Lately I have taken a lot of time to sit down and look at some numbers for the past almost 40 years.
Maternity, cesarean section, Vaginal Birth After Cesarean (VBAC) and Maternal Mortality numbers, and I found some shocking patterns. While I am not statistics professor and I am clearly not a medical professional, the patterns that some of these numbers show us is alarming to say the least.
Because of lack of standardized reporting, many of the numbers before 1980 were not regulated or actually accurately kept, so this is all I was able to find through the CDC.
2008 Cesarean Birth Rate = 31.8%
1970 Cesarean Birth Rate = 5.5%
Maternal Mortality Rate per 100,000 live births in the United States
1970 – 21.5 (5.5% Cesarean Section Rate) *2.2% VBAC Rate
1975 – 12.8 (10.4% Cesarean Section Rate) *2% VBAC Rate
1980 – 9.2 (16.5% Cesarean Section Rate) *3.4% VBAC Rate
1985 – 7.8 (22.7% Cesarean Section Rate) *6.6% VBAC Rate
1989 – 7.9 (22.8% Cesarean Section Rate) *18.9% VBAC Rate
1990 – 8.2 (22.7% Cesarean Section Rate) *19.9% VBAC Rate
1991 – 7.9 (22.6% Cesarean Section Rate) *21.3% VBAC Rate
1992 – 7.8 (22.3% Cesarean Section Rate) *22.6% VBAC Rate
1993 – 7.5 (21.8% Cesarean Section Rate) *24.3% VBAC Rate
1994 – 8.3 (21.2% Cesarean Section Rate) *26.3% VBAC Rate
1995 – 7.1 (20.8% Cesarean Section Rate) *27.5% VBAC Rate
1996 – 7.6 (20.7% Cesarean Section Rate) *28.3% VBAC Rate
1997 – 8.4 (20.8% Cesarean Section Rate) *27.4% VBAC Rate
1998 – 7.1 (21.2% Cesarean Section Rate) *26.3% VBAC Rate
1999 – 9.9 (22.0% Cesarean Section Rate) *23.4% VBAC Rate
2000 – 9.8 (22.9% Cesarean Section Rate) *20.7% VBAC Rate
2001 – 9.9 (24.4% Cesarean Section Rate) *16.4% VBAC Rate
2002 – 8.9 (26.1% Cesarean Section Rate) *12.6% VBAC Rate
2003 – 12.1 (27.6% Cesarean Section Rate) *10.6% VBAC Rate
Starting around 1980, we see the maternal mortality rate start to decrease, while the number of cesarean sections increase, as well as the number of VBAC’s. Which is a good thing, anytime the maternal mortality rate decreases, it is good. Sadly we still lack behind the majority of other industrialized nations in the world when it comes to Maternal, as well as neo natal mortality rates.
During 1996 we see two things that stand out the most, the lowest maternal mortality rate, as well as the highest number of Vaginal Birth’s after cesarean sections, although the c-section rate is still too high according to the World Health Organization standards. But then once 1997 comes we not only see an increase in maternal mortality, but we start to see a decrease in VBAC’s which never recovers.
1998 till the represent numbers in 2003 how how not only the VBAC numbers suffered, dropping over 17% but also the maternal mortality rate started to increase again, but to an alarming 12.1 per 100,000 live births in the United States.
The decrease in VBAC’s as well as VBAC access is a controversial issue. Not only are hospitals decreasing access to VBAC, but they are doing it at drastic rates. Here are a couple alarming numbers for you.
Since 1996 the c-section rate in the United States has increased 50%.
8% of women who previously had c-sections had a VBAC in 2006.
28% of hospitals in the United States do not ALLOW VBAC.
0.7% of women rupture their uterus while attempting a VBAC.
The last number is something I want to focus on because this is the main risk that Doctors use in discouraging mothers to choose VBAC. They do not tell you that according to this statistic, you are more likely to get struck by lightening twice in your lifetime, or you are two more times likely to be murdered, or even twice as likely to have your car stolen in ONE year. But they are using this as a big scare tactic for discouraging women to sign up for surgery.
The problem is, the huge risks of repeat cesareans are being sugar coated. They are not discussing the risk of uterine rupture any time during pregnancy with these women. Uterine rupture can and does happen to women any time during pregnancy, not just while attempting to deliver vaginally. They do not tell you that you are more likely to be re-hospitalized in the following weeks after your surgery, suffer infection, increased risk of your uterus adhering to other organs such as your bladder, and the laundry list of problems that comes with abdominal surgery after abdominal surgery.
What else? Increases your risk of a blood transfusion, hysterectomy, Placenta accreta which is when the placenta actually grows into the walls of the uterus making a hysterectomy a common result. And these are also things we are seeing in increased numbers over the past 30 years.
In a recent blog, Michele Demont of BirthCut a website for post cesarean section mothers to express their feelings, blogged about ‘The Gift that Keeps on Giving” which details the amount of complications mothers are experiencing due to cesarean sections, but now we are just starting to see the long term effects because in the past 30 years, the cesarean section rate has drastically increased.
“Another article talks about one study where the rate of placenta accreta in women that had placenta previa with no prior cesareans was 5%, but if she had one prior cesarean it was 25%, 2 or more prior cesareans, the rate jumped to 50%.”
Frightening numbers that women are not being informed about up front when signing up for their cesarean sections, or repeat cesarean sections.
The problem we are seeing is defensive medicine, not evidence based medicine being practiced and sadly the women of childbearing age are becoming the victims of this system. Another article that I came across in the past couple weeks is from Jill who writes her own blog called The Unnecessarean. She discussed Multiple Cesarean Sections and the Long Term problems. In the piece, Jill discusses an e-mail she got from a reader regarding their mothers health after having two cesarean sections almost 40 years ago.
“Twenty or so years later, I had to rush my mother to the emergency room, and then consent to surgery (she was already comatose) to address what turned out to be a direct result of her two C-sections. The scar had opened up on the inside and her small intestine got tangled into the incision, causing a blockage severe enough that she nearly died.
A year later, it happened again with a different part of the incision. At that point, the surgeon elected to go ahead and open the entire incision back up and then re-sew it with a reinforcing plastic-type mesh to prevent it from opening again.
So my mother’s two major surgeries for having children ultimately resulted in two *more* major surgeries, when she was twenty years older and thus less able to bounce back. It was the beginning of a downhill spiral in her overall health.”
Shared the reader who chose to share this situation with Jill. Still we are not seeing this at large enough number for concern YET because we look back to the 1970′s and c-sections were not nearly as wide spread as they are today. 5.5% in 1970 compared to 31.8% in 2007 is a huge difference. What are we going to see over the next two decades in Maternal Health?
Last I just want to address VBAC Vs. Elective Repeat Cesarean Section. No matter how many studies, reports, information, or even just internet websites, they all say the same thing, VBAC is safer than repeat surgery. There are cases in which mothers have specific health issues, or results from their previous cesarean section that make VBAC a riskier choice, and a repeat cesarean may be warranted, but in Connecticut, only 6% of women in 2007 chose a VBAC over having a repeat cesarean section.
That may have to do with the strict rules local hospitals have put in place, or the hospitals such as Charolette Hungerford, St. Vincent’s Medical Center, Day Kimball Hospital, and Johnson Memorial Hospital. All of which do not allow women to make informed choices about their own maternity care, instead they are forced into a repeat cesarean section if they would like to birth there.
