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A troubling trend in women’s health issues is the inappropriate use of cesarean sections. This method of delivery grew significantly in recent decades, and a 1993 report in Soc Sci Med states that half of the C-sections performed in the United States are unnecessary. According to this study, the main reasons for performing a cesarean-including a previous C-section and slow or difficult labor, among others-have been least clearly connected to benefits.7 The studies below point to a host of potential complications associated with cesarean deliveries—starting with higher rates of maternal mortality than with vaginal deliveries.8-9 Other problems include ruptured uterus and hemorrhage, fever, urinary tract infections, and wound infection.10-12
This article indicates that in the U.S., almost 1 out of 4 deliveries are performed by cesarean section. These rates are among the highest recorded in the developed countries. From 1970 to 1993, overall rates of primary cesarean sections increased by 4-folds, from 5.5% to 22.8%. Since deliveries by cesarean section carry a significantly higher risk of complications for both the mother and the newborn, the national health goal for the year 2000 has been to lower its rate to 15% or below, a value that has not been observed since 1978.
—Rates of Cesarean delivery-United States, 1993. MMWR Morb Mortal Wkly Rep 1995 Apr 21; 44(15):303-7.
The results of this study show that the rate of cesarean sections in Scotland increased by over 3-fold in the period from 1962 to 1992, with no apparent cause to justify this increase other than a lowered threshold of acceptance of the procedure in obstetric practice.
—Leitch CR, Walker JJ, The rise in caesarean section rate: the same indications but a lower threshold. Br J Obstet Gynaecol 1998 Jun; 105(6):621-6.
This article emphasizes that half of the cesarean sections performed in the U.S. are unnecessary. This surplus needlessly endangers women and their babies and adds over $1 billion to the annual health care costs. Cesarean section deliveries are associated with a 2- to 4-fold increased rate of maternal mortality and with a 5- to 10-fold increased rate of maternal morbidity, compared to vaginal deliveries. Newborns delivered via cesarean section are at increased risk of respiratory disease and of being delivered before proper time. The author highlights how decisions concerning the need for cesarean delivery seem to be influenced more by social, economic, and physicians’ personal reasons than by medical factors. This is well illustrated by the fact that those women who are at highest risk of pregnancy complications and who would benefit the most from a cesarean section are the least likely to receive it. On the other hand, indications such as previous cesarean, slow or difficult labor or delivery, presentation of the rear of the baby at the uterine cervix and fetal distress, are the main reasons for performing a C-section, even though these conditions have been least clearly associated with benefits for the fetus and the mother.
—Shearer EL, Cesarean section: medical benefits and costs. Soc Sci Med 1993 Nov; 37(10):1223-31.