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More women are delivering their babies by C-section. Why? There is concern because much of this increase in C-sections involves women with no identifiable medical reason for a C-section. As pointed out in the British Medical Journal, "...women, researchers, and the medical establishment are once again debating the use of this procedure." The "caesarean section rates in Canada and the United States are close to 25%...." This is in stark contrast to the 15% mark suggested by WHO as an upper limit.
Apparently, no new large trials exist that compare the risks and benefits of C-sections with vaginal delivery and there certainly are no randomized, controlled studies. There are a number of factors including the fact that C-sections are increasingly safe for women and children. One of the most interesting aspects is that where a few years ago, a C-section was viewed by many women as excessive medicalization of a natural process (think home births), now there is an increased demand for contemporary medical technology.
Comment: With the spate of reality shows currently showing all sorts of surgical procedures including women have tummy tucks, butt implants, and hymen reconstruction on television, we wonder if these shows aren't also encouraging some pregnant women to ask their OBs to deliver them by C-section.
But national statistics may mask the regional nature of the problem. "The American College of Obstetrics and Gynecology looked at regional care, and there are disparities in unindicated C-sections," Rebarber said. "These things may actually happen more in more affluent areas, particularly on either coast."
Rebarber said that, at his hospital, about 26 percent or 28 percent of all births are C-section and, of those, only about 2 percent to 3 percent are unindicated. At other hospitals in the New York City, though, the rate of C-sections is as high as 40 percent.
"States could actually use [this data] for their own purposes," Declercq said. "It wouldn't be very hard for them to develop a simple model to look at hospitals in the state to see which are doing most of the C-sections and which aren't."
In the meantime, Declercq is now researching the medical bottom line: How dangerous are these unindicated C-sections? "That's the next logical step -- looking at the outcomes of those mothers," he said.
SOURCES: Eugene Declercq, Ph.D., professor, maternal and child health, Boston University School of Public Health, Boston; Andrei Rebarber, M.D., associate professor, obstetrics and gynecology and maternal fetal medicine, New York University School of Medicine, New York City; Nov. 20, 2004, British Medical Journal
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