Tuesday, January 12, 2010

C-sections at "epidemic" levels - does it matter?

Today's MSNBC article C-section rates around globe at ‘epidemic’ levels highlights again the rise in c-section rates over the past few decades, particularly noting China's c-section rate at nearly 50%.

The article cites many reasons for this - financial incentives for hospitals, perception of "safety" with surgical birth, women who are scared of the pain of childbirth (but not the pain of major abdominal surgery?), fear of stretched vaginas, concern over breech babies, big babies and so forth.

But somehow, the article left me feeling that this issue was nothing beyond the typical health warning that we all become indifferent to - just another statistic, without any clear way to back off of that number and reduce c-sections. With financial incentives for hospitals to perform the operation and women's incorrect perception of increased safety and control with c-sections (and the association of an increase in c-sections with wealth, status and better hospital conditions - the "too posh to push" crowd) - how would this number ever fall?

I find it incredible that, as a society, there is not more outcry at this. Or maybe there is, but few of us are listening. Or maybe, we as women have just given up, or have not considered why this matters.

So why should we be alarmed at this trend to have such a large percentage of women having surgical births?

I'll tell you why I care about the c-section rate.

Unnecessary surgery not only drives health care costs up significantly - and everyone should care about that, having a c-section has a significant number of risks. Not little risks - big risks. Risks to mother and baby. Then, once a woman checks out of that labor and delivery room, the medical staff goes on to the next birth, but the woman herself is left with the recovery of all that happened to her and her child. Some of those consequences impact a woman's health for a lifetime.

And when a woman is already dealing with stressors such as poverty, domestic violence, financial issues or anything else in addition to a new baby, adding unnecessary medical complications, additional costs, longer healing time and increased risk of postpartum depression makes caring for a new baby that much harder.

In addition, each c-section has a great impact on health during future pregnancies and births, so increased costs - financial and health - not only apply to this birth, but to future births.

I'm not saying c-sections are all bad - they save lives. Many are done for legitimate reasons with firm medical indication. Most doctors truly do care and believe they are doing the right thing. Even the article talks about a lack of available emergency c-sections causing needless deaths. I had a c-section myself, one of those unambiguous ones, and don't regret it one bit. But my c-section did have complications, and my scar still pulls and aches to remind me, even 7 years later. I know from experience that it isn't just a minor thing.

So why care? Care because birthing is as important to the mother as it is to the baby. Care because the health risks of c-sections are real - it's major abdominal surgery with all the risks that go along with that. Care because the cost of unnecessary procedures is carried by all of us through taxes, increased insurance premiums and steeper hospital costs. Care because birth has an impact on a woman's life that lasts her whole life. Care because there can be another way - the world should not move in a direction such that something so fundamental to women's health as birth must be removed to the realm of the hospital and surgery. Women have not changed so drastically in the past 20 years that suddenly our bodies fail 50% of the time.

I'd love to hear your thoughts on this in the comments section!

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