September 2, 2010

CNN Article: Ripple effect seen from rising C-sections in first-time moms

Please take a moment to watch this video and read the article about the alarming upward trend in C-sections for first time mothers.

Ripple effect seen from rising C-sections in first-time moms
One in three first-time moms are now delivering their babies by
Caesarean section, according to a new study.

This has a tremendous ripple effect because most of these moms are
likely to have repeat C-sections, says lead study author Dr. Jun
Zhang. “C-section in first-time mothers is increasing and VBAC
(vaginal birth after C-section) is decreasing.”

Zhang is a labor and delivery expert at the Eunice Kennedy Shriver
National Institute of Child Health and Human Development, which funded
the research. He says his study, published in the American Journal of
Obstetrics & Gynecology, also found that 44 percent of women who
attempted vaginal delivery were induced, and in this group the
C-section rate was twice as high as women who were not induced.

More research is needed to determine whether inducing a pregnancy
leads to complications, which then make a C-section necessary, Zhang

Zhang also says the study suggests that doctors may not be patient
enough. Researchers found that with first time moms attempting
natural delivery, the decision to deliver the baby by C-section was
made before the recommended three hours of “second stage of labor”
(when moms are pushing) or before the moms were at least 6 centimeters
dilated, both short of the recommended guidelines set by the American
College of Obstetricians and Gynecologists.

Zhang and his co-authors analyzed electronic medical records from more
than 200,000 births at 19 hospitals across the United States.

In March, the Centers for Disease Control and Prevention released data
that shows that 32 percent of babies in the United States are
delivered by C-section, which is the highest rate ever recorded and 53
percent higher than the rate in 1996. Some pregnancy complications
that could make a C-section more likely include the age of the mother,
the mother’s weight and twin or multiple pregnancies.

Zhang says scheduled repeat C-sections now contribute to almost a
third of all Caesarean deliveries. He says only one in six women even
attempted natural delivery after having a C-section in a previous
pregnancy. “Prelabor Caesarean delivery due to a previous uterine
scar (from previous C-section) was the most common reason for
Caesarean section,” the study said. According to an NIH panel of
experts on vaginal birth after Caesarean, the risk of uterine rupture
is a common reason for doctors to suggest a repeat C-section, even
though that risk is lower than 1 percent.

Carol Hogue, a maternal and fetal health expert at Emory University
in Atlanta, Georgia, was on the NIH panel. She strongly believes
that moms-to-be need to be better educated before they have their
baby. “C-section itself is not a benign thing,” says Hogue. While many
people may no longer view Caesareans as a major operation, she says
women need to remember that there are risks
for a mother because it is still major surgery, which can include
complications with anesthesia and scarring. ‘The process of labor
helps the baby survive,” Hogue adds.

Just last month, ACOG reaffirmed its guidelines that VBAC is a viable
option and urged physicians to counsel women who have had one or two
previous C-sections to consider delivering their baby naturally.

The study concludes that if fewer women were induced, if better
guidelines for the timing of Caesareans existed and if women were
better educated about their ability to deliver a baby after a surgical
birth, it could help lower the number of C-sections in this country.



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