April is Cesarean Awareness Month

If you are a woman- if you have given birth, if you haven't given birth yet but will likely in the future, if you know someone who will give birth, please read this. It is really important.

General disclaimer: Cesarean sections can be lifesaving for mothers and for babies. I am so grateful that is safe for the mothers and babies that need it.

My concern: In 2008, the national cesarean section rate was 32.3%
This graph has a breakdown of primary (first) cesareans, total cesareans and the vbac rate from 1983-2006.

The World Health Organization has found that a cesarean rate above 10-15% causes more harm than good. Between 5-10% seems to optimize outcomes. Midwives have been able to pretty consistently achieve a cesarean rate at 5% or below with as good or better outcomes: The British Medical Journal CPM 2000 study had a 3.7% cesarean rate and The Farm midwives made their statistics available in 2000. They have a 1.4% cesarean rate. If you click through to those links, you will be able to read more, but this is with similar mortality rates and much lower morbidity rates.

This means that many, many women are undergoing major surgery unnecessarily. With all the risks that go with it- immediate risks and those that impact future pregnancies. From Childbirth Connection:

Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. Short-term harms for mothers include increased risk of infection, surgical injury, blood clots, emergency hysterectomy, intense and longer-lasting pain, going back into the hospital and poor overall functioning. Babies born by cesarean section are more likely to have surgical cuts, breathing problems, difficulty getting breastfeeding going, and asthma in childhood and beyond. Perhaps due to the common surgical side effect of "adhesion" formation, cesarean mothers are more likely to have ongoing pelvic pain, to experience bowel blockage, to be injured during future surgery, and to have future infertility. Of special concern after cesarean are various serious conditions for mothers and babies that are more likely in future pregnancies, including ectopic pregnancy, placenta previa, placenta accreta, placental abruption, and uterine rupture (Childbirth Connection 2006).

So what can you do to avoid having an unnecessary cesarean?

• Be a good consumer. Found out your care provider's cesarean rate. Count on being the rule and not the exception.
• Read up on modern birth practices. Most procedures and protocols in the hospital are *not* evidence- based medicine.
• If you have already had a cesarean, consider vbac. Go to ICAN to find out more.
• If you are a low-risk woman, get a midwife. In general, midwives have as good or better outcomes than doctors. Birth is a normal, biological function and not a disease- go to an expert in normal birth, not a surgeon. Visit the Midwives Alliance of North America, the North American Registry of Midwives or the American College of Nurse-Midwives.