Rising Caesarean Section Deliveries in the US-Causes and Effects - Essay Example

? Running head: Rising Caesarean section deliveries in the US-Causes and effects Ceaserean rates in the US have been on a steep increase since with arecent survey conducted in 2008 estimating that nearly one-third of the deliveries being conducted as a C-section. It is the most common procedure conducted in operation theatres and most of the operations are done even when there are no identified maternal risks. Some of the major medical causes for this rise include a previous delivery by c-section, problems during labor such as obstruction, signs of fetal distress and breech presentation of the fetus. In addition other factors that have been shown to influence c-section such as women in affluent families opting for a caesarean delivery, physicians may suggest the procedure for financial gains even if it is not medically required, the use of modern technology has given the confidence both to the physician as well as the patient for choosing a c-section, the notion that it would ensure a safe delivery for the child and the preference to avoid the hardship and turmoil of a natural delivery. However, the positive effects of the procedure is lesser compared to the risks involved for both the mother and the baby. These include increased risk of maternal and neonatal morbidity and post-partum pain, respiratory problems with the newborn, need for c-section deliveries in subsequent pregnancies, higher rate of mental trauma and depression in the post-partum period and lesser degree of bonding between the mother and the child compared to normal vaginal deliveries. Possible solutions for reducing the rates of caesarean deliveries include preference of pregnant women for normal birthing, use of managed care support during pregnancy, mid-wife support and employment of skilled maternity care providers to help in complicated labor processes as in the case of breech babies or large babies. Various studies have shown that with the above support c-section rates have sharply declined without any compromise to mortality or morbidity of the mother or the child (Niino, 2011). A recent study conducted revealed that the cesarean rate in the US was at 31.8% (Niino, 2011). Data collected by the Center for Disease Control and Prevention has shown that between 1996 to 2007 cesarean rates increased by nearly 53% and included mothers of all ages and racial groups and for infant’s at all gestational ages with increased C-sections conducted for preterm babies. This increase was observed in all the states across the US (Menacker & Hamilton, 2010). The increases were observed both in the primary cesarean rate and due to a decline in VBACs (vaginal birth after cesarean) (MacDorman, Menacker & Declercq, 2008). The most common cause for this increased rate has been attributed to the changing practices in obstetrics and the entry of newer technology aimed to make deliveries quicker and safer thus eliminating the need to endure the longer duration and tedious nature of normal vaginal deliveries. While cesarean deliveries are required in cases where the mother is medically unfit to undergo a normal vaginal delivery or when serious complications are involved both to the mother and the fetus, surgical deliveries can however be avoided in cases where vaginal deliveries are possible (MacDorman, Menacker & Declercq, 2008). Women belonging to the upper class and affluent families and who have insurance or support from private organizations opt for cesarean deliveries. In some cases the practicing physicians themselves advocate C-sections even in cases where there is no requirement for surgical intervention solely for the purpose of earning money. The use of modern technology in obstetrics is making both the women and physicians more confident in carrying out a c-section. There are a few medical conditions that require a c-section to be performed. Uterine scars from a previous c-section that has an increased risk of rupturing during a subsequent pregnancy is one of the primary reasons for performing a c-section in subsequent pregnancies of mothers who went under the knife for their first pregnancy. Cesareans are also widely indicated in cases of obstructed labor which does not give way for a normal vaginal delivery and in cases where there is evidence of fetal distress due to inadequate blood supply for the baby that warrants for surgical intervention as waiting for a normal delivery can lead to fetal death (Anderson, 2004). C-section is the preferred choice in cases where the babies are in breech presentation and risks are involved while attempting to pull the baby in the breech mode. Other causes that have contributed to the increase include a general perception among physicians and patients that cesareans are safer both to the mother and the baby and the supposed long-term benefits such as protection from conditions such as prolapse of the uterus, incontinence and the ability to have a more satisfying sexual life. Some recent factors that are contributing to the rise in C-sections include delivery of a large fetus in which case there is no research supporting the need to employ surgical intervention. The use of mid-wives and other labor support companions has steeply declined over the years (Niino, 2011). A study conducted by researchers from the Yale School of Medicine found that a higher rate of c-section was being conducted in cases of twin pregnancies or when there is a risk of pre-eclampsia and slow progress of labor or problems