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Thursday, January 23, 2014

Monsday Monday: Reducing the US C-Section Rate

How we can safely deliver babies is a complex topic, and one that has to consider mom in the mix. We know that c-section rates over the past 15 years have risen by more than 60% and most experts agree, that rate is alarmingly high as moms have changed a bit, but not enough to warrant such a dramatic increase. It is clear that we can decrease the c-section rate, and there are some proposals as to how from a new study of over 225,000 women that has been producing many interesting publications. In this study from the Consortium on Safe Labor, published by Boyle in OBSTETRICS And  GYNECOLOGY in July 2013 they highlight the risks of Cesarean birth as a reason to try to reduce the American C-section rate which in 2009 was at 32.9 % and appears to still be risking. Although there may be many reasons to have a c-section to increase the safety for mom and the baby(s) in the current pregnancy there are reasons that c-section present risks. It increases the risks in the next pregnancy of having a ruptured uterus, and a placenta that is implanted improperly. At the time of the c-section and in the next pregnancy it increases the risk that that the mom will have hemorrhage, a hysterectomy, or even die. Proponents of increased c-sections talk about fewer cases of shoulder dystocia (stuck babies) and less bladder problems for mom as she ages and other benefits. And there are many arguments for both increasing and decreasing c-section rates.Induction of labor is not one of the major reasons for the overall c-section rates, but reducing elective inductions has become a target that can help ease the overall rate down. In 1990 only 10% of women in the US were induced, now about 1/4 women has labor induction. Other ways of decreasing c-section rates would be to always try to get a woman to 6 cm dilated before calling the labor stalled, even if it takes longer than normal. We have continued to use oxytocin to enhance labor contraction, but we have introduced medications such as the dinoprostone insert and device use, such as inserting a foley balloon in the cervix to try to improve the success of women who do get induced. Also trying to deliver the mom vaginally when she is stuck in the second stage (fully dilated) is important.  in 2014 the natoionl twin birth rate reached the all time high of 33.9 according to the National Centers for Health Statistics. Not only are twins more likely to be premature, thus needing c-section for reasons associated with their prematurity, but they often are not in a safe head down-head down position for each to have a safe vaginal delivery. Trying to get more twins delivered vaginally, and helping to turn some breech babies to head down are also ways this group is suggesting we can lower c-section rates with this growing group as well. Whether watching your weight, or approaching pregnancy at a normal weight can reduce c-sections wasn't studied in this paper, but it may be another way to reduce your individual risk.

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