Factors Contributing to the High Cesarean Rate

The United States’ cesarean birth rate skyrocketed from 4.5 percent in 1965 to a high of over 24 percent in 1988. This has decreased slightly to the current rate of approximately 21 percent. This decrease was the result of a concerted effort to reduce the high rate of cesarean deliveries. Among the factors that contributed to the reduction is the increase in vaginal births after a cesarean.

Many factors contribute to the high cesarean rate. One reason given by some doctors is the threat of a malpractice suit if a cesarean is not done and a “less than perfect” baby results. At least 79 percent of obstetricians have been sued at least once. About 80 percent of these lawsuits involve a claim that a cesarean was not done or was not done soon enough.

The training that obstetricians receive is changing. Because of the risks involved in the use of forceps, doctors now receive less training in managing difficult deliveries (breech births and fetal distress) using this tool. High forceps deliveries have been completely replaced by cesarean sections, and some doctors now also substitute surgical intervention for the difficult midforceps delivery.

Obstetrical training revolves mostly around handling complications. As a result, many doctors treat all laboring women as potentially high risk and rely on sophisticated equipment such as electronic fetal monitors and on the routine use of IVs. A dramatic increase in the use of epidurals for labor may also be contributing to the high rate of cesareans.

The increase in women over 30 years of age giving birth is another factor in the high cesarean rate. They are at increased risk for complications, and physicians may be more likely to perform cesareans if they perceive that an adverse outcome may result. Also, multiple births have increased dramatically in the past 20 years, and these infants are more likely to be delivered by cesarean, especially if one of the babies is in an abnormal presentation. Additionally, c-section is often used for very low birth weight babies.

Some professionals feel that at least a small percentage of the increase in cesareans is due to the convenience and increased income the procedure offers doctors. Higher fees result from the surgical procedure, the longer hospital stay, and the guaranteed insurance coverage.

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