Consumer Reports Questions Cesarean Frequency

Main Category: Women's Health / Gynecology
Article Date: 30 Dec 2005 - 1:00 PDT

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Consumer Reports has named cesarean section number three on its list of "12 Surgeries You May Be Better Off Without." The recommendation, based on research at the non-profit Rand Corporation, encourages consumers to "check out safer alternatives" before having any of the 12 listed "invasive procedures."

Consumer Reports has named cesarean section number three on its list of "12 Surgeries You May Be Better Off Without." The recommendation, based on research at the non-profit Rand Corporation, encourages consumers to "check out safer alternatives" before having any of the 12 listed "invasive procedures." CLICK HERE.

The number three ranking of cesarean surgery appears just above episiotomy (#4) and hysterectomy (#5) and below angiography (#1) and angioplasty (#2). The recommendation from Consumer Reports Medical Guide comes on the heels of the Centers for Disease Control report showing that the primary cesarean rate in the United States has reached a historical high of 20.6 percent and an overall rate at 29.1 percent in 2004. The latest overall rate reported in Canada is 22.6 percent.

"Women need to be selective consumers and study their birth options," said Tonya Jamois, president of the International Cesarean Awareness Network (ICAN). "The priority should be to avoid that first cesarean, and if you have a scar on your uterus, educate yourself about vaginal birth after cesarean (VBAC). Twenty years of research shows VBAC to be safer for mother and baby than repeat cesarean surgery."

According to Consumer Reports Medical Guide, most cesareans are performed because labor is progressing too slowly. The Guide notes that a number of less invasive procedures may be enough to stimulate labor. Consumer Reports encourages women to ask "what percentage of normal deliveries as well as births following a prior cesarean the physician delivers by C-section. Ideally, look for rates below 15 percent in women who haven't had the procedure and about 60 percent in those who have."

The guide also states that physicians perform cesareans in the vast majority of women who have already had one. But ACOG, the American College of Obstetricians and Gynecologists (as well as SOGC, the Society of Obstetricians and Gynaecologists of Canada) has published research showing most women could safely try for a VBAC, which would succeed about 70 to 80 percent of the time; and if it does not, a cesarean can take place. Unfortunately, cost concerns and fears over liability have led some physicians and hospitals to ban VBAC and require repeat cesarean.

Consumer Reports also recommends women consider giving birth in a hospital with a certified nurse-midwife, if available, since their births have lower cesarean rates than births with obstetricians.

"Giving birth in a free-standing birth center or at home with a midwife is another option that women should consider," Jamois said. "Midwifery care has been proven to be a safe alternative for most pregnant women. Countries where the majority of babies are born into the hands of midwives, such as The Netherlands, have cesarean rates below 10 percent, and they boast the best maternal and infant health outcomes in the world."

Those who seek information about preventing a cesarean, or support in recovering from a cesarean, can visit ican-online.org for more information. In addition to more than 70 local chapters across North America, ICAN hosts an active online discussion group that can serve as a resource for mothers.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight; prematurity; respiratory problems; and lacerations. Potential risks to women include: hemorrhage; infection; hysterectomy; surgical mistakes; re-hospitalization; dangerous placental abnormalities in future pregnancies; unexplained stillbirth in future pregnancies and increased rate of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean.

INTERNATIONAL CESAREAN AWARENESS NETWORK
http://www.ican-online.org