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Is the increased C-section rate women's fault?

What's driving the trend to surgical birth

By
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Originally published in Today's Parent August 2006

In 2005, we saw record-high C-section rates in both Canada (25 percent) and the US (29.1 percent), and a sharp increase over rates in the