For years doctors have told women who have had Cesarean sections that they would have to deliver all future babies the same way. They based this on a rule postulated in 1916 which said, "Once a Cesarean, always a Cesarean." This policy has caused the C-section rate in the U.S. and Canada to soar dramatically over the last ten years. In Canada, there are about 66,000 Cesareans per year; and almost 970,000 in the U.S. each year. Of these, an estimated 25 percent to 50 percent were clearly unnecessary.
In Canada, the number of Cesarean sections has quadrupled in the last 20 years, as it has in the U.S. Forty percent of these operations were repeat Cesareans. The majority of these repeat sections were not only completely unnecessary, but two to four times riskier to the mother compared to vaginal birth.
The July 1991 report of the Cesarean Birth Planning Committee of the Ontario Government estimated that between 60 to 70 percent of the 11,000 repeat Cesareans performed every year in Ontario could have been avoided. The report also said that the need for many first time Cesareans could be reduced, particularly for so called dystocia or failure to progress in labour.
Canada's Cesarean birth rate is one of the highest in the world, fourth after the United States, Puerto Rico, and Brazil. By contrast, European countries that have the same good outcomes for mothers and babies have half the C-section rate.
Sixty To Seventy Percent Of Repeat Cesareans Are Unnecessary
In October 1985, a nationwide committee of obstetricians and other experts in Canada met to consider safe ways to reduce the number of Cesareans being performed in this country.
On the basis of convincing data, they concluded that vaginal birth after one Cesarean section could be safely recommended to the majority of women as long as they satisfied certain prerequisites. These prerequisites were that they had a healthy pregnancy, that they had a horizontal and not a vertical cut into their uterus with the previous section, that they are now carrying a single baby in the normal head down position; and, finally, as long as no new reason for a cesarean develops during pregnancy or labour.
The exact same conclusions were reached by the U.S. Department of Health and Human Services in 1986, and the American College of Obstetricians and Gynecologists in 1985.
Reasons For Sections
First time sections are still being done for such vague reasons as prolonged labour or fetal distress, which are subject to a wide variety of interpretations, and which depend more on the doctor's philosophy, convenience, and fear of lawsuits than actual validly defined reasons. In the U.S. especially, Cesareans bring in more money than normal births. The increasing use of fetal monitors, inductions and other interventions have also led to many unnecessary sections.
Most of the reasons a Cesarean section is done the first time do not tend to repeat themselves the second time around.
These include prolonged or difficult labour; failure of the cervix to open up; the baby's heart rate dropping during labour, and even the pelvis being too small for the baby's head (the pelvis gains several centimetres in diameter when a mother squats or assumes an upright position).
For women who have had two or more Cesarean sections, recent studies have shown good success rates with a vaginal birth. Some hospitals now routinely allow a trial of labour for women who have had no more than two repeat Cesareans. Doctors vary on an individual basis as to whether they will allow a trial of labour for three or more Cesareans.
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