Cesareans Are Increasingly Being Questioned

14 Mar

In a video address to the Coalition for Improving Maternity Services (CIMS) Forum participants on March 1, Michael C. Lu, MD, MS, MPH, Director of the U.S. Maternal and Child Bureau, stated, “Cesarean has its place, but given the real risks associated with cesarean it should not be performed without clear maternal, fetal or obstetrical indication…Cesarean delivery increases the risk of placenta accreta which intern increases the risk of postpartum hemorrhage and cesarean hysterectomy.“

Michael C. Lu, MD, MS, MPH, Director U.S. Maternal and Child Health Bureau

Michael C. Lu, MD, MS, MPH, Director U.S. Maternal and Child Health Bureau

In an interview with Rebecca Dekker, Ph.D., RN, of evidencebasedbirth.com, Celeste G. Milton, MPH, BSN, of the Joint Commission expressed her concern about preventable cesareans,  “When medications are used to force labor, a first-time mom doubles her chance of having an unplanned C-section…A substantial number of unplanned C-sections are due to physicians mislabeling a woman’s labor as ‘failure to progress’- a term that research says is more aptly named ‘failure to wait.’“ The Joint Commission which accredits and certifies health care organizations wants hospitals to perform fewer early elective cesarean deliveries (before 39 weeks) and fewer cesareans on low-risk first-time mothers.

Milton stated that “physician and hospital practice patterns-not pregnant women’s conditions or their diagnoses- are the major reason for differences in C-section rates among hospitals.”  The Joint Commission has made it mandatory, as of January 2014, for hospitals with more than 1,100 births a year to publicly report on their elective cesarean rates and rates for low-risk first-time mothers.

In a recently published White Paper on cesarean section in the U.S. the California Maternal Quality Care Collaborative recently concluded:

Cesarean delivery has come to be regarded as the safer option, when in fact it has greater risks and complications than vaginal birth. Higher cesarean delivery rates have brought higher economic costs and greater health complications for mother and baby, with little demonstrable benefit for the large majority of cases. With the marked decline in vaginal births after cesarean, cesarean deliveries have become self-perpetuating; and every subsequent cesarean brings even higher risks…

Some women prefer cesarean birth, or view it as a positive experience. However, there is growing evidence that for the majority of women, having a cesarean (compared with giving birth vaginally) is associated with greater psychological distress and illness, including postpartum anxiety, depression, and post-traumatic stress disorder. Cesarean deliveries can have an adverse influence on maternal-infant contact at birth, women’s satisfaction with and feelings about the birth, their babies’ experiences, and their success with breastfeeding.

In its recent systematic review comparing harms of cesarean with vaginal birth, Childbirth Connection cautioned, “Overuse of cesarean delivery in low-risk women exposes more women and babies to potential harms of cesarean with minimal likelihood of benefit. Of particular consequence are downstream effects including childhood chronic illness and placental complications in any subsequent pregnancies. These include life-threatening complications that occur more frequently with accumulating surgeries.”

In Dr. Michael C. Lu’s video address he also emphasized that “…no woman should be subjected to unnecessary interventions and… every woman should be cared for in a system that respects her autonomy and upholds the principles of Empowerment, Do No Harm, and Responsibility (principles of the Mother-Friendly Childbirth Initiative) and be given the choice of mother-friendly maternity services…”

Caring for childbearing women according to the recommendations of the evidence-based Ten Steps of the Mother-Friendly Childbirth Initiative can effectively reduce exposure to unnecessary interventions that can lead to avoidable cesareans.





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