Although we in maternity care got “good” news last month when the CDC announced that the 2010 cesarean rate had declined ever so slightly from 32.9% in 2009 to 32.8% in 2010, there is no doubt that we still have a cesarean crisis in the U.S. (and in most other parts of the world). In a riveting article published in The Boston Globe Magazine on October 30th, Dr. Adam Wolfberg explored our sky-rocketing cesarean rate. I am haunted by this story that he told:
At a recent Las Vegas conference on obstetrical safety, some 125 members of the audience were asked to raise their hand to indicate their personal C-section rate. “Less than 15 percent?” the speaker asked. Two hands in the large auditorium were up. “Fifteen to 30 percent?” Half the hands were up. “More than 30 percent?” The rest. Then the speaker asked the room, “How many of you care?” No one raised a hand, and the room broke out in laughter.
No one cares? In the Boston Globe article, Dr. Goldberg makes a compelling argument about the pressures that an OB faces when he fears that a baby may not be coping well with labor. To cut or not to cut? Of course, everyone wants a safe and healthy birth for both baby and mom. Lawsuits and high malpractice rates are a fact of life for OB health care providers. But Dr. Goldberg also explored possible reasons for the differences in cesarean rates among Massachusetts hospitals. A hospital that has one of the lower cesarean rates in the states has OB “hospitalists” who are present and responsible only for delivering babies during their shifts. Consequently, they are not in a rush to get babies delivered so that they can get back to a waiting room full of patients or to other commitments. This hospital also attracts some health care providers who work hard to minimize unnecessary interventions such as elective induction, which is known to double the risk for cesarean delivery. More than half of the births at this hospital are done by nurse-midwives and family practice docs, both groups known for having lower cesarean rates (and lower intervention rates) than OBs. So, it is clear that we have some proven strategies to lower the cesarean rate.
But it is not going to happen if the majority of maternity health care providers in this country don’t care about the cesarean rate. Why should they care? Because we know that women who undergo cesarean surgery are four times more likely to die than women experiencing vaginal births. Because we know that serious complications increase for the mother in each subsequent pregnancy. Because we know that babies have more breathing problems and less success at breastfeeding when they are born by cesarean. Because we know that there is evidence that the risk of developing auto-immune diseases such as type I diabetes and asthma increases for babies born by cesarean.
As childbirth educators, we have a responsibility to equip our students with the knowledge and skills to help them avoid unnecessary cesareans. We also have a responsibility to work with other members of the health care team, especially OBs, to recognize that the cesarean rates in most of our hospitals are too high and to adopt strategies to reduce unnecessary cesareans. We do care and we need to do whatever we can to make sure that others do too.