Saturday, March 27, 2010

US Has Waaaaaay Too Many Caesarian Births

One in three births in the US is currently a caesarian section (C-section).   The World Health Organization suggests that the normal percentage of C-sections should be about half what we currently have, i.e. about 15%. (I should note that other countries have even higher rates. In Puerto Rico and China, nearly 50% of all births are by caesarian.) Here is an article from the New York Times about the US C-section rate and its implications:
US C-Section Rate Hits All Time High

Some C-sections are for primary deliveries (first birth), while others are C-sections following an earlier C-section. Fewer than 10% of women who have had a C-section in the US will go on to have a subsequent vaginal birth, or VBAC. VBAC, is considered risky, but so is a caesarian. The National Institute of Health recently held a conference devoted specifically to VBAC. You can read about the NIH conference here (with links to lots of data, reports, etc):
NIH VBAC Conference

The issues of primary caesarian and VBAC are separate, but of course related. They reflect an overall state of extremely poor maternal health care in the US. Amnesty International recently released a report with some shocking statistics about birth in the US:

"The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this, women in the USA have a higher risk of dying of pregnancy-related complications than those in 40 other countries. For example, the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. African-American women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years."

Here is a link to Amnesty International's report, along with suggestions for action you can take:
Amnesty Campaign for Maternal Health

Interestingly, although Native Americans generally lag behind other Americans in nearly every aspect of prosperity and health care, in terms of labor and delivery, their very lack of access to what is considered state-of-the-art medical care may be working in their favor. A recent NY Times article looked at births in Tuba City, Arizona, where most patients are Native Americans, and most births are attended by midwives. A number of factors contribute to the low C-section rate here (about 13.5%) and the high VBAC rate (about 32%). One is just patience; vaginal births take a lot longer, on average, than C-sections. Midwives don't mind waiting. Another is compensation: "Doctors and midwives here earn salaries and are not paid by the procedure, so they have no financial incentive to perform surgery." Native American cultural traditions also play a part. Make sure to check out the beautiful narrated slide show that accompanies this article:
Lessons at Tuba City Hospital, Run by Navajos, About Births

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