C-sections at all-time high in new CDC report

The rate of births that ended in Caesarean-sections climbed by 53% in the years between 1996 to 2007, when they stood at 32%, the highest rate ever reported in the United States, the National Center for Health Statistics reported on Tuesday.

The rate is higher than those most other industrialized countries are experiencing, according to the report from the NCHS , which is an arm of the Centers for Disease Control, based in Atlanta, Ga. The cost of a C-section is almost double that of a vaginal delivery, the report notes.

C-sections were up for all groups across the board in the 11 years that were the major focus of the study, in terms of age, race, location, and how far along women were in their pregnancies.

About 1.4 million women gave birth by Ceasarean in 2007. In 2006, Caesarean delivery was the surgical procedure most often performed in American hospitals.

Here are the major findings of the report:

The U.S. C-section rate, 21 percent in 1996, was 32 percent in 2007, an increase of 53 percent. The steepest rise occurred between 2000 and 2007.

C-section rates went up by 50 percent or more in 34 states. In six states -- Colorado, Connecticut, Florida, Nevada, Rhode Island, and Washington -- the rate increased by more than 70 percent.

The rate rose for women of all age groups, with women under 25 having greatest rate of increase, 57 percent.

All racial and ethnic groups experienced increases. Black women had the highest C-section rate in 2007, 34 percent. Native American women had the lowest rate, 28 percent.

Caesarean rates increased for deliveries of infants of all gestational ages. C-sections for pre-term babies (less than 34 weeks gestational age) increased 36 percent; the rates for late pre-term babies (34 to 36 weeks) and term and post-term babies (37+ weeks) went up nearly 50 percent.

Early and late pre-term babies were more likely to be delivered by Caesarean section than were babies born at 37+ weeks.

The report cited possible reasons for the increases in Caesarean sections, in addition to medical indications for the surgery, as "maternal demographic characteristics," like advanced maternal age, fears of malpractice suits among physicians, doctors' preferences, and maternal preferences.

Nature is not always our friend

The World Health Organization estimates that the "natural" maternal mortality rate, which women with no access to health care could be expected to suffer, is between 1,000 and 1,500 per 100,000 births.

In Ireland, which has the world's lowest rate of maternal mortality, one woman dies per 100,000 births, so attention to laboring mothers makes a difference. In 2005, the worldwide maternal mortality rate was 402 deaths per 100,000 births.

The highest rates occur in politically unstable parts of Africa and Asia, notably Sierra Leone (2,000 deaths) and Afghanistan (1,900). The rate in the United States is 13, up from 12 the previous year. (All figures are from 2005.)

WHO defines maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the duration or site of the pregnancy, as long as the cause of death is related to or aggravated by the pregnancy or its management, and not from accidental or incidental causes.

Smile, baby!

The use of prenatal ultrasounds rose 55 percent for both high-risk and low-risk mothers in Ontario, Canada, between 1996 and 2006, according to a population-based study of nearly 1.4 million women published in the Canadian Medical Association Journal this week.

More than one-third of women delivering “singleton” babies had three or more outpatient ultrasounds during their second and third trimesters. Nearly twenty percent of prospective mothers had more than four ultrasounds in the second and third trimesters.

Two ultrasounds are generally recommended in uncomplicated pregnancies -- one in the first trimester, and another in the second, the report states.

The researchers, from Toronto-area facilities, led by John J. You MD, ventured that their findings are consistent with evidence accumulating in other health fields that "interventions most beneficial to high-risk individuals are frequently directed at low-risk populations."

Reasons for this, in the case of obstetrics, include... "the practice of defensive medicine, the desire to reassure a patient that her pregnancy is progressing normally, patient demand and even the 'entertainment' value of seeing one's fetus."