Dear Friends:
    Wanna bet breastfeeding problems will increase? And why don't the authors
consider the rise in inductions as having an impact on cesarean rates? Don't
they know that induction in a primipara has a 30-50% increased risk of
cesarean section?
    AAARGH!!

Caesareans on the Rise Again

By LAURAN NEERGAARD
.c The Associated Press

WASHINGTON (Aug. 29) - Caesarean sections started dropping slowly in the
early 1990s after an outcry that American women undergo too many - but now
they're on the rise again.

Most puzzling: Why C-sections are increasing in first-time moms, not just in
women who previously had one. And where pregnant women live determines how
likely they are to wind up on the operating table - C-sections are more
common in the South than out West.

Now, with Caesareans inching back up to 22 percent of U.S. births, the
nation's leading obstetricians' group is issuing new guidelines to reduce
unnecessary C-sections and reserve the surgery for mothers and babies who
truly need it.

There are many suspects in the C-section rise - state-by-state variation
particularly suggests doctors' habits sometimes can overshadow medical need.

``Maybe we've become too technical,'' says Dr. Jean Walker, an attending
obstetrician at Chicago's Rush-Presbyterian-St. Luke's Medical Center, which
is taking new steps to lower C-sections. ``We're going back to natural things
like walking more often and birthing balls and really encouraging natural
descent of the fetus.''

To do that, Rush just began a nursing change - back to more continuous,
hands-on care during early labor, especially for first-time moms whose labor
takes longer, a big reason for C-sections. After all, studies show women who
have continual care from nurses or midwives get fewer C-sections than when
busy nurses just pop by every so often to check how early labor is
progressing.

Make no mistake: Caesareans can be life-or health-saving for many mothers and
babies. Fetal distress, disorders that make labor risky for the mother, a
baby simply too big or wrongly positioned all are important reasons for
C-sections - and hospitals that specialize in high-risk pregnancies will
perform more.

But avoiding unnecessary C-sections also is important. Women's risk of death,
although still small, is three to seven times higher than during vaginal
delivery, says the American College of Obstetricians and Gynecologists. Not
to mention increased pain, longer hospital stays and a higher risk of
post-delivery infection.

C-sections have risen for three years, climbing another 4 percent in 1999 to
account for 22 percent of live births, the government reported this month.

That's lower than the nation's high of 25 percent in 1988 - but nowhere near
the federal goal of a 15 percent C-section rate this year. And it reverses a
steady decline in C-sections between 1989 and 1996.

Now look state-by-state: Fewer than 17.5 percent of births in Utah,
Wisconsin, Colorado, Alaska or Vermont are C-sections. But more than one in
four births are C-sections in Mississippi, Louisiana, Arkansas and New
Jersey.

Worse, the most dramatic variations in hospitals' C-section rates are among
first-time moms with healthy babies in the right birth position, says the
ACOG.

Those discrepancies suggest doctors' habits play a big role, says Dr. Roger
Freeman of the University of California, Irvine, who chaired the new ACOG
guidelines that outline practices and conditions linked to higher C-sections
- and urge doctors to check for ways to improve.

Among the list:

A previous C-section is the biggest risk factor for having another. If the
surgical cut was in the lower abdomen - not the upper - ACOG says most
healthy women can try vaginally delivering their next baby as long as a
surgeon is standing by if emergency surgery is needed. Most low-risk mothers
who try can deliver vaginally, says ACOG, encouraging women to carefully
discuss this option with their doctors.

Yet the rate of vaginal births after C-section fell to 23.4 percent last
year, down 17 percent since 1996.

Slow labor is a big reason for C-sections in first-time moms. ACOG cautioned
against surgery too early, and Chicago's Walker also stressed patience,
saying here that nurses are key. ``With younger nurses, I get more phone
calls saying, 'Nothing's happening, she needs a C-section,''' while older
nurses are ``a little more attentive, more patient'' with slow labor.

ACOG says demanding a painkilling epidural too early, before the cervix is
dilated 4-5 centimeters, increases your C-section risk. But this is
controversial - Walker urges women to ask for a less potent ``walking
epidural'' that she says doesn't increase the risk.

For breech, or feet-first, babies, doctors should consider trying to turn the
baby headfirst by ``external version,'' pushing on the mother's abdomen
before automatically operating, ACOG advised.

While ACOG targets doctors, consumer advocates advise pregnant women to ask
about C-section rates when choosing a physician and hospital. Pick one with a
lower rate, or who's open to a second opinion for nonemergency surgery, and
``it's more likely you're going to avoid an unnecessary C-section,'' says
Public Citizen's Dr. Sidney Wolfe.

AP-NY-08-28-00 1624EDT

Copyright 2000 The Associated Press. The information contained in the AP news
report may not be published, broadcast, rewritten or otherwise distributed
without the prior written authority of The Associated Press.  All active
hyperlinks have been inserted by AOL.


Nikki Lee RN, MSN, Mother of 2, IBCLC, CIMI
craniosacral therapy practitioner; childbirth educator
Elkins Park (a suburb of Philadelphia, Pennsylvania; northeastern USA)
supporter of the WHO Code and the Mother Friendly Childbirth Initiative

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