Cesarean section rate in the United States has risen 30% and while the use of this method is in the form of a life-saving operation, cesarean section significantly increases a woman’s risk morbidity mortality. This work will examine the potential risks to the mother and infant with cesarean section. The cesarean section for the United States will be examined and the rates compared to countries with much lower rates. This work will discuss why the rate is so high in the United States and what is being done to reduce the rates of cesarean sections as well as what nurses can do to reduce the cesarean section rate and to foster and support vaginal birth.
Recent Reports on Cesarean Deliveries
AU.S. News Today report published recently reports that the number of cesarean deliveries “rose significantly from 27% of births to 34%” and that the jump in C-sections “is a national trend.” (2011) The senior physician consultant for HealthGrades, Dr. Divya Cantor states, “Doctors need to better understand when a C-section is called for. Patients need to have a better understanding of C-sections and not go into it blindly.” (2012) The March of Dimes expresses a great deal of concern about the rate of Cesarean sections stating that the primary reasons for C-sections are those stated as follows: (1) convenience for doctor or mother on timing of delivery; (2) older women giving birth and raised complications in pregnancy and delivery; (3) increases in maternal risk factors including obesity and diabetes; (4) increases in multiple births often attributed to increases in fertility treatments; (5) increases in willingness of doctors to perform cesarean deliveries; (6) pregnant women’s lack of understanding of the possible complications of cesarean deliveries; (7) women requesting C-sections; (8) fear of malpractice for failure to perform cesarean deliveries; and (8) common labor practices including induction of labor and use of epidural drugs. (U.S. News Today, 2012) Recent studies published are stated to “reaffirm earlier World Health Organization recommendations about optimal rates of cesarean deliveries and states that the best outcomes from women and babies “appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good.” (Althabe and Belizan, 2006, cited in: Childbirth Connection, 2012)
II. C-Sections Raise the Risk of Childhood Obesity
The work of Boyles (2012) states that birth by cesarean delivery has been recently linked to “an increased risk for allergy and asthma in children and as well it is believed that delivery by c-section is linked to the risk of childhood obesity. The report additionally states “New York ob-gyn Mitchell Maiman, MD, believes a large percentage of C-section deliveries performed in the United States fall into the category of “not medically necessary. Maiman is chairman of the department of obstetrics and gynecology at Staten Island University Hospital, near New York City, where close to 1 in 5 babies is delivered by C-section.” (Boyles, 2012) The report states that according to Maiman a new study has found that there is “an association between C-section delivery and childhood obesity…even after the researchers controlled for known obesity risk factors.” (Boyles, 2012)
III. World Health Organization Report
According to one report the World Health Organization has indicated that C-section rates above 15% are “probably too high.” (Norton, 2012) The study reports that researchers state findings that “69 countries worldwide top that 15% rate. On the other end of the spectrum, 54 countries had C-section rates lower than 10% — which may be below what is medically needed.” (Norton, 2012) When the costs were calculated by researchers, they estimated that bringing the C-section rate down to 15% would result in a savings of $2.3 billion globally each year. (Norton, 2012, paraphrased) It is reported that in countries with low rates of C-sections the cost of bringing them up to 10% would result in a cost of approximately $432 million. (Norton, 2012, paraphrased) It is stated that the research findings:
“…paint a picture of the global “inequities” in C-sections, according to Drs. Jose Belizan and Fernando Althabe, who worked on the study. One implication is that a “better distribution” of resources could allow more women in poorer countries to get medically needed C-sections, said Belizan, and Althabe, of the Institute of Clinical Effectiveness and Health Policy in Buenos Aires, Argentina. Recruiting professionals from high-rate countries to perform C-sections in low-rate ones — or to train local health providers to perform them — is one possibility, the researchers said in an email.” (Norton, 2012)
IV. Costs Not the Only Factor to Consider
Costs however, is not the only factor that should be considered as the best interest of the patient is cited as a primary concern. Concerns include that while the procedure “…is generally safe, it is still major abdominal surgery with inherent risks, like infection or too much blood loss. C-sections also boost the odds of certain problems with later pregnancies, including abnormalities in the placenta that can lead to severe bleeding during labor.” (Norton, 2012) Included among the factors driving the rate of C-sections in the United States is the fact that some women “…request the procedure, for instance, so as to choose when they give birth or to avoid long labor. And obstetricians may be quicker to do them now than in years past.” (Norton, 2012) Cited as one way to reduce the number of C-sections is the reduction and avoidance of “first cesareans, and do them only when indicated.” (Norton, 2012) The way that this can be accomplished, according to the report “is to limit labor inductions to only cases where they are necessary.” (Norton, 2012) Induction of labor involves the use of medication or instruments by doctors that serves to stimulate labor and when labor does not progress normally a C-section may be deemed as necessary. The work of Park (2010) reports that 43% of women “attempting vaginal delivery were induced” into labor. Cited as another way to limit C-sections “is to do more vaginal deliveries in women who’ve had a C-section in the past. Repeat C-sections account for a large share of the U.S. total, even though experts say many women can successfully deliver vaginally after a past C-section. There is a chance the C-section scar will tear during labor, but it’s rare.” (Norton, 2012)
V. Failure to Offer Options in U.S. Hospitals
It is reported that many hospitals in the United States “…do not offer those women the option of a vaginal delivery because they cannot guarantee a team on hand to perform an emergency C-section if necessary.” (Norton, 2012) It is noted in the report that the rate of cesarean deliveries in the United States was down from 32.9 to 32.8% and while this difference is not a large one it is reported that experts have hope that this reduction indicates a leveling off in the use of C-section deliveries. In poorer countries, there are many obstacles to women receiving needed C-sections including the “high rates of home births, too few hospitals, and too few providers who can perform the surgery.” (Norton, 2012)
Summary
From the literature reviewed in this study it can be clearly ascertained that induction of women into labor combined with factors that include convenience for both doctor and mother on timing of delivery, failure to offer women the option of vaginal birthing, risk of being sued for not having performed a C-section, an overall tendency in the United States to perform C-sections and at a rate of 39.8% with induction rates at 48%, as well as other factors contribute to the high rate of cesarean deliveries. Poorer countries however, have lower rates of C-sections because there are not medical professionals with the skills to perform cesarean deliveries available even in cases where cesareans are actually and often critically needed. In addition, it has been garnered in a study that the costs of C-sections are significantly higher than for vaginal deliveries costing $432 million annually.
Conclusion
In light of the facts that have emerged during the course of this study, there are specific conclusions that have resulted in light of what the nurse can do to reduce the rate of cesarean deliveries. Firstly, the obstetric nurse can instruct the expectant mother of the proper nutrition and most particularly exercise regimen for enhancing vaginal labor and delivery without an extended labor period. This is common knowledge among many women although not promoted as it should be in todays care of expectant mother’s health status. Secondly, the labor and delivery nurse can encourage the mother to use proper techniques for breathing and relaxation that serve to enhance the timely progression of labor and delivery while simultaneously reminding doctors that cesarean deliveries are not desirable due to the health outcomes and the costs associated with this procedure and through supporting hospital and healthcare policy and regulation centered on this issue. There are associated risks of vaginal birth deliveries that emerged in the literature and specifically that reported in the work Wells and Cunningham (2012) entitled “Choosing the Route of Delivery After Cesarean Birth” which reports on women having a vaginal birth after c-section with complications that included “uterine rupture-related maternal and perinatal morbidity… at rising rates. It is certain that along with the problem is a great deal of uncertainty on how this problem will ultimately be resolved. What is certain is that the nurse practitioner is in a unique position to positively affect the rate of women giving vaginal birth rather than having a cesarean delivery and with this known arises certain recommendations based on the literature reviewed in this study.
Recommendations
The literature reviewed in this study has emerged to indicate that a study should be instituted that examines this matter and that the study be qualitative in nature as this will include the need to understand certain social phenomenon that contribute to this specific choice among doctors and expectant mothers that demands to be disseminated along with the study of other factors that have already been examined and cited in this brief study examining the use of cesarean deliveries in the United States.
Bibliography
Boyles, Salynn (2012) C-Section May Raise Child Obesity Risk: Obesity Rate Twice as High in Surgically Delivered Children. WebMD. 24 May 2012. Retrieved from: http://www.webmd.com/diet/news/20120524/c-section-may-raise-child-obesity-risk
Cesarean Section (2012) Why Is the National U.S. Cesarean Section Rate So High? Childbirth Connection. Retrieved from http://www.childbirthconnection.org/article.asp?ck=10456
Norton, Amy (2012) Curbin C-sections could save countries billions. Reuters Health. http://www.reuters.com/article/2012/03/23/us-cesarean-idUSBRE82M0Z020120323
Park, Alice (2010) Understanding the High C-section Rate in the U.S. Health Land TIME. Retrieved from: http://healthland.time.com/2010/08/31/understanding-the-high-c-section-rate-in-the-us/
Reinberg, Steven (2011) C-section rate in U.S. climbs to all-time high. 22 Jul 2011. USA Today. HealthDay report retrieved from: http://www.usatoday.com/news/health/wellness/pregnancy/story/2011/07/C-section-rate-in-U.S.-climbs-to-all-time-high/49607756/1
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