A 31% C-section rate? What the heck, people?

So recently a friend shared this article about having a C-section on the source of all essential knowledge, Facebook. Never having had a C-section, I was fascinated and totally freaked out.  

Ok, so you just read it right? I realize this is just one lady's experience- definitely not the final word in how C-sections are.  As with any birth experience, it's a varied as we are as individuals.  

Before I go on, let's set the record straight:  C-sections save lives.  Of babies. Of moms.  There are so many birth scenarios that have turned out happy because of C-sections.  And I am grateful that should something go awry, this option if available to me to save my life or my baby's life. I know many women who had no other option; some knew they'd have to have a C-section from the get-go, while some had C-sections as a last-minute emergency.  And, thankfully, I get to have those wonderful people (and their cute kiddos) in my life.  C-sections are nothing short of a wonderful modern miracle! 

That said, a 31% C-section rate in this country is nothing short of embarrassing. (And to think it was less than 5% in the early 1970s!!)  Only 5.2% of planned homebirths end in a C-section at the hospital. Hate to say it OB/GYN's, but midwives are kicking your trash here. Really, we're supposed to believe that almost 1 in 3 births is an essential C-section? Let's take a look at a few facts:

• The WHO (World Health Organization) says that no country is justified in having a rate over 10-15%
   
• Rates above 15% have been shown to do more harm than good (Althabe and Belizan 2006)
•  
• Countries with the lowest rates, like Nigeria (1.8%) and Ethiopia (1.0%), are typically poorer third world countries without the facilities or medical sophistication to do C-sections for any other reason than a last ditch effort to save lives.  C-sections done in these countries also are much riskier to the mother and baby
•  
• Other industrialized nations have rates similar to the U.S's.  Almost all European nations have rates in the teens and twenties (Italy is the highest in Europe, at 38%, Finland near the lowest at 16%).  South America and several Asian nations have rates higher than the U.S. (Holy Cow, Brazil! You're at 45%!) This C-section epidemic isn't unique to our nation.

  (These figures are from a 2010 study by the WHO, see the whole thing here- scroll to the bottom to see the tables). 

So, what's going on?  This article outlines a few reasons for the crazy rates. (And this isn't some hippy article, by the way. It's intended to be read by health care professionals and patients alike. Check it out for yourself.) In summary, it says:

• Low priority of enhancing women's own abilities to give birth: "Care that supports physiologic labor, such as providing the midwifery model of care, doula care providing continuous support during labor, and using hands-to-belly movements to turn a breech baby reduces the likelihood of a cesarean section" Side note- I've heard a lot of wonderful things about CNM's (certified nurse midwives- they usually work under an OB/GYN) that deliver in hospitals that have embraced this midwifery model of care, to the benefit of their patients. Many are supportive of the presence of doula's, the desire for a natural birth- and even water births in some cases.
• Side effects of common labor interventions: "Current research suggests that some labor interventions make a c-section more likely" (i.e. labor induction for a first-time mom)
• Refusal to offer the informed choice of vaginal birth: "...many women with a previous cesarean would have liked the option of a VBAC, but did not have it because health professionals and/or hospitals were unwilling (Declercq et al. 2013)"  Side note- according to the Mayo Clinic, 75% of VBACs are successful. Them good odds, ladies.
• Casual attitudes about surgery and variation in professional practice style: "Our society is more tolerant than ever of surgical procedures, even when not medically needed."
• Limited awareness of harms that are more likely with cesarean section: "Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth."
• Incentives to practice in a manner that is efficient for providers: "Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. Even when payment is similar for both, a planned cesarean section is an especially efficient way for professionals to organize their hospital work, office work and personal life. Average hospital payments are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit."  

 So that last reason- for profit- really irks me. What the heck, medical professionals? That feels a little like a betrayal.  Whatever happened doing what's in the best interest of your patients, not your vacation schedule? You're going to subject a patient to a whole slew of new risks because you want to speed up their delivery and get a fatter paycheck? Not cool, people, not cool.

Again, I recognize that C-sections save lives.  Lots of lives. But only in about 5-10% of cases. Heck, for all I know this pregnancy might end in a C-section. And that's okay. If that happens, I will feel that I am in that 5-10%. And at least I won't be wondering if I was just taking 'too long', and my doctor had a hot date to get to.