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Sunday, November 27, 2016

C-Section Births Rising in the U.S. by Rishma Parpia


Women
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C-Section Births Rising in the U.S.

cesarean operationStory Highlights
  • C-section surgeries have markedly increased in the United States during the past two decades.
  • High C-section rates are not translating into better birth outcomes.
  • Research reveals that vaginal births strengthen the newborn’s immunity.
According to the World Health Organization (WHO), cesarean section (C-section) births are on the rise in wealthy nations.1 In 1965, the U.S cesarean birth rate was 4.5 percent.2 Since then, the national cesarean birth rate has increased seven-fold. In 2009, the rate peaked to 32.9 percent and dropped slightly to 32.2 percent in 2014.2 Currently, one in three women give birth via C-section, the country’s most common operating room procedure.2

High C-Section Rate in the U.S. is Not Producing Better Birth Outcomes

A cesarean birth is an abdominal surgery whereby doctors cut through the skin, the abdominal wall and the uterus in order to delivery a baby.3 In cases when there are pregnancy complications such as breech birth and umbilical cord prolapse, C-sections are medically necessary to assist in saving the mother and child’s life.3

There are other reasons why C-sections are performed but these reasons not always supported by medical research.4 For example, if a baby’s heart rate goes up or down, that can call for a C-section even when it is not absolutely clear that the baby is in distress4 Another such reason is that pregnant women carrying babies deemed to be “too big” to deliver vaginally often get C-sections even though there is no accurate test to determine the baby’s size.4
Many experts agree that too often C-sections are performed when the pregnancy is low risk and medically unnecessary.5 A few medically unnecessary reasons for a C-section include planning a due date around the mother’s personal plans or even a doctor’s schedule.3 A healthy labor can take up to 24 hours; on the other hand, a scheduled C-section operation of less than two hours can greatly improve scheduling and reduce staffing needs.5 C-sections require a longer hospital stay and usually cost more than vaginal births, especially if there are complications such as post-partum hemorrhage. Other reasons for a maternal preference for C-sections include fear of vaginal trauma or urinary incontinence, etc..3
Skyrocketing C-section rates are not producing better maternal health outcomes. The maternal mortality rate in the U.S. has increased in the last two decades to 14 deaths per 100,000 live births. This rate is higher than other industrialized nations such as Canada, Germany and the United Kingdom.6 A 2011 report on high infant mortality rates in the U.S. noted that,
Because all medical interventions carry risks, their use in situations when they are not demonstrated to offer benefits exposes women to risks that are unwarranted. For example, overuse of induction of labor and of cesarean sections, and lack of access to vaginal births after cesarean sections, all can lead to higher incidences of postpartum infection and higher rates of hysterectomies.7
The infant mortality rate in the U.S. is also concerning at six deaths per 1,000 live births. This rate is double that of countries such as Japan, Finland and Portugal.8
Research also shows that babies delivered through C-sections are at an increased risk of a number of chronic illnesses later in life.9 A study published in the British Medical Journal highlights that children delivered by C-section have a higher incidence of Type 1 diabetes, obesity and asthma.9 Author of the study, Dr. Jan Blustein of New York University’s School of Medicine states:
It is clear that cesarean-born children have worse health, but further research is needed to establish whether it is the cesarean that causes disease, or whether other factors are at play. Getting definitive answers will take many years of further research. In the interim, we must make decisions based on the evidence that we have. To me, that evidence says that it is reasonable to believe that cesarean has the potential for long-term adverse health consequences for children.10

Vaginal Birth Builds the Baby’s Immunity

C-sections are medically necessary in some cases. However, research suggests that given the option, vaginal births can lead to a healthier baby.11 This mode of delivery is extremely beneficial for inter-generational transfer of the microbiome from the mother to her child. This helps the baby build a strong immune system  beginning from the time of the birth.11
During vaginal delivery, newborns are introduced to the world of bacteria, viruses and other pathogens as they pass through the birth canal.11 The birthing process is their first form of immunization against pathogens that they will encounter in their new environment while their immune system is developing and building a stock of the microbes.12 They acquire the microbes from their mother’s gut. Over time, the newborn’s immune system begins to identify between the good and bad microbes and begins attacking harmful bugs while leaving  beneficial ones, such as those that live in the gut, alone.12
On the other hand, C-section surgeries skip this important immunizing stage leaving newborns more vulnerable to infections since their immune systems are in the process of catching up.12 In a study published in the Canadian Medical Association Journal, infants born by C-section had fewer colonies of Escherichia and Shigella bacteria than those born through vaginal delivery.13 An author of the study, Dr. Anita Kozyrskyj at University of Alberta’s Faculty of Medicine explains:
These are the seeding species that lay the foundation for the next groups of microbes to come. They are critical for priming the newborn’s immune system to learn which agents are potentially dangerous and which, particularly those on foods, can be given a pass.13
Sharon Meropol, assistant professor at Case Western Reserve University School of Medicine in Ohio explains:
Not only do we have to consider the microbiome of the child but also that of the mother, and the irony is that some of our modern medical practices, through their effect on these early microbiota, could have unintended consequences, interfering with normal development of children’s immune, metabolic, and neurologic systems. Disturbed microbiota could potentially contribute to a wide range of childhood diseases including allergies, asthma, obesity, and autism-like neuro developmental conditions.14

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