US health workers try to stem a tide of unnecessary c-sections

Caesarean sections are among the most frequently performed operations in the US. As the rate declines slightly from its 2009 peak of 32.9 per cent of births in 2009, medical researchers and health practitioners are working to reduce the number of surgical deliveries.

One movement is trying to change the guidelines that define how childbirth is handled for low-risk patients. “We know women who are admitted in early labour are more likely to have a caesarean and routine interventions, even if not clinically necessary,” said nurse practitioner Holly Smith, in an online seminar introducing a new set of guidelines from the California Maternal Quality Care Collaborative (CMQCC) aimed at reducing this form of surgical delivery.

Delaying labour is one of several suggested tactics to reduce caesareans. “There is a little bit of denial that [caesarean delivery] is major surgery and that it poses a lot of problems,” says Carol Sakala of the National Partnership for Women & Families. Along with the CMQCC and other maternity care groups in the country she wants to improve the quality of care for mothers and newborn.

The rate of caesarean births in the US has ticked up steadily since the late 1990s. Of particular concern to many medical professionals is the “overuse” of the procedure among patients who might otherwise be suited to a vaginal birth. There are several life-saving reasons why doctors in the US turn to caesareans — for example, if a baby is poorly positioned or if the baby’s heart rate changes. The reasons on the part of the mother range from conditions such as diabetes or obesity to complications with the placenta.

In 2014, the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine issued a joint report raising concerns over the increase in the number of caesarean births without evidence of improved mortality rates. While factors such as a rising maternal age might explain the increase, many believe the relative efficiency that caesarean deliveries allow is responsible. Doctors can plan for a much shorter delivery than through natural labour. Some research indicates obstetricians opt to perform caesareans to help prevent malpractice suits for serious birth injuries.

But caesarean deliveries carry the risk of complications, such as infection, of major surgery, along with longer recovery times than most vaginal births. Newborns delivered by caesarean are at risk of impaired respiratory function. Caesarean deliveries in the US are also some 50 per cent more expensive than vaginal births.

“It’s much more convenient to say, ‘Well, you know, it’s getting to be my dinner time and my family time. Labour is not progressing very fast. I’ll just do the caesarean now’,” says Sakala. Vaginal birth, in contrast, “requires a lot more patience and resources and inconvenience on the system”.