Tag Archives: Consortium on Safe Labor

A closer look at a new study on cesareans

Posted on by
1

The full text of the article "Contemporary cesarean delivery practice in the United States" published on-line in the American Journal of Obstetrics and Gynecology reveals some interesting insights into the particulars of the study. Birth Story published an earlier post this week based on the abstract.

"The national rate of cesarean delivery in the United States has increased more than 50 percent since 1996, to 31.8 percent in 2007," the report states. "This upward trajectory appears likely to continue in the near future."

The study was performed as part of the Consortium on Safe Labor, an initiative of the National Institute of Child Health and Human Development. It used electronic medical records of 228,668 births at 19 American hospitals between 2002 and 2008.

Here are some highlights:

  • A total of 93 percent of babies who presented "nonvertex" — with any body part other than the head in the lead— came into the world via C-section.
  • Almost 66 percent of multiples — twins or more — were delivered by cesearean section. Most of these moms did not attempt a trial of labor.
  • The C-section rate doubled from 21 percent at age 20 to 42 percent after age 35, "mainly due to repeat pre-labor cesarean deliveries."
  • Half of cesareans performed once labor had begun were because of "failure to progress" or  the belief that the baby's head was too large for the mother's pelvis. More than a quarter were performed because of "fetal distress."
  • Among women who had had previous deliveries, most C-sections occurred before labor began, and that was true no matter when they delivered.
  • More than 60 percent of deliveries at 28 weeks gestation were C-sections. That rate went down as pregnancies progressed.
  • The trial of labor in women with a uterine scar was 48 percent in 1999, 31 percent in 2002, and 29 percent by 2007.
  • The success rate of vaginal births after cesarean (VBAC) in the study was 57 percent (of the 28 percent of women who attempted a VBAC), "markedly lower" than in "previous large studies," which had ranged as high as 87 percent.
  • Overall, 84 percent of women with a uterine scar delivered by C-section.
  • Pre-labor repeat C-sections "have a profound impact on the overall cesarean rate."
  • "Truly elective" cesareans accounted for 9.6 percent of C-sections before labor commenced, and 2.1 percent undertaken during labor.
  • The hospitals in the study represented a wide range in rates of C-sections, from 20 to 44 percent.
  • Nearly 10 percent of the women who participated in the study added more than one delivery to the database; only the first delivery for each was included in the analysis.
  • Two of the hospitals in the study were non-teaching community hospitals. Nine were teaching community hospitals and eight were university-affiliated teaching hospitals.

    • Too many first-time moms get C-sections

    Posted on by
    1

    The most telling finding of a new study on cesarean sections in hospitals in the United States is that 31.2 percent of first-time mothers had C-sections.

    "Reducing primary cesarean delivery is the key" to bringing down the overall C-section rate, the researchers concluded. In 2007, the last year studied, America's C-section rate stood at 32 percent, a new high.

    The study, an analysis of nearly 229,000 births at 19 hospitals between 2002 and 2008 published on-line ahead of a print article in the American Journal of Obstetrics and Gynecology, was conducted under the aegis of the National Institute of Child Health and Human Development.

    The study found that 44 percent of women attempting a vaginal delivery were induced. Half of the women who had C-sections for dystocia — slow or difficult labor — were cervically dilated to less than 6 cm, far short of the 10 cm dilation that signals that birth is imminent, when the decision was made to operate.

    Of the 29 percent of women in the study who had previous C-sections, and were allowed a trial of labor, 57 percent delivered vaginally.

    The overall cesarean rate was 30.5 percent.

    The abstract of the study concludes, "To decrease cesarean delivery rate in the United States, reducing primary cesarean delivery is the key. Increasing vaginal birth after previous cesarean rate (sic) is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparous women and in induced labor."

    Many of the births included in the study took place at teaching hospitals, where more complicated birth often land, the study's authors noted.