Why C-Section Rates Are Crazy High
The average South African woman has her irst kid at 22 (according to a report by Chartmix), and up to one in three of those infants emerges not from the birth canal but from a lower-abdominal incision. This procedure, called a Caesarean or Csection, is now the most common operation in the country. More than 25% of babies are being born via C-section in South Africa’s public sector; those numbers may be even higher in the private sector.
Perhaps that’s why people tend to think of it as no big deal – despite the fact that it is a major op that requires a sharp knife through the belly, a slicing of the uterus and some organ rearrangement. (Actor Dax Shepard compared wife Kristen Bell’s C-section to getting ‘Completely disassembled. Your liver’s out, I think. And … definitely your intestines.’)
The operation can be life-saving if baby is facing bottom-first or mom has a condition that makes labour dangerous. But research suggests nearly half of all C-sections are medically unnecessary. ‘It’s true that C-section rates are alarmingly high,’ says Dr Lindi Murray, a gynaecologist at Lila, an ob/gyn practice in Cape Town (Lila.co.za). ‘Many private hospitals perform more Caesarean than normal births, while state hospitals and clinics maintain C-section rates of less than 40% (despite seeing more patients, and often more complicated pregnancies). Countries such as the US and the UK have taken active measures to bring down the number of C-sections by ensuring that these are performed for valid reasons only, and taking a stand that vaginal birth is the preferred route of delivery in most cases – which we agree with.’
The statistics are startling: C-section rates have jumped nearly 500% in the US since 1970 – and in South Africa, known in certain circles as ‘Caesar’s Palace’, the numbers are even higher. ‘It’s difficult to say why the rate is so high here – but it’s likely due to the fact that because a C-section is planned and controlled, it’s deemed to be safer,’ says Murray.
‘Many patients also perceive a C-section as being easier and quicker. But don’t be fooled: a wellmanaged normal birth is safer for both mom and baby in the vast majority of cases; it also promotes mother-baby bonding and will give you a huge sense of accomplishment.’
Like any surgery, a C-section carries risks such as haemorrhage and infection. Nearly 90% of women who have had one Caesarean will have another in future deliveries – and every time that scar gets reopened, the risk of complications increases. Particularly scary is placenta accreta, which can occur when the placenta (which feeds the foetus) attaches to the C-section scar, threatening massive haemorrhaging. ‘This has become 1200% more common in a generation, and it’s entirely due to C-sections,’ says Neel Shah, an assistant professor of obstetrics, gynaecology and reproductive biology at Harvard Medical School.
A SURPRISING CULPRIT
It would be easy to blame overeager gynaes who, wanting to move things along, default to a speedier process. (Including labour, vaginal births can last for days, while a typical C-section takes about an hour and can be scheduled in advance.) But there are many other factors at play, including the obesity epidemic and gynaes’ fear of being sued.
Many doctors consider C-sections a safer option because they bypass the complex variables (pelvic bones, contractions) involved in vaginal births. ‘There is also an increase in patients seeking legal advice in the event of alleged wrongdoing or bad outcomes,’ says Murray. ‘Doctors therefore easily find themselves following the predictable route so as to ensure good outcomes for mother and baby.’ But avoiding risk in the moment may mean introducing new risks later on.
New research shows that the biggest factor is not who delivers your baby but where you give birth. Hospital C-section rates vary wildly – from seven to 70% – even in the same city. In hospitals lacking labour rooms and enough nurses, staff may be more likely to perform C-sections during high-traffic times. Communication – or lack thereof – is also an issue. When things get busy or fraught (as they can when intense labour is involved), doctors, nurses and moms might not really talk to one another.
Ironically, tech that has made births safer for some may be fast-tracking C-sections for others. Innovations such as foetal heart monitors, for example, have made it easier for staffers to stay glued to screens. ‘If patients’ information is on monitors, that means nurses are typically not as present at their bedside,’ says Ginger Breedlove, former president of the American College of NurseMidwives. And when those sometimes-imprecise monitors show a potential problem, a C-section may seem like the easiest solution.
THE WAY FORWARD
In the US, new ‘dashboards’ are being tested in delivery rooms that clearly track a woman’s labour progress. The goal is to help patients understand what’s happening so they can voice their wishes, and to encourage shared decision-making. Doctors are also creating clearer guidance about when an operation should be considered.
In the meantime, there are still certain things women can do to get the birth they want. (See ‘How to Reduce Your Risk’.) ‘To increase your chances of having a natural birth, start by choosing a gynae or midwife you can build a trusting relationship with – one who listens to your wishes,’ says Murray. ■
CUTE BABY, UNNECESSARY SCAR?