- The Washington Times - Wednesday, November 16, 2005

ATLANTA — The rate of Caesarean sections in the U.S. has reached a record high, despite efforts by public health authorities to bring down the number of such deliveries, the government said yesterday.

Nearly 1.2 million Caesarean sections were performed in 2004, accounting for 29.1 percent of all births that year, the National Center for Health Statistics reported. That is up from 27.5 percent in 2003 and 20.7 percent in 1996.

The increase is attributed to fears of malpractice lawsuits if a vaginal delivery goes wrong, the preferences of mothers and physicians and the risks of attempting natural births after Caesarean sections.

The Caesarean-section rate increased for all births, even those that involved healthy pregnancies and a full-term, single child. In 2000, the government announced a national public health goal of reducing Caesarean sections for such births to 15 percent by 2010, but the rate is about 24 percent and rising.

The government also reported that more than a half-million infants were born preterm — at less than 37 weeks’ gestation — in 2004, which is another record. The proportion of infants with a low birth weight rose to 8.1 percent in 2004, from 7.9 percent the previous year.

Increases in multiple-child pregnancies and in preterm Caesarean sections seem to help explain the preterm and low birth-weight numbers, said Joyce Martin, an epidemiologist who co-wrote the report.

A Caesarean section is major surgery. A doctor cuts open a mother’s abdomen to retrieve the baby. The risks include infection and, in rare cases, death. Recovery time is longer than with a vaginal delivery. Doctors often perform a Caesarean section when the baby lacks oxygen or is in some other kind of life-threatening distress.

For decades, Caesarean sections were performed in only a small fraction of births. In 1970, the national rate was 5 percent. Then it rose, surpassing 20 percent by the mid-1980s.

Officials and scholars say many factors drove the rate: Mothers increasingly preferred the convenience of Caesarean sections, which could be scheduled. Technological innovations let doctors better see problems before birth.

The trend temporarily reversed in the early 1990s, partly because health maintenance organizations pressured doctors to curtail unnecessary procedures. But by the late 1990s, health insurers had cut back their Caesarean-section control efforts.

Also, some doctors became worried that women who have had a Caesarean section during an earlier pregnancy can suffer a ruptured uterus if they later attempt a vaginal delivery — a potentially lethal complication for both mother and child.

Some hospitals have banned vaginal deliveries after Caesarean section, or VBAC, said Tonya Jamois, president of the International Cesarean Awareness Network, an advocacy organization.

“Women are struggling to avoid unnecessary surgery, but the medical system has abandoned them. For many, they have to submit to major surgery in order to get medical care,” she said.

The VBAC rate has dropped to 9.2 percent of 2004 births after a previous Caesarean, compared with 28.3 percent in 1996.

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