Efforts to reduce medically unnecessary cesarean sections in the United States may be paying off. From 2009 through 2011, the rate of cesarean deliveries has been stable at 31 percent, after rising nearly 60 percent over the previous 13 years, according to a National Center for Health Statistics report released Thursday. The report analyzed singleton births; multiple births are nearly 2.5 times more likely to be delivered by cesarean.
"I think this data is very significant because it isn't just one year. It's three years of flattening of the cesarean delivery rate," says Dr. George Macones, chair of obstetrics and gynecology at Washington University in St. Louis School of Medicine. "I think most people in obstetrics think that is a good thing."
A cesarean delivery, where the baby is born through a cut in the mother's belly and uterus, comes with increased maternal risk of infection and bleeding and a longer recovery time than a vaginal birth. "It's invasive abdominal surgery," says Michelle Osterman, a health statistician and an author of the report.
In 1996, the most recent low point, 19.7 percent of singleton births were delivered through cesarean section, according to the new report. The rate climbed to 31.3 percent in 2009, where it has remained.
Macones says multiple factors contributed to the earlier surge in cesareans, including physicians who have a lower threshold for performing the surgery, hospitals that refuse to allow vaginal births once a woman has had a cesarean, and patients who pressure their doctors to schedule delivery. "If you induce labor, the risk of a cesarean section is higher," says Macones.
Inducing labor before 39 weeks of gestation can also mean extra days in the hospital for babies, says Macones, who may have transient problems with breathing, feeding, regulating body temperature, and regulating bilirubin levels in the blood. Bilirubin is a yellowish pigment produced when the body removes older blood cells. Large amounts of bilirubin in the blood can lead to jaundice.
For several years, the March of Dimes and the American College of Obstetricians and Gynecologists have been working to reduce medically unnecessary cesareans and elective labor prior to 39 weeks through education programs and written guidelines.
Those efforts may account for what appears to be a shift of cesarean deliveries to later in pregnancy. While the overall rate of cesarean deliveries has remained unchanged since 2009, the cesarean delivery rate at 38 weeks of gestation declined 5 percent and the rate at 39 weeks increased 4 percent. "I tried to highlight the contrast between the two weeks. It's very specific," says Osterman.
"I think that is really great news," says Macones.