I’ve been kicking around this post in my head for quite some time, and am finally getting it out of my head where everybody else can see it.
First, what is “the ideal C-section rate”? 100% for every mother or baby who truly needs it, and 0% for everyone else. Ok, so that’s a tad idealistic. 🙂
So what is ideal?
The most known recommended figure is the 15 percent upper limit suggested by the World Health Organization (WHO) in 1985 (2). This recommendation was based on the cesarean section rates of the countries that had the lowest maternal and neonatal mortality rates in the world at that moment (approximately 10%). Since those were developed countries, WHO increased the recommended cesarean section rate to 15 percent, taking into consideration that developing countries had a larger proportion of population at risk that could benefit from cesarean section. (Quote from page 2 of this document.)
The same document also noted that while C-sections reduce maternal and neonatal mortality when medically justified (same page, right-hand column),
Cesarean section is an ineffective intervention to reduce maternal and neonatal mortality, compared with vaginal delivery, when it is medically unjustified. This assumption is supported by the lack of experimental studies comparing cesarean section and vaginal delivery in healthy pregnancies and by extensive published observational evidence. Moreover, this observational evidence shows that unjustified cesarean section can even be harmful to women and children (11).
In other words, if the mother or baby is going to be harmed or killed by a vaginal birth, then a C-section will statistically reduce the mortality rate; but elective C-sections, or medically unjustifiable C-sections, don’t help anybody, and may indeed be harmful.
While it’s obvious that higher-risk women and babies will need more C-sections than lower-risk women and babies, looking at countries on an average, researchers concluded that a 10% C-section rate in a typical developed country with its mix of low- and high-risk women had low maternal and neonatal mortality. If a country has a higher proportion of high-risk women, then it would be understandable and even laudable to have a higher C-section rate, just as an individual doctor who is a “high-risk specialist” and sees only high-risk women would obviously be justified in having a higher C-section rate. But if low-risk women are having just as many C-sections as high-risk women, then it seems like something is seriously mixed up. Since women who plan homebirths are typically low-risk (many pre-existing or underlying medical conditions will cause a woman to “risk out” of home birth), and have approximately a 10% hospital transfer rate, the rate of C-sections in this low-risk population is lower than 10%, with it possibly being even lower than 5%. With low maternal and neonatal mortality and morbidity.
So why does the United States have a 30% C-section rate? Even if it’s legally justifiable, it’s not medically justifiable. I just recently read this comment somewhere: “We do not have a justice system. We have a legal system.” While the comment was in regards to a person who may have been wrongly convicted of murder, it works here too. Doctors are at too much legal risk if they do not suggest, coerce, or force C-sections when a situation is “iffy”. It doesn’t matter if the doctor was medically justified in allowing the mother to continue laboring; it only matters if he is legally justifiable in doing it, and as the comment goes, “The only C-section you’ll get sued for is the one you didn’t do.”
So, is 15% ideal? Depends. I think that it should be a goal — something for doctors to keep in mind. As the song “Happy Talk” from the movie South Pacific goes, “You’ve gotta have a dream — If you don’t have a dream, how’re you gonna have your dream come true?” If you don’t look at the C-section rate (just avoid it and hope it goes away), it won’t get any better. An unnecessary C-section opens up serious risks to the mother and baby without any counter-balancing benefit. So it is a worthy goal to make these surgeries as rare as possible. But that can only happen if doctors start seriously looking at why women end up with C-sections, and trying to avoid those causes. Otherwise, it’s beginning to sound like Mark Twain’s quote about the weather — “Everybody talks about it, but nobody does anything about it.”