Why is the share of cesarean deliveries rising?

The number of American women having C-sections is still skyrocketing.

Published November 17, 2005 5:16PM (EST)

Nearly one-third of all births in America are now performed by cesarean delivery, according to CNN and a report released yesterday by the National Center for Health Statistics. That represents 1.2 million C-sections in 2004 -- 29.1 percent of births last year -- and marks a strong spike despite recent government pledges to reduce C-section births by 15 percent by the year 2010.

That the rise in C-section births does not reflect a corresponding surge in high-risk pregnancies -- according to the Centers for Disease Control, premature-birth rates rose only 7 percent between 1990 and 2001 and the new NCHS study shows that the procedure rose in all births, including healthy, full-term, first-time pregnancies -- does suggest that that behind the statistics, significant cultural, rather than clinical, forces are at work. "Women are getting the message that birth is something you need to be afraid of, something very overwhelming and powerful that they won't be able to handle on their own, and comes with all sorts of risks," Manhattan nurse and midwife Stacey Rees told Broadsheet.

The NCHS study concludes that the steady increase is due to a combination of factors, including fear of malpractice suits, the preferences of mothers who wish to schedule their deliveries, and the risks -- such as a ruptured uterus -- facing pregnant women who have undergone previous cesarians. Tonya Jamois, president of the International Cesarean Awareness Network, tells CNN that as a result, many hospitals have gone so far as to outlaw vaginal births after C-section. "Women are struggling to avoid unnecessary surgery, but the medical system has abandoned them. They have to submit to major surgery in order to get medical care."

Women's health experts worry that as multimillion-dollar claims drive the cost of malpractice insurance into the six-figure range, more and more obstetricians are being pulled into the practice of defensive medicine, ordering tests and procedures that, while possibly unnecessary, reduce their exposure to liability. A study from the Syracuse University School of Citizenship and Public Affairs asserts that upwards of 20 percent of all cesareans performed are prompted by a physician's fear of litigation. Doctors in Connecticut and Washington state have even begun to issue blanket consent forms to all new patients, graphically detailing the possible risks mothers and children face during childbirth, including permanent brain damage and disability.

That fear has also had a profound impact on natural-birthing clinics and midwifery centers. In the New York metropolitan area, according to figures released by the New York State Department of Health, the number of births attended by midwives dropped from 12.2 percent in 1997 to 9 percent in 2002 alone. In the fall of 2003, two of Manhattan's most respected and popular birth centers, SoHo Midwives and the Elizabeth Seton Childbirth Center, were forced out of business after insurance companies declined to renew their policies.

Twenty years ago, almost no women opted for C-sections, Dr. Sarah Kilpatrick, of the American College of Obstetricians and Gynecologists, tells CNN, and she worries that "nowadays the public [has] the sense that it's like a zipper -- [doctors just] open you and then close you back up." Indeed, as more women wait until later in life to have children and try to juggle the demands of a career with the commitments of pregnancy and motherhood, many have come to see cesarians as a convenient way of taking control of the birth process. In an interview last year with CBS News, new mother Randi Rosenberg said that for her the decision to elect a cesarian was simple. Today "women are so busy; people are so busy. I run my own business and I didn't have the luxury of maternity leave because there's no one to fill in for me when the office is closed. So knowing when I was going to have the baby was really a benefit."

Convenience is one thing, but what about vanity? Last September, a New York magazine feature about pregnant New Yorkers raised hackles when it suggested that some mothers were electing early cesareans in order to stave off the weight gain of the final stages of pregnancy.

The doctor who delivered Rosenberg's baby is blunt about the dangers that accompany such an attitude. "There's a risk in all of this control, and the risk can be death. This is a major operation. It's not like going to the beauty salon, or getting your nails done, or getting a bikini wax."

By Sarah Karnasiewicz

Sarah Karnasiewicz is a freelance writer and photographer based in Brooklyn, N.Y. Until recently, she was senior editor at Saveur magazine; prior to that she was deputy Life editor at Salon. She has contributed to the New York Times, the New York Observer and Rolling Stone, among other publications. For more of her work, visit thefastertimes.com/streetfood and Signs and Wonders.

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