C-Sections On The Rise Again

Caesarean sections, which had been dropping slowly in the 1990s after an outcry that American women undergo too many, are on the rise again.

They are increasing in first-time moms, not just in women who previously had one, and it appears that 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.

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.

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 f 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.

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