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Outcomes for increasing C-section rates

Massachusetts women rely on their doctors to determine when the time for a cesarean section has come during delivery. However, high C-section rates do not translate to better birth outcomes, and complications during the procedure may have long-term consequences for both mothers and infants.

Stat News reports that the rates of cesarean delivery are particularly high in the United States, where nearly one-third of all infants are born by C-section, a number that is significantly higher than the 19 percent rate considered optimal for positive birth outcomes. Tellingly, U.S. rates for infant and maternal mortality—six deaths per thousand live births and 14 deaths per 100,000 live births, respectively—are also high compared to those of other wealthy countries.

There are several possible drivers for America’s high C-section rates. For example, women in the United States are free to choose whether they wish to deliver vaginally or by cesarean section. Physicians also may order C-sections simply to defend against negligence lawsuits that could arise from bad outcomes after vaginal births.

Additional, there is limited research into certain factors indicative of the need for a C-section, such as how long the mother should try for vaginal birth before surgery becomes necessary and at what size the infant should be considered too large for vaginal delivery. Policies about when and why a C-section should occur vary among clinics and may rely on the obstetrician’s opinion. Similarly, little is known about how doctors should interpret readings from continuous fetal monitoring, and fluctuations in the readings could cause the physician to recommend a C-section, regardless of whether a problem actually exists.

WebMD notes that the majority of C-section patients recuperate without complications and that the procedure is generally considered safe, although recovery from an uncomplicated cesarean birth can take at least twice as long as recovery from an uncomplicated vaginal birth.

Common problems associated with a C-section range from blood loss, infection and clots to nausea. More severe complications include damage to another organ during surgery and maternal death. Scarring from the surgery may cause problems in the long term with future pregnancies, including the following:

  •          Placenta previa, which occurs when the placenta blocks the cervix by developing low in the uterus
  •          Placental growth deep in the uterine wall (termed placenta accreta, placenta increta or placenta percreta depending upon severity)
  •          Rupture of the scar during labor or gestation

Infants, too, may face severe risks during a cesarean birth, particularly during a preterm delivery. If the due date is calculated incorrectly, the premature infant may have difficulty breathing as a result of underdeveloped lungs. Babies delivered by C-section may also sustain injury during the procedure.

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