Over the past few decades, the use of C-sections has risen exponentially. C-sections now make up nearly one third of births, rising from about 5% in 1970. However, this rise hasn't been correlated with any notable decrease in maternal or infant mortality. On the contrary, C-sections are associated with more complications for both mother and child. In fact, women are 3.6 times more likely to die from a C-section than from a natural birth.
Even though American mothers are, on average, older, sicker, and more obese, it is still estimated that nearly half of these C-sections are not medically necessary. Mothers may be less healthy, but they are still very capable of natural birth. According to the World Health Organization, the ideal rate of C-sections lies between 10-15%; the U.S. rate is much higher than that. If organizations want to reduce the rate of C-section deliveries, then the responsibility will fall onto the shoulders of the doctors and hospitals to take those necessary steps.
Data and C-Sections
To reduce the C-section rates, doctors may need to work with administrations and hospitals to increase both data collection and data quality. One of the biggest barriers to quality studies is a lack of data. Making sure each step of all births are comprehensively recorded is vital. Administrations, hospitals, communities, and states would need to ensure that the data collected is of quality. It must be large in sample sizes, include births from a variety of hospitals, and regard mothers of different ages, races, socioeconomic backgrounds, health levels (such as low risk versus high risk pregnancies), etc.
For instance, California's exceptional data collection has led to reduced C-section rates. By showing data to both doctors and hospitals, California was able to work in conjunction with physicians and administrations to lower the rate of C-sections. Hospitals made it more difficult for doctors to schedule C-sections without approval. Instead, they implemented a process that doctors have to go through before scheduling them, leading to more thoughtful decisions and lowered C-section rates.
Financial Motivations and C-sections
As malpractice lawsuits become more common and carry higher stakes, many doctors choose to err on the side of caution by advising C-sections when any risk (no matter how small or normal) occurs. While a quick and natural response, this may not always be in the best interest of mothers.
Multiple studies have shown that C-section rates vary from hospital to hospital, but the most common denominator could be the "busyness" of the hospital. Busier hospitals have more C-sections. C-sections are known to take less time than natural births, but can be billed up to twice as much as the natural alternative. Thus, they are a win-win for administrations.
One way to reduce C-section rates is to change the financial incentives. California saw decreases in C-sections after hospitals negotiated with insurers to pay the same rate for natural and caesarean births. Getting rid of the financial motivations to choose C-sections can influence hospitals to choose natural births more often.
To reduce rates of C-sections, doctors should avoid bending to these pressures, and should instead always work from the patient's side — unless medically necessary, C-sections should be avoided. And, in the case of low-risk pregnancies, doctors should let natural birth run its course.
Drilling Down Definitions
According to American College of Obstetricians and Gynecologists, doctors may need to define "normal" and "abnormal" labor. They may need to make sure these terms are completely defined, yet are also fluid to a certain extent. If this is noted with an official organization like the American Medical Association, that certain factors present in the mother and baby are still indicative of a healthy natural birth, and certain ones need the C-section operation, patient care could be more standardized. Doctors, nurses, and other staff should be uniformly trained with sets of procedures to do in each case. Doctors could review birth plans completely with mothers and birthing teams to make sure all are on the same page. They could advise against elective C-sections and make sure that mothers are fully informed of the risks.
Worst Case Scenario
In the case of complications or death, doctors and hospitals need to examine each incident seriously and in depth. Although it's not directly linked, the encouragement of personal responsibility with such an investigative strategy in Great Britain has contributed to their low maternal mortality rate. Similarly, the creation of committees dedicated to focusing on this one issue can have astronomical effects. Namely, we should view each near-death complication or death as systems failures and public health emergencies than as individual incidents.
Ultimately, doctors should continue to foster relationships with patients. These lead to healthier, happier patients and doctors who are better advocates for them. Furthermore, trust in the doctor-patient relationship leads to less stress for the mother and, in turn, better results. Cultivating patience and mindfulness for both mother and doctor during naturally high-stress labors can lead to healthier deliveries.