequences make up only a small percent of cases,
"we are noticing an almost 10-times increase of those significant
complications," Yasin said. "We need to make sure we are doing this
surgery to the right patient for the reason -- the right timing for
the long-term health of the patient," he added.
In the new study, researchers working with the Consortium on
Safe Labor collected data on cesarean delivery throughout the
United States using data from almost 229,000 electronic medical
records from 19 hospitals.
They found that 30.5 percent of all deliveries were done by
cesarean section in 2007, including 31.2 percent of women having
their first child.
Among women who underwent C-section due to an abnormal or
difficult childbirth or labor (dystocia), half of the deliveries
were done before the cervix had opened less than 6 centimeters --
early in the labor process, Zhang said.
Among women who had a cesarean delivery
before going into labor, about 31 percent had a uterine scar
from an earlier pregnancy. A uterine scar can be caused by many
conditions that damage the uterus. In some cases, scar tissue can
prevent the uterus from fully dilating, thus resulting in a
However, almost 29 percent of women with a uterine scar did
manage to have a normal vaginal delivery, the researchers noted.
And in these cases, vaginal delivery was successful in about 6 out
of 10 cases.
There are many reasons that could help explain why the number of
cesarean deliveries is rising, the researchers said. These include
women delaying childbirth until they are approaching middle-age,
increasing obesity rates among pregnant women and the increase in
multiple births due to the use of fertility treatments.
Also, when a woman has already had one C-section, doctors are
likely to deliver her other children the same way. That's a
practice obstetrical experts have been trying to curb, however. In
July, the American College of Obstetricians and Gynecologists
issued new guidelines stressing that many women who've had a
C-section may be candidates for vaginal birth in future
Litigation concerns on the part of doctors may be driving the
trend towards C-sections, as well. Many obstetricians fear being
sued should something go wrong in a vaginal delivery, the
"To make a significant impact on the high cesarean delivery rate in the United States, the focus should be preventing unnecessary primary cesarean deliveries from several aspects," the researchers wrote.
First, there needs to be fewer induced deliveries, and
performing a C-section in cases of problem birth should
not be done before the start of labor -- especially in women
having their first child, the researchers said.
Vaginal delivery after an earlier cesarean should be encouraged,
if possible, and there needs to be an accepted standard among
physicians that indicates when a cesarean is needed, they
"Finally, increasing access to, and patient education on, trial of labor in women with a previous uterine scar and improving the [delivery] success rate are urgently needed," the researchers said.
Zhang noted that one limitation of the study is that the sample
the researchers used is not necessarily representative of the
United States as a whole, since much of the data came from teaching
hospitals, which tend to see more complicated pregnancies than
For his part, Yasin said he wasn't surprised by the
"That's the way things are," he said. "We are inducing labor more than we should. We are not being patient with or giving adequate time for women who are in labor. We are intervening before giving the patient every chance possible."
For more information on pregnancy, visit the
National Institutes of Health.
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