Are There Too Many C-sections?

Today C-section rates around the world are relatively high, especially in developed countries. Since 1985 the WHO has considered the ideal rate of performing C-sections to be 10-15% but many developed countries today perform C-sections at rates of 25-30%. Some countries like Brazil are closer to 40% C-section rate. The WHO projects that the global rate of C-sections rate will be closer to 29% by 2030.

While C-sections are often medically necessary and are lifesaving, the steady creeping up of C-section numbers may indicate the decision to perform a C-section may be more subjective and relied on more than needed. Because C-sections are so commonly performed it’s often not thought of as an invasive surgery that carries some risks. Often the decision to deliver by C-section is sprung on the patient while already in delivery when the patient’s decision-making relies on the doctor’s judgment. More than the steady incline of C-sections over time, another indicator of subjectivity in choosing a C-section is how rates vary by region, and by hospital and doctor. Women with healthy pregnancies are often unaware that the hospital they chose may have a C-section rate closer to 40%. Kaiser Health points out that in the US, C-section rates are exceptionally higher in southern states than in their northern counterparts. One reason C-section rates may be higher in the south is that people on average are less healthy, making deliveries more high risk. C-section rates in America are highest among African American patients. Kaiser Health interviewed a patient from Mississippi whose doctor told her, “You’re not in distress, and your baby is not in distress — but we don’t want you to get that way, so we need to think about a C-section.” Feeling defeated, the patient agreed without knowing what the surgery would entail because she was already in labor. For women entering a healthy delivery process, the switch to a C-section is often a surprise. California and New Jersey saw a decrease in their C-section rate when hospital reporting was implemented. Doctors seem more eager to label a delivery as “latent labor” by increasing the marker of “labor” from 4 centimeters dilated to 5 or 6 centimeters. Moving the goalpost allows a reason to conduct a c-section and shortens the delivery time. There are medical reasons but also financial and time management reasons doctors would prefer to conduct a C-section instead of allowing for a longer delivery window. Using a midwife or doula can help as a patient advocate if the decision arises. Of course, some women prefer C-sections for the same reason doctors do - it’s scheduled during business hours. Because of the nature of the delivery process, doctors generally have little accountability to keep their patients informed about what frequently becomes a surprise surgery. Recently The Skimm provided a guide to what to expect and how to recover from a c-section.