detected in detected in fetal heart tracings also contributed majorly for rise in primary cesarean deliveries (Reasons for Dramatic Rise in Cesarean Births). Managed care for expectant mothers will help them perform their routine activities in a manner that will aid in normal delivery. Mid-wives would help expectant mothers cope with the stress of pregnancy and help them undergo a normal delivery with less technological intervention and focus on promoting good health for both the mother and the baby. In addition, physicians also lack the patience to wait for a vaginal delivery, to take efforts to try and turn babies in breech position prior to delivery or give pregnant women who have undergone a previous c-section a choice of VBAC. There is also increased impatience on part of the physicians to assist their patients and encourage them to deliver normally in cases of twins or breech babies (Niino, 2011). In case of international organizations like FIGO (Federation of International Gynecologists and Obstetricians) surgical interventions are required to enhance or save the life of the mother and the fetus. There is no ethical justification for performing C-sections under unwarranted conditions. However, the American College of Obstetricians and Gynecologists (ACOG) leave the decision to the physicians who could opt for a c-section considering the health and welfare of the mother and the child. ACOG has also encouraged physicians to create better awareness on VBAC among their patients while at the same time stressing that such deliveries should take place in a facility that is well equipped with emergency services. The World Health Organization has also supported vaginal delivery with a ceiling of maximum cesarean rates in a country up to 15%. It has also proposed various programs to reduce the cesarean rates with increased emphasis on the use of mid-wives to assist in the labor process (Niino, 2011; Lake, 2012). The two main benefits of cesarean delivery determined through observational studies are that C-sections are safe for the mother and the fetus and they carry a lesser degree of pelvic floor problems such as uterine prolapse (Anderson, 2004). However, the risks involved do outweigh the benefits as there is a very clear indication that there are increased risk factors associated with cesarean as compared to vaginal deliveries despite their requirement in under certain medical conditions when the life of the mother and the child are at risk. There is higher maternal and neonatal mortality and morbidity associated with C-sections. In addition women also suffer more pain and post-partum difficulties. These include emergency hysterectomy, hemorrhages, blood clots, bowel obstruction, surgical injuries, pelvic pain, lack of immediate bonding between the mother and the baby and longer time taken to recoup health. The subsequent pregnancies in these women are also complicated with higher risks in stillbirth, miscarriages and placental problems. There is also the risk of lower breast-feeding rates in the case of cesarean deliveries. In the case of the fetus there is a major risk of getting cut injuries during a c-section and children are also more prone to respiratory problems such as asthma later in life. In the case of vaginal delivery as the baby passes through the birth canal fluids are expulsed from the lungs that results in early and quick breathing in these children. These children also have early colonization of beneficial bacteria in their intestines. Thus if the birthing process involves these many possible problems there are more chances of post-partum depression which would have a negative bearing on the child’s immediate development (Niino, 2011; Lake, 2012). In conclusion, apart from the significant risks to mother and fetus, cesarean deliveries are also expensive and hence it would be wiser on the part of women who are capable of a normal vaginal delivery to avoid the risk of a c-section. Also the use of managed-care providers and mid-wives could be increased which will help women to cope and understand pregnancies and the process of delivery. Overall reduction in primary cesarean rates is a crucial factor that will help in the reduction of cesarean rates in the country. Reference 1. Niino, Y. (2011). The increasing cesarean rate globally and what we can do about it. BioScience Trends, 5(4): 139-150. Retrieved 18 March, 2013, from http://www.biosciencetrends.com/action/downloaddoc.php?docid=444 2. Menacker, F., & Hamilton, B. E. (2010). Recent Trends in Cesarean Delivery in the United States. NCHS Data Brief. Centers for Disease Control and Prevention. Retrieved 18 March, 2013, from http://www.cdc.gov/nchs/data/databriefs/db35.htm 3. MacDorman, M. F., Menacker, F., & Declercq, E. (2008). Cesarean Birth in the United States: Epidemiology, Trends and Outcomes. Clinics in Perinatology, 35: 293-307. Retrieved 18 March, 2013, from http://www2.cfpc.ca/local/user/files/%7BCB26B78C-E421-4510-A76E-BA338489A90D%7D/CS%20US%20Meneker%20%20and%20Declerque.pdf 4. Reasons for Dramatic Rise in Cesarean Births Identified. (2011). ScienceDaily. Retrieved 18 March, 2013, from http://www.sciencedaily.com/releases/2011/06/110622102820.htm 5. Lake, N. (2012). Labor, Interrupted. Harvard Magazine. Retrieved 18 March, 2013, from http://harvardmagazine.com/2012/11/labor-interrupted 6. Anderson, G. M. (2004). Making sense of rising cesarean section rates. British Medical Journal, 329(7468): 696-697. Retrieved 18 March, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC518883/ Read More