Why C-Sec­tion Rates Are Crazy High

Cosmopolitan (South Africa) - - WORKOUT - BY EMILY KUMLER

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.’

NOT-SO-ROU­TINE PRO­CE­DURE

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?

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