Increasing the number of vaginal births in the United States, both for first-time births and after a prior c-section, is “urgently needed” according to a study published this month in the American Journal of Obstetrics and Gynecology.
A government-funded study, led by Dr. Jun Zhang, for the National Institutes of Health Consortium on Safe Labor, examined labor and delivery data from 19 hospitals around the country, collecting statistics from over 228,000 medical records. Researchers found that not only is the overall c-section rate currently at 30.5 percent but that number is expected to rise.
From the Associated Press:
Overall, cesarean deliveries account for about a third of births in the U.S. While much attention has recently focused on women having repeat C-sections, researchers with the National Institutes of Health found that nearly one third of first-time moms delivered by cesarean.
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That is “somewhat surprising,” said Dr. Jun Zhang, lead author of a study that looked at nearly 230,000 deliveries in 19 hospitals around the country. “It has consequences for future pregnancies,” he added, since many doctors and hospitals follow a policy of “once a cesarean, always a cesarean.”
As US News & World Report notes, the study’s authors confirm the importance of increasing women’s access to Vaginal Birth After Cesareans (VBACs):
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 added.
A recent NIH Consensus Development Conference released a statement, earlier this year, encouraging hospitals to re-examine policies which make it more difficult for women to attempt a trial of labor after a previous c-section.
US News & World Report quotes Dr. Salih Yasin, an associate professor of obstetrics and gynecology at the University of Miami Miller School as saying that birthing via c-section is not “just having a baby. It’s having a baby via major surgery. So there is a chance of bleeding, infections and longer healing and recovery…You end up having many more cases of cesarean-related hysterectomies and transfusion and maternal death.”
The study also found that there must be a focus on increasing first-time vaginal births, preventing “unnecessary cesarean sections.” Among the reasons for skyrocketing c-section rates in the United States is a tendency towards “over-medicalizing” birth by initiating labor induction, before there may be reason to do so.
From US News:
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.
“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,” says Dr. Zhang.
The study found that 44 percent of women who attempt vaginal delivery have their labor induced.
What’s most troubling, notes Dr. Zhang, is that, “The upward trajectory seems likely to continue in the near future.”