C-Section Births At All-Time High
ROBERT SIEGEL, Host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MELISSA BLOCK, Host:
To talk about what's behind these numbers, we're joined by Dr. Caroline Signore. She's an obstetrician/gynecologist at the National Institute of Child Health and Human Development in Bethesda, Maryland. Welcome to the program.
D: Thank you.
BLOCK: Now, these numbers show the C-section rate is up for women of all maternal ages, all racial and ethnic groups, and also for infants across all gestational ages. What do you think explains it?
D: I think that there are probably a number of reasons, and no single factor. We are seeing more women becoming pregnant through the use of assisted reproductive technologies, which leads to multiple births. And multiple births are more often delivered by cesarean.
D: Another factor is, in fact, that older women are having children these days. And though the cesarean rates increased in all ages, we know that women who are at older age at the time of their pregnancies are also more likely to deliver by cesarean.
BLOCK: What about on the doctor side of things? Would fear of litigation be entering into this in any way?
D: It's impossible to ignore the fact that medical malpractice is a difficult issue for obstetricians. And it's reasonable to consider that for fear of litigation, obstetricians would be more likely to intervene if they were at all concerned, for any reason, about the progress of a pregnancy or a labor.
BLOCK: Although if you look at the risks associated with c-sections, I suppose that might work in the opposition direction.
D: There are certainly risks associated with cesarean delivery: higher risk of bleeding, higher risk of infection. And in particular, there are risks associated with having multiple cesarean deliveries over the reproductive lifespan. For example, when a woman has had three or more cesareans, she stands a much higher risk of having placental implantation abnormalities in subsequent pregnancies, which can lead to severe hemorrhage and even maternal death.
BLOCK: If you look back at c-section rates - going back, say, to 1965 - the rate then was 4.5 percent in the U.S. Thirty-two percent now, as we said. How does that rate compare with other countries?
D: Well, our cesarean rate does tend to be higher than many other Western countries; however, still remains lower than some countries. Brazil, for example, is known for extremely high cesarean delivery rates. And there's recent evidence from China that their cesarean delivery rates are quite high as well.
BLOCK: There's been, of course, a lot of debate about whether or not a high C-section rate is a bad thing. Where do you come down on that?
D: I think that the safest delivery for a woman is an uncomplicated vaginal delivery. And any time major abdominal surgery is entered into the picture, that increases maternal risk.
BLOCK: Where you surprised, Dr. Signore, when you saw this latest number - that nearly one-third of all births are performed by C-section?
D: It is curious that up to a third of women really require these deliveries. However, the trend has been progressing slowly through the most recent years, and preliminary data indicated that it was approaching this level.
BLOCK: And what would you expect the trend to show in the years that come?
D: You know, just given the past history, there is concern that the rate will continue to climb. I think that we in the obstetrical practice should aim to decrease primary cesarean delivery rates - the number of women who have a first cesarean - because certainly, they're at much higher risk for having multiple, repeat cesareans at this time.
BLOCK: Dr. Signore, thank you for talking with us.
D: Thank you very much for having me.
BLOCK: That's Dr. Caroline Signore. She's an obstetrician/gynecologist with the Pregnancy and Perinatology Branch at the National Institute of Child Health and Human Development.
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