Cesarean Births – How Many Is Too Many?

The most common type of surgery in the United States has become cesarean childbirth. Until the early 1970s less than 5 percent of births were by cesarean, but by the early 1990s almost 20 percent of live births were by cesarean; and by 2005 the rate was 30 percent.

There has never been any question as to the validity of cesarean delivery in circumstances of high-risk mothers or where infants are at risk. Some factors dictate planning for cesarean almost as soon as pregnancy is confirmed. Women with abnormally shaped or positioned uterus, previous cesarean delivery, or genital herpes will usually have a planned cesarean procedure. Other situations that could precipitate a cesarean delivery include: placenta previa, uterine rupture, breech position, fetal distress, failure of labor to progress, and a baby with too large a head compared to the pelvis.

The World Health Organization has gone on record that only between 10 and 15 percent of pregnancies should require cesarean delivery. This percentage is the average worldwide, except for the United States. Many health care professionals believe that the current rate in this country is higher than necessary.

Cesarean delivery is the delivery of a fetus through a surgical incision in the abdominal and uterine wall. The origin of the term cesarean is unclear. The word may have come into the usage during the Middle Ages from the Latin caedere (to cut). References to abdominal delivery have been made in many cultures, but the ancient medical writers, including Hippocrates, do not describe such a procedure. In 1581, Francois Rousset of Paris, France wrote on the history of the cesarean birth. He described 14 such procedures from information he received, but he never actually witnessed such a procedure. By the middle of the 17th century more reports of this operation appeared, though abdominal delivery was performed only in rare circumstances.

Women who have cesareans face longer and more painful recovery, greater risk of infection and longer hospitalization. Why then are so many women, who would do as well with vaginal delivery, having cesarean procedures? There are known cases where women with no medical reason have requested cesarean’s to accommodate schedules and planning. Studies in the United States and other countries suggest that this is not common.

More doctors are opting for cesarean as the practice has become safer and anesthesiology has improved, though there is no evidence to suggest that pregnancy and birthing is any more risky than thirty years ago. Doctors who schedule cesareans for patients who do not require them are most likely making their schedule easier to handle. There is also the suggestion that doctors are wary of malpractice suits if something should happen during vaginal delivery.

Women who have no medical reason for a cesarean, and would prefer a natural birth, must be their own advocate and assert their medical preference firmly. Only if women are involved in preventing unnecessary cesarean deliveries is the trend likely to change.