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OB lists reasons for rising cesarean rate

7/13/10:  I updated this article, almost two years to the day it was originally published, in response to some comments left on a message board indicating that some women believed after reading the article that I thought all cesareans were unnecessary.  Of course, nothing can be further from the truth.  There are many reasons for medically indicated cesareans including, but not limited to, placental abruption, uterine rupture, cord prolapse, transverse lie, and placenta previa.  I apologize for not including this clarification in the original article and hope that women will read this article and see the primary subject: that obstetricians are aware that some of the cesareans they perform are avoidable.


I read a public message board for medical professionals and the discussion of cesareans came up.  This is what one OB wrote:

The main reason for the rising primary C/S rate is:

  1. Fear of litigation
  2. Convenience
  3. Reimbursement
  4. Patient satisfaction
  5. Inductions
  6. Poor management of labor

It’s so sad to note that “health of the mother” or “health of the baby” are not listed.

Additionally, any reference to “a good outcome” is missing, other than “patient satisfaction.”  Unfortunately, this is likely linked to how terrified most women are of vaginal birth.  It’s really sad that there are women that are more afraid of vaginal birth than major abdominal surgery.

Most of the horror birth stories we read are the result of reasons number 5 & 6: inductions & poor management of labor.  It’s odd that we are so happy that our cesarean “saved us and/or our baby” from a bad situation when that situation was likely created by our OB.

Since these are the anecdotal reasons listed for the first, or primary, cesarean, it’s hard to imagine that the reasons for subsequent cesareans would be any different.  Knowing that this is the mindset of this, and many other OBs, is it any wonder that they make VBACs sound so risky?

When your OB says, “VBACs are dangerous.  Let’s just schedule a cesarean,” what they are likely thinking is, “By performing a cesarean, I won’t be sued and I can do it on my schedule.”  It’s right out of the mouths of OBs which you can read two examples here and here.  (That said, there are wonderfully supportive OBs out there, you just need to find them.)

Actions speak louder than words.  Does your OB have a high primary cesarean rate?  The World Health Organization recommends 10-15%.  As I said here:

The World Health Organization (WHO) has repeatedly stated that a 10-15% cesarean rate is optimal.   Below 10% and you have mothers and babies dying because they don’t have access to medically necessary cesarean section.  Over 15% and you see higher maternal and infant mortality and morbidity rates from cesarean related complications.  As the 2009 edition of WHO’s “Monitoring Emergency Obstetric Care: A Handbook” states, “It should be noted that the proposed upper limit of 15% is not a target to be achieved, but rather a threshold not to be exceeded.”

If your care provider is not truly supportive of VBAC, it’s time to find a new OB.

Some women even consider having home VBAC.  I wish more young, unmarried women could read birth stories like mine, not to convince them to have a home birth, but rather to counter all the horror stories they will inevitably hear from their mom, aunts, sisters, grandmothers, and friends.  Birth can be a wonderful thing, at home or in the hospital with the right care provider.

It would be lovely if women would look forward to birthing their children.  If they would see it as an incredible experience, forever changing them, bonding them to their husbands, learning their true strength of their bodies and minds, experiencing the oxytocin high, meeting their alert, drug-free baby.

I feel truly sorry for women who wanted to experience birth, but didn’t.  Complications happen, medically necessary surgeries happen, and unfortunately, medically unnecessary surgeries happen.  There are things we can’t plan for – like those life saving medically necessary surgeries – but by hiring a care provider who is truly supportive of vaginal birth, you are one step closer to preventing the unnecessary kind.

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2 comments to OB lists reasons for rising cesarean rate

  • I agree completely and feel that failed birth inductions are the number one cause for our c-section rate moving beyond rationality. Thank you for writing this article. Best wishes, Gail J. Dahl

  • You don’t even know how much your website has helped me! I keep reading your HBAC story for inspiration – mine is just around the corner. Thanks for the time you spend on this.

    Tonya, I’ve been following your pregnancy on your blog… I’m wishing you a wonderful HBAC!! That means so much to me that the website has helped you. I love logging on early in the morning and seeing people, like you, from all around the world reading the website via the Live Traffic Feed! So fun! Best, Jen

    Updated 8/26/08: Hey ladies, just wanted to share that Tonya HBACed in Italy! Read her blog The Unrepentant Gallivanter.

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