Reducing the Cesarean Rate

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Looking back nearly 40 years, the cesarean rate in the United States in 1970 was only 6%. This meant that about 94% of women were giving birth vaginally in this country. However in 1987, it reached a whopping 24.4%. Many wondered if the trend would continue.

Although there was a slight decrease in the cesarean birth rate between 1990 and 1996, there has been a steady rise since then. In response, both the CDC and US Department of Health and Human Services in 2000 recommended that the national cesarean rate be reduced to what was considered to be a reasonable target of 15%. Was there reason to think that we could reach that target?

Unfortunately, in 2003, the cesarean rate grew again to 27.1%. Again the target set by the Department of Health and Human Services for cesarean births for the year 2010 at no more than 15% for a first time mother and 63% for repeat cesareans.

The reality is that our latest statistics do not show that we are anywhere near that goal. In fact we are moving in the wrong direction. In 2004, the statistics showed a 29.1% primary cesarean rate. The Listening to Mothers II survey reports a possible rate closer to 31% for 2005 or approaching nearly one third of all births in the United States. There are many possible reasons why the cesarean rate is so high right now including the high rate of inductions and the use of electronic fetal monitoring for nearly every hospital birth.

Is there anything you can do about the rising cesarean rate? If you are expecting, here are eleven ways to reduce your own chances of a cesarean:

  • 1. Choose a provider with low cesarean rate and high VBAC rate.
  • 2. Choose a supportive place of birth with a low cesarean rate. (Consider a birth center or homebirth.)
  • 3. Use continuous labor support (doula) during labor and birth.
  • 4. Delay getting an epidural until you are 5 cm dilated, the baby is at zero or lower station and the baby is rotated into the anterior position.
  • 5. Take a good childbirth preparation class that reviews and practices a variety of pain relief techniquesand positions for labor.
  • 6. Write a birth plan.
  • 7. Allow labor to start on its own and avoid a labor induction unless there is an indicated risk for you or your baby.
  • 8. If you are low-risk, spend early and most of active labor at home.
  • 9. Stay upright and mobile during labor and while pushing.
  • 10. Realize that labor has its own timetable and pattern. Some mothers will need only hours to labor and others will need several days. Both are normal.
  • 11. If your baby is breech, try methods to turn your baby to vertex or finding a provider skilled to deliver your baby in the breech position, instead of scheduling a cesarean.

Do you think the cearean rate is too high? Share it with us on the forum.