Risks of cesarean delivery are under reported, benefits overstated

Mar 20 2006

Unnecessary cesarean delivery constitutes a threat to the future health of mothers and babies who undergo major surgery, according to experts who spoke at a media briefing hosted by the American College of Nurse-Midwives (ACNM), in Washington, D.C. today.

According to these experts, the risks of cesarean delivery are largely misunderstood and underreported, and any benefits are often overstated. Women undergoing the procedure are doing so without being properly informed and are placing their future ability to have a normal delivery in serious jeopardy.

29% of all babies born in 2004 were delivered by cesarean and cesarean deliveries are the most often-performed surgical procedures in the United States, at a cost of $14 billion. The overall rate has increased an unexplainable 40% since 1996.

During the briefing, two women who underwent what they believe were preventable cesareans spoke about the complications they endured after their surgeries. Karen Salinetti of Falls Church, Virginia, underwent additional surgery to remove adhesions, a frequent complication of surgery, which developed after her cesarean. "I want women to know all the risks; too often, information about the surgery is glossed over, and in my case, had I been better informed, I might have made different decisions," Salinetti said. Barbara Stratton from Baltimore, Maryland, said, "I don't believe that any woman should go through this major surgery unnecessarily."

Also at the briefing, Peter Bernstein, MD, of Albert Einstein College of Medicine in New York, NY, presented an update of his article 'Complications of Cesarean Delivery,' which was published by Medscape.com in September 2005. Bernstein wrote, "With the increasing rate of cesarean deliveries, providers will see more and more of these complications. It is also critical for the provider and the patient to be aware of the risks for complications so that they can make informed decisions about the best mode of delivery given the individual clinical situation they face."

Maureen Corry, MPH, of Childbirth Connection, a national not-for-profit organization that works to improve maternity care quality, presented data from Listening to Mothers, a national survey of women's childbearing experiences. The new survey, conducted by Harris Interactive® among women who gave birth in 2005, offers the first national data collected from mothers themselves on many views and experiences with cesarean section. "Mothers have spoken: Contrary to common belief, they are not electing to plan primary cesarean sections without medical reason; and furthermore, many believe that the current malpractice environment leads providers to perform cesarean sections that are not really needed. It's time for policy makers, health professionals, and women themselves to confront the legal, financial, clinical and other factors that contribute to the escalating U.S. cesarean rate."

"Midwives, as specialists in women's health care, are very concerned that decisions to perform surgery are being made based on circumstantial evidence, misinterpretation of evidence and/or lack of respect for the short and long term risks of this major abdominal surgery," said Katherine Camacho Carr, CNM, PhD, president of the ACNM.

The briefing was part of the ongoing ACNM REDUCE Campaign, which was launched to raise public and policymaker awareness about the troubling rise in cesarean sections performed in the United States. REDUCE stands for 'Research and Education to Decrease Unnecessary Cesarean Sections.'

The following organizations have joined ACNM in the REDUCE Campaign: American Association of Birth Centers, Citizens for Midwifery, the Coalition for Improving Maternity Services, the International Cesarean Awareness Network, and Lamaze International. Leaders from those organizations offered these statements in support of the REDUCE Campaign briefing:

* "It is imperative that we educate the public about cesarean births including the risks of cesarean birth, and risk factors for future pregnancies, which are largely unknown to the public, and how to prevent cesarean sections by choosing birth centers and the midwifery model of care," said Jill Alliman, CNM, MSN, president of the American Association of Birth Centers.

* "Only women themselves can tell us if they are actually demanding cesarean section surgery. With what we are learning from Childbirth Connection today, we now know that women VERY rarely schedule first cesareans by choice without a medical reason," says Susan Hodges, president of Citizens for Midwifery. "Only women can tell us what kind of informed consent process was provided to them. Citizens for Midwifery believes that women are not being given adequate and unbiased information about all the risks and benefits of cesarean sections. Research is needed to understand who and what are now influencing decisions to perform major abdominal surgery 'for no medical reason' despite substantial evidence that all cesareans increase harmful risks for mothers and babies."

* "Voluntary cesarean surgeries are being sold as a woman's right to choose," says Lamaze International President Raymond DeVries, Ph.D. "But for a woman to choose the best option for her and her baby, she must know all the risks of surgical delivery and the comparative risks of a well-managed vaginal birth. Health care providers have the ethical and legal responsibility to provide this information to the women they care for."

* "While public health officials may capture the harms of cesarean in overall morbidity and mortality statistics, we see the harms of cesarean on a much more personal level," said Tonya Jamois, president of the International Cesarean Awareness Network. "Many of the women who come to our group are struggling with post-operative pain, infections, chronic pain, secondary infertility, miscarriages, and fears about what complications that scar might pose for their next pregnancy. Some women breeze through their cesareans, but many pay a high price, and it should never be done without a good medical reason."

Additional resources for reporters - including a comprehensive source list, handouts from the media briefing, and other materials - are available online at www.midwife.org or by contacting Tim Clarke, ACNM Associate Director for Communications via e-mail or (240) 485-1821.

The ACNM REDUCE Campaign - Research and Education to Decrease Unnecessary Cesarean Sections - is a public service campaign of the American College of Nurse-Midwives and its partners. For more information about the REDUCE Campaign, visit www.midwife.org.