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Relentless Rise In Caesareans
						
				
				
						Recent studies reaffirm WHO’s optimal caesarean section rate guidance. 
						Best outcomes occur with a 5% to 10% rate. 
				
		
		
				Over 15% seem more harmful 
				(Althabe and Belizan 2006). 
		
		National U.S. rate was 4.5% and was so in 1965 
		
				when first measured 
				
						(Taffel et al. 1987). 
				
				Recently many healthy, low-risk 
		
		American women who had care enhancing their bodies' innate capacity for 
		giving birth have a 4% rate and good overall birth outcomes 
		
				(Johnson and 
				Daviss 2005, Rooks et al. 1989). 
		
		The national rate is higher and over ten years 
		increased steadily. A 2007 national rate of about one mother in three 
		
				having a caesarean, 
				
						a record level for the U.S 
				
				is likely. Most mothers are 
		
		healthy and anticipate uncomplicated birth. A caesarean is major surgery 
		and increases possible short and long-term sequelae for mothers and 
		
				babies
				
						. 
				
				Clear, authoritative judicious recommendations are available 
		
		
				(U.S. 
				Department of Health and Human Services 2000). 
		
		To explain the steady rise, 
		health professionals and journalists often point at mothers, assuming 
		leading factors are: 
		
				
						1) more and more women are asking for c-sections that have 
						no medical rationale, and 2) the number of women who genuinely need a caesarean is 
						increasing. 
				
		
		Neither accounts for much of the increase. 
		
				
						Despite talk of 
						
								"maternal request" 
						
						caesareans, it is rare. A survey of women 
				
				
						delivered in hospital 
						
								(2005): 
						
						first to poll US. women about decisions. Those 
				
				who had caesareans were asked why and who had initiated it. Of 1600 
				only one reported planned first caesarean at own request without medical 
				
						reason 
						
								(Declercq et al. 2006a). 
						
						In other countries similar results are found. 
				
				
						(McCourt et al. 2007). 
				
				Many point to population changes: older women with 
				medical conditions and the extra challenges of multiple births. Researchers 
				found some overall changes in this population: caesarean rates rising for 
				all groups, regardless of age, parity, extent of health problems, race/ 
				
						ethnicity, or other breakdowns 
						
								(Declercq et al. 2006b)
						
						. A change in practice 
				
				standards reflects increasing professional willingness to always consider a 
				caesarean. 25% of caesarean survey participants reported perceived 
				
						professional pressure for caesarean 
						
								(Declercq et al. 2006a). 
						
						Interconnected 
				
				factors influence rising rates. Enhancing women's own abilities to deliver is 
				a low priority. Supporting physiologic labour, 
				
						like continuous support with a 
						doula or other companion and ECV reduces likelihood of caesarean. 
				
				The caesarean 
				decision is often made instead of using watching waiting, positioning and 
				movement, comfort measures, oral nourishment etc. to facilitate labour 
				
						
								progress. Research suggests some labour interventions increase 
								caesarean likelihood. 
						
						Eg. Nullipara induction on unripe cervix; continuous CTG has been associated with greater caesarean likelihood; early labour epidurals or lacking high-dose boost of syntocinon. Many professionals and/or hospitals do not offer informed choice of vaginal birth in some circumstances. The survey found many previous caesareans would like the VBAC option but health professionals and/or hospitals were unwilling (Declercq et al. 2006a). 9:10 with a previous caesarean are having repeats. Few with a breech have the option to plan vaginal birth.
		
		
				
						Society is tolerant of surgical procedures, even without medical need reflecting this in the comfort level of health professionals, insurers, administrators, and women with caesarean trends. A major surgical procedure compared with vaginal birth has high possible harm for mothers and babies. Short-term material harm includes increased infection risk, surgical injury, thrombosis, emergency hysterectomy, intense prolonged pain, readmission and poor overall functioning. These babies are susceptible to surgical cuts, breathing problems, difficult breastfeeding, and asthma. "Adhesions" mean caesarean mothers are more likely to get ongoing pelvic pain, bowel blockages, future surgical injuries, and infertility. After caesarean various serious conditions more likely in future pregnancies, like ectopics, praevia, accreta, abruption, and uterine rupture (Childbirth Connection 2006).
				
		
		
				Given how legal, liability insurance, and health insurance systems work, caregivers may feel a caesarean reduces the risk of being sued or losing a lawsuit, even when vaginal birth is optimal care. Many health professionals feel squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra for those who patiently support a longer vaginal birth.  Some payment schedules pay more for caesarean than vaginal birth. A planned caesarean section is an especially efficient way for professionals to organize hospital work, office work and personal life. Average hospital charges are much greater for caesarean than vaginal birth, and may offer hospitals greater scope for profit. All of these factors contribute to a current national caesarean section rate of over 30%, despite evidence that a rate of 5% to 10% would be optimal. 
		
		
				
						Source WHO