Tuesday, August 29, 2000

After years of decline, C-sections on rise

By Lauran Neergard
The Associated Press

        WASHINGTON — Caesarean sections started dropping slowly in the early 1990s after an outcry that American women undergo too many — but now they're on the rise again.

        Most puzzling: Why C-sections are increasing in first-time moms, not just in women who previously had one. And where pregnant women live determines how likely they are to wind up on the operating table — C-sections are more common in the South than out West.

        Now, with Caesareans inching back up to 22 percent of U.S. births, the nation's leading obstetricians' group is issuing new guidelines to reduce unnecessary C-sections and reserve the surgery for mothers and babies who truly need it.

        There are many suspects in the C-section rise — state- by-state variation particularly suggests doctors' habits sometimes can overshadow medical need.

        “Maybe we've become too technical,” says Dr. Jean Walker, an attending obstetrician at Chicago's Rush-Presbyterian-St. Luke's Medical Center, which is taking new steps to lower C-sections. “We're going back to natural things like walking more often and birthing balls and really encouraging natural descent of the fetus.”

        Caesareans can be life- or health-saving for many mothers and babies. Fetal distress, disorders that make labor risky for the mother, a baby simply too big or wrongly positioned all are important reasons for C-sections.

        But avoiding unnecessary C-sections also is important. Women's risk of death, although still small, is three to seven times higher than during vaginal delivery, says the American College of Obste tricians and Gynecologists.

        C-sections have risen for three years, climbing another 4 percent in 1999 to account for 22 percent of live births, the government reported this month.

        That's lower than the nation's high of 25 percent in 1988 — but nowhere near the federal goal of 15 percent.

        Greater Cincinnati hospitals also report recent, slight increases in C-section rates.

        In 1999, the unadjusted community average C-sec tion rate was 19.8 percent. That was up 1 percentage point from 18.8 percent in 1998 and 18.6 percent in 1997, according to the Greater Cincinnati Health Council.

        The community average was based on reports from 17 Tristate hospitals performing deliveries in 1997 and 1998 and 14 hospitals in 1999.

        Tim Bonfield of the Enquirer contributed to this report.



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