August 31st, 2010
12:30 PM ET

Ripple effect seen from rising C-sections in first-time moms

One in three first-time moms are now delivering their babies by Caesarean section, according to a new study.

This has a tremendous ripple effect because most of these moms are likely to have repeat C-sections, says lead study author Dr. Jun Zhang.  "C-section in first-time mothers is increasing and VBAC (vaginal birth after C-section) is decreasing."

Zhang is a labor and delivery expert at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which funded the research.  He says his study, published in the American Journal of Obstetrics & Gynecology, also found that 44 percent of women who attempted vaginal delivery were induced, and in this group the C-section rate was twice as high as women who were not induced.

More research is needed to determine whether inducing labor leads to complications, which then make a C-section necessary, Zhang says.

Zhang also says the study suggests that doctors may not be patient enough.  Researchers found that with first time moms attempting natural delivery, the decision to deliver the baby by C-section was made before the recommended three hours of "second stage of labor" (when moms are pushing) or before the moms were at least 6 centimeters dilated, both short of the recommended guidelines set by the American College of Obstetricians and Gynecologists.

Zhang and his co-authors analyzed electronic medical records from more than 200,000 births at 19 hospitals across the United States.

In March, the Centers for Disease Control and Prevention released data that shows that 32 percent of babies in the United States are delivered by C-section, which is the highest rate ever recorded and 53 percent higher than the rate in 1996.  Some pregnancy complications that could make a C-section more likely include the age of the mother, the mother's weight and twin or multiple pregnancies.

Zhang says scheduled repeat C-sections now contribute to almost a third of all Caesarean deliveries.  He says only one in six women even attempted natural delivery after having a C-section in a previous pregnancy.  "Prelabor Caesarean delivery due to a previous uterine scar (from previous C-section) was the most common reason for Caesarean section," the study said.  According to an NIH panel of experts on vaginal birth after Caesarean, the risk of uterine rupture is a common reason for doctors to suggest a repeat C-section, even though that risk is lower than 1 percent.

Carol Hogue,  a maternal and fetal health expert at Emory University in Atlanta, Georgia,  was on the NIH panel.  She strongly believes that moms-to-be need to be better educated before they have their baby. "C-section itself is not a benign thing," says Hogue. While many people may no longer view Caesareans as a major operation, she says women need to remember that there are risks
for a mother because it is still major surgery, which can include complications with anesthesia and scarring.  'The process of labor helps the baby survive," Hogue adds.

Just last month, ACOG reaffirmed its guidelines that VBAC is a viable option and urged physicians to counsel women who have had one or two previous C-sections to consider delivering their baby naturally.

The study concludes that if fewer women were induced, if better guidelines for the timing of Caesareans existed and if women were better educated about their ability to deliver a baby after a surgical birth,  it could help lower the number of C-sections in this country.

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