Cesarean Sections in the U.S. — The Trouble with Assembling Evidence from Data (Guest Blog at Scientific American)

I’ve been invited to guest blog at Scientific American today. The article, which is about the c-section rate in the U.S., was an interesting one for me to write. I initially approached it from the perspective that there were too many c-sections in the U.S., and I wanted to dig around and see whether there was good support for the litigious nature of American society being a causative factor. In the process of my digging, however, I found evidence that changed my thinking. Here’s an excerpt:

While it’s tempting to look at the data and make the assumption that over-medicalization is responsible for the high rate of induction and c-section in the U.S. — and to further extrapolate that the high rate of c-section is responsible for increased maternal mortality — there are several problems with this interpretation. First, it goes without saying that c-sections, while not medically necessary in the majority of deliveries, are lifesaving for both mother and infant when medically required. Per WHO data, those undeveloped nations with the very lowest c-section rates have staggeringly high maternal mortality, with more than 1 in 100 labors resulting in the mother’s death. By comparison, maternal mortality in much of Europe and North America is in the range of 0.001 – 0.03% [3]. This somewhat deromanticizes the image of a native tribeswoman squatting in her hut, giving birth “as nature intended.” It’s easy to forget that if we desire completely natural childbirth, we have to accept the natural maternal and neonatal mortality that accompanies it.

Read more at Scientific American’s guest blog.




5 Comments (+add yours?)

  1. Laurel
    Mar 29, 2012 @ 08:38:58

    I think you’ve not noticed that that analysis is assuming that the high maternal mortality rate could be reversed by c-sections alone. I’d be willing to bet good money that in poorer countries the maternal mortality rate has more to do with infection, undernourishment, hemmoraging etc. None of which has a solution or prevention in c-sections.


    • SquintMom
      Mar 29, 2012 @ 10:32:45

      I’m not completely sure I understand your comment, but here’s the simple truth: the maternal mortality rate in developed nations with excellent access to skilled medical care during labor and delivery is a tiny fraction of that in areas without access to skilled medical care.


  2. Pauline Hull
    Mar 30, 2012 @ 13:59:24

    I just wanted to say thank you for taking such a refreshing approach during your investigation into cesarean rates, and for making the time and effort to look more widely at the data available than some commentators have in the past. I posted a comment on your article (no.8), and referred to it on my blog too – cesareandebate.blogspot.com


  3. Mary
    May 11, 2012 @ 07:10:34

    Thank you for approaching this often polarizing topic with an open mind. It’s great to read a thoughtful and well-researched article on the subject.

    I also wanted to mention the fact that vaginal delivery is the frequent cause of maternal morbidity as well, though those injuries are rarely mentioned in discussions of c-section rates. Fecal and urinary incontinence, prolapse, and sexual dysfunction are very common medical issues that often result from vaginal delivery and often cause pain and humiliation, as well as necessitating unpleasant and often unsatisfactory treatments. Anecdotally, I know many women are quietly requesting cesareans to avoid these issues or because of a preference for the risks of surgical birth over the risks of planned vaginal delivery.

    I haven’t seen any data to support this directly, but I think as c-sections have become safer over the years, the risks have shifted so that doctors may also more willing to perform them than to pursue a difficult vaginal delivery, especially if potentially dangerous (to both mother and baby) instrumental delivery or shoulder dystocia seems likely.


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