Rising Caesarean Section Rates in the Developed World - Scholarship Essay Example

Rising Caesarean section rates in the developed world- what needs to be done? Among major surgeries, Caesarean section is becoming the most common and the most preferred option by health professionals and patients, alike. Back in the nineteenth century and the early twentieth century, C-sections were performed in emergency cases only, where the life or the health of the mother and the baby were considered to be at risk. Elective C-section has become the norm of the developed world. A number of reasons account for this; various demographic factors of women population in the developed world have triggered the rate of Caesarean section. These include: maternal health, age, education, marital status, ethnic background and socio-economic perspectives. Women in the developed world are generally career oriented, and therefore, usually delay child birth. Thus the age and the health factors have impeded the natural process of giving birth in such women. Elective C-section is also opted for by such women because they find it easier to get an appointment for a C-section rather than waiting for their water to break, or for the labour to begin unexpectedly. The fear of labour pains forces many women to choose elective C-section. Education of pregnant women is essential, so as to encourage them to go through the natural process of child birth. Media can play an important role in advocating vaginal birth and in preventing unnecessary C-sections in the developed world. The socio-economic factor of the women in the developed world is pushing the rates even higher. The cost of a C-section is higher than a vaginal delivery- no wonder how private hospitals pay hefty fees to their surgeons! Insurance coverage is a compelling factor for the physicians to opt for C-section because the majority of the litigation cases are based on the claim that a timely C-section was not performed. The health insurance policies in the developed countries deal strictly with cases of head injuries or cerebral palsy that may occur during vaginal birth. ‘But fear of malpractice and complications on the part of physicians also has increased the use caesareans unnecessarily, Flamm says. On average, 90% of breach-babies are delivered by C-section, as are half of twins. C-section rates also are higher among women with any history of sexually transmitted disease. But the single greatest factor in rising rates, Flamm says, is fear of malpractice suits.’ (Lowers, 37) The rise in the C-section rates in the developed world has become a cause of concern. To a certain extent, abdominal birth, or C-section birth is taking over the natural process of giving birth. The far reaching effects of the preference of C-section over vaginal birth can be evolutionary. There are profound cases in which a C-section is inevitable: non progressive or obstructed labour, foetal distress, or anoxia. ‘There has been a marked rise in the frequency of caesarean deliveries in Europe and in Australia and New Zealand (table 2) but the highest rates are found in the United States. National differences are related to differences in obstetrical practice with regards to complications in pregnancy and delivery and the frequency of vaginal deliveries following a caesarean section. The practice of repeat caesarean sections was undoubtedly a major contributor to the higher rate in the United States. Also of interest is the higher incidence of the diagnosis of fetal distress in the United States, compared with other countries.’ (Rostow&Bulger, 30) ‘Anoxia is dangerous primarily because brain cells die if they are starved of oxygen for than a few minutes. Severe anoxia can initially cause poor reflexes, seizures, heart rate irregularities, and breathing difficulties. In the long run, severe anoxia can lead to memory impairment or cerebral plasy, a neurological disability associated with primarily, difficulty controlling muscle movements...’ (Sigelman&Rider, 109) Normal labour and child birth takes hours; while a C-section is performed in approximately one and a half hour. The hospitals in the developed world seem to have more facilities for a C-section than for normal birth. Pharmaceutical and surgical equipment manufacturing companies greatly influence the practice of doctors and hospitals. The profits reaped by conducting C-sections are far more than earned by normal delivery. So, health professionals and hospitals in most cases pressurize the patients to opt for caesarean section, particularly in case of breech presentation. The financial benefits of conducting C-section have compelled the management of hospitals and private clinics to focus on this area only. Most hospitals are specialized in providing the treatment and after-care facilities to C-section patients only. A normal delivery does not require surgical tools and machines; however, it needs time and patience of the medical staff to assist the patient during labour. Perhaps, it is not feasible for the hospitals to hire more medical staff such as nurses and mid wives for the conduction of a normal delivery, and it is rather convenient for them to operate her. ‘We conclude that individual practice style may be an important determinant of the wide variations in the rates of cesarean delivery among obstetricians. Our data do not permit us to say with certainty whether the procedure is overused by some obstetricians or underused by others, but we found no obvious differences in neonatal outcome associated with differences in the cesarean-section rate.’(Gregory, 706-709) Interestingly, China has the highest rate of C-section in the world - a whopping 60%. The National Institute of Health (NIH), USA held a state-of-the-science conference in 2006, which discussed ‘Caesarean delivery on maternal request’. The findings of the survey are given by The Childbirth Connection as under: ‘survey results suggest that the overall rate continues to steadily rise: whereas the provisional national 2004 cesarean rate was 29.1%, 31.5% of survey participants had cesareans in 2005 9% of the mothers reported feeling pressure from a health professional to have a cesarean, in contrast to 0.06% (1/1573) of all participants who had a "maternal request" cesarean (planned, primary, at mothers request, understanding that there was no medical reason) fully 25% of mothers who had a cesarean reported feeling pressure from a health  professional to  have this procedure, in contrast to just 2% of mothers who had a vaginal birth 42% of participants believed that the current malpractice environment leads maternity care providers to perform cesareans that are not really necessary to avoid being sued 81% felt that is necessary to know every complication associated with cesareans before consenting to have one, yet most were unable to correctly recognize established complications of cesareans 85% felt that a woman with a previous cesarean should be able to have a vaginal birth after cesarean (VBAC) if she so desired, but just 11% of those who had had a previous cesarean did have a VBAC, and most (57%) who did not have a VBAC were denied this option, primarily because caregivers (47%) or hospitals (26%) were unwilling.’ The adverse side-effects of C-section have been discussed time and again but what really needs to be done is to prevent it. Many women are not aware of the fact that the mortality rate of women undergoing a C-section is higher than a vaginal birth. It, being a major surgery, takes longer to recuperate; and it requires prolonged care of the stitches. Infections of the uterus and other pelvic parts may also result; while internal bleeding requiring blood transfusion is also becoming common. Subsequent pregnancies become difficult and may result in successive C-sections. This can however be prevented by opting for Vaginal Birth after C-section. ‘Called vaginal birth after caesarean (VBAC), this option has become increasingly advocated in the United States over the past decade (and for much longer in other parts of the world).’ (Carlson, 131) Some other problems associated with C-section are decreased bowel function, and formation of blood clots in the legs, or pelvic organs, or lungs. ‘Cesarean section is a modest risk factor for ectopic pregnancy and an important risk factor for placental problems.’(Hemminiki, 1569-1574) With such a massive increase in the C-section rates in the developed world, it seems to be a daunting task to reverse it. Patients should have the right to know about the possible complications of unnecessary C-sections. Doctors and health institutions should play their part in minimizing the C-section rates. Unfortunately, the pharmaceutical industry has changed the entire concept of health care institutions. There are possible solutions to lower this rate. Women with a previous C-section should be given a trial of normal delivery. ‘The American College of Obstetricians and Gynecologists has supported the concept of a trial of labor in patients with a previous lower uterine transverse cesarean section, and its safety is generally accepted... The results of this study suggest that a trial of labor is a safe alternative for patients with a previous single or multiple lower uterine transverse incision or a lower uterine vertical incision.’(Stovall, 70(5):713-7) General awareness programmes for the patients in the hospitals should be conducted nationwide. They should be informed about the pros and cons of C-section; and whether it is required in their case or not. The pros of this solution are that educated women might prefer a normal delivery and they might overcome their fears of giving birth naturally; while the cons are the financial loss to the hospitals, doctors, and health insurance companies. Giving a trial for natural birth in cases of breach presentation should also be encouraged. Manoeuvring the baby in such cases increases the likelihood of having a normal delivery. A great deal of expertise is required in handling such cases. The consent of the patient is also a major factor in such deliveries. The downside of this option is probable head injuries, obstruction in labour, or lack of oxygen to the baby. ‘... the areas on which efforts could be focused were identified as: 1. Attempting external cephalic version at term in women with a breech presentation and no other complication; 2. Careful assessment of primigravid women in labour, ensuring that the labour is effective; 3. Ensuring that, where practical, the diagnosis of fetal distress is confirmed by fetal scalp blood sampling; 4. In addition, there may be scope to increase the vaginal delivery rate after one previous caesarean section in women with vertex presentations.’ (Wilkinson). Work Cited: Carlson, J. Karen. The New Harvard Guide to Women’s Health. USA: Harvard University Press, 2004. Goyert, L. Gregory. “The Physician Factor in Cesarean Birth Rates.” New England Journal Medical. (1989): 706-709. Hemminki, Elina. “Long-term effects of cesarean sections: Ectopic pregnancies and placental problems.” American Journal of Obstetrics & Gynecology.Vol. 174. Issue 5. (1996): 1569-1574. Lowers, Jane. Medical Guidelines and Outcomes Work. Alexandria, USA: Capitol Publications, Inc, 1995. Rostow, P. Victoria. Bulger, J. Roger. Medical Professional Liability and the Delivery of Obstetrical Care: An Interdisciplinary Review. Institute of Medicine (U.S.). Committee to Study Medical Professional Liability and the Delivery of Obstetrical Care. Washington DC, USA: National Academies Press, 1989. Sigelman, K. Carol & Rider, A. Elizebeth. Life-Span Human Development. 6th ed. Belmont, CA, USA: Cengage Learning,2008. Stovall, Thomas. “Trial of Labor in Previous Cesarean Section Patients, Excluding Classical Cesarean Sections.” Obstetrics & Gynecology. 1987. Wilkinson, Chris. “Is a rising caesarean section rate inevitable?” BJOG: An International Journal of Obstetrics and Gynaecology. 1998. “NIH Cesarean Conference: Interpreting Meeting and Media Reports”. October 2006. Childbirth Connection. 10 June 2008. (http://www.childbirthconnection.org/article.asp?ck=10375 Read More