Unplanned, emergency, elective, planned - c-section rates are on the rise, and the reasons are not cut and dry. As of 2018, 31.7% of all births end in c-section in the USA. The WHO and other organizations say that the c-section rate should be closer to 10-15%. The ACOG has released guidelines to reduce the c-section rate in the USA. So what's the deal?
First, let's discuss the optimal c-section rate of 10-15%. Where did that number come from? The WHO has concluded, by analyzation of many research studies, that "at population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates." So in other words, more c-sections do not equal fewer deaths for moms/babies.
So why are there so many c-sections done that aren't beneficial for mom and baby? The answer is nuanced, complicated, and greatly depends on the location and culture.
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To be clear - this blog post is NOT to demonize hospitals, doctors, nurses or to say that if you got an "unnecessary" c-section, that somehow you made a mistake. In fact, I (Jessica), have had a c-section for a reason that many would deem as unnecessary (breech presentation). The reasons for c-sections are complicated, and to over-generalize would do a disservice to everyone. C-section birth IS birth and is just as special as any other way of birthing.
But, to say that having a c-section is a positive experience for everyone would also be untrue. For some women, having a c-section was traumatic. It was unwanted. So if there's something we can do to prevent unnecessary c-sections, shouldn't we all be for it?!
When deciding what to write for this post, I decided to take a different approach. Instead of listing all the reasons that c-sections could be medically unnecessary (and then get into the weeds of nuance, hospital culture, research, cultural expectations, etc), I decided to list all the reasons that c-sections are for sure, 100% medically necessary.
So here we go - below are most common medically necessary reasons to get a c-section:
Placenta Issues - such as placenta previa (when the placenta covers the cervix, making it impossible for baby to pass through) or placental abruption (when the placenta detaches from the uterine wall)
Cord prolapse - when the umbilical cord slips below baby's head and through the cervix. The cord could be compressed and baby deprived of oxygen.
Baby Position - this one can be complicated. A baby in the transverse position cannot be born vaginally. A baby in the breech position (with either feet or buttocks presenting first) can be delivered vaginally; however, vaginal breech delivery requires specialized training and carries with it risks. Many OBs today do not have this type of training. If you can find an OB or midwife with vaginal breech training, then this could be an option for you to explore. Babies in the posterior position can be born vaginally, but posterior babies usually require longer labors and the risk of complications (and c-section) is higher.
Birth Defects - a c-section may be a good choice if your baby has a genetic disorder that will require medical care directly after delivery.
Pre-eclampsia - sometimes mothers with severe pre-eclampsia need to deliver baby ASAP for their health.
Fetal distress - ahhh, this is a complicated one, folks. 23% of c-sections are due to "non-reassuring fetal tracing." However, the ACOG has sounded the alarm that many of these c-sections due to fetal distress could be avoided with the use of other interventions. However, if baby's heart rate is not improving after these interventions, a c-section is necessary.
Repeat C-section - this one is also complicated, and honestly, the vast majority of repeat c-sections could and should be VBACs. However, there are some situations where a repeat c-section would be wise.
Active Herpes Infection - a c-section is sometimes recommended for an active herpes infection to reduce the risk to the baby.
Multiple Gestation - depending on Baby A and Baby B's position, a c-section may be required for safe delivery.
Are these all of the reasons? No. Are some of these reasons complicated? Yes.
You may be wondering - if I'm in one of these more "complicated" situations, how will I know if getting a c-section is really the right decision for me?
Choosing a provider that aligns with your values and that you trust is SO IMPORTANT - because it's just impossible to be educated on all of the potential outcomes of birth. When creating our birth class, we wanted to educate our students completely about all of their options, all potential interventions - but quickly realized that in order to do so (and do it well) we'd need to teach for MANY hours (and basically get an advanced degree in the process).
You need someone on your team that can look at you and say "it's time for a c-section," and you trust and agree with them completely. It's worth the time and effort to interview OBs, consider midwifery care if available, and switch around providers.
I know this isn't possible for some of my readers, and if you're in that situation, then educating yourself on the most common interventions and how to prevent complications (that are preventable) is KEY. Our birth class will do just that for you. Check it out!
Information provided on this site is NOT medical advice. Please discuss all of your medical questions and care with a medical professional.