On July 19th, 2011, HealthGrades Obstetrics and Gynecology in American Hospitals (an independent source of physician information and hospital quality outcomes) released a study that puts the US Cesarean rate at 34%. Hello people; that’s more than one in three!  Look around your childbirth class, or the waiting room at your midwife’s. Count heads and do the math.  Odds are pretty good it’s going to be you on that table surrounded by masked strangers with your arms pinned down.

In the words of Howard Beale in the film Network:

“We know things are bad; worse than bad, they’re Crazy!”

So what are we going to do about it? What are YOU going to do about it?

“All I know is that first, you’ve got to get mad.”

Recent studies reaffirm The World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good.  That means that 5% to 10% of the women having babies in this country actually benefit from cesareans; that the surgery improves the outcome for them and/or their baby. Cesareans can be lifesaving – not doubt about it, but only less than 10% of the time.

So stop here for a minute and stretch your brain with me.

If the optimal cesarean rate is 8% (just picking a number between 5% and 10%), and  the US rate is 34%, even my basic math skills can figure out that 26% of women giving birth (that’s about 1 in four)  will have Cesareans that DO NOT improve their or their baby’s outcome.

If cesareans over 15% do more harm than good, then 19% of the women that give birth in this country (that’s one in 5)  have Cesareans that DO MORE HARM THAN GOOD!

Are you still with me on this my little Mathematicians?   Great! Let’s extrapolate then!!!

In the US, we have more women having unnecessary and possibly harmful Cesareans than should be having cesareans at all. That means that if you have a cesarean in the US, you are more likely than not (55% likely) to be having a cesarean that will do MORE HARM THAN GOOD.

“So, I want you to get up now. I want all of you to get up out of your chairs. I want you to get up right now and go to the window, open it, and stick your head out and yell,

“I’m as mad as hell,
and I’m not going to take this anymore!”

Feel Better?  Not so much?

Well, how about actually doing something to prevent YOUR “unnessicesarean”…

Start by educating yourself.
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Choose your provider and your birthing facility carefully.
Ask them what their Cesarean rate is. Find out their philosophy on birth and what their normal routine delivery practices are. Don’t be afraid to change providers if you feel uncomfortable with some of the answers.  Just because someone has been the best GYN for you, doesn’t automatically mean they will be the best OB for you. The most luxurious or most modern facility is not necessarily the best. Talk to people you know who have given birth in your area.  Consider options you might not have thought about in depth before, like home or birth center birth.

Avoid excessive testing and monitoring.
Obviously some testing is beneficial, but the more testing and monitoring you have done, the more opportunity there is for a false cause of alarm.  Currently, even the best ultrasound fetal weight prediction methods can yield errors as high as ±15%.  And the American Pregnancy Association states the risk of a cesarean birth increases by up to one-third by using continuous fetal monitoring during labor. Steven Clark and Gary Hankins, two prominent obstetricians, concur.  “A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best,” they wrote in the American Journal of Obstetrics and Gynecology. “Electronic fetal heart rate monitoring has probably done more harm than good.”

Choose not to induce labor before 42 weeks.
A study published in the July 2010 issue of the Journal of Obstetrics & Gynecology found that among more than 7,800 women giving birth for the first time, those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.
According to the ACOG a post-term pregnancy is one that lasts 42 weeks or longer. There is no reason to assume a woman needs to be induced before then, and with additional testing it is often perfectly safe to continue to await the natural onset of labor beyond that.

Bring professional support.
A February 2011 Cochrane review found that a trained labor support specialist like a doula, has the strongest impact on your health and safety during labor and birth. Compared with women who have no support in labor, women who have support from a companion who is neither a member of the hospital staff nor a friend or family member are 28% less likely to have a cesarean section. In addition, a doula can help you earlier in your pregnancy by providing evidence based information as you make decisions that may impact your risk for cesarean.

VBAC
Don’t let a previous cesarean eliminate your opportunity to deliver vaginally.  VBAC (Vaginal Birth After Cesarean) is a viable option for most women. Overall rates of VBAC success average 74%, and even in women who are not considered good candidates, the chance of having a vaginal birth is almost always above 50%.  Even if your provider or birth location is not openly encouraging VBAC, you have the legal right to refuse any medical treatment, including cesarean surgery. VBAC “bans” exist only because they have not been challenged by patients. The doctrine of informed refusal is upheld by common law, case law, Constitutional law, federal law, state law, state mandated medical ethics and the ethical guidelines of the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). Any facility or care provider claiming that you must undergo a cesarean you wish to refuse is violating the governing principles of their respective institutions and professions, as well as the rule of law.

The only way we are going to bring down the C-section rate in this country is if we each take responsibility for ourselves and our births.  It’s up to you. What will YOUR cesarean rate be?   Own your responsibility, own your decisions, own your birth.

I don’t want to close this post without adding a reminder about choice – we are so lucky (actually luck has nothing to do with it – sweat blood and tears have more to do with it.) to have the right to choose for ourselves, our births and our babies.  Along with that right comes the responsibility to respect others’ choices for themselves, their bodies and their babies.  Some women choose Cesarean. That is their right. Whether they choose it for health reasons,  personal reasons, or scheduling reasons, it is their right.  Let’s not rush to judgement. Women may not want to share the reasons or the reasoning behind their choices. Some are personal – STDs, congenital abnormalities, injuries etc, and they have no responsibility to answer or explain their choices to the rest of us.  So the next time a women tells you she is planning a Cesarean delivery, don’t ask her why, or judge; just ask if there is anything you can do to help and be supportive of HER CHOICE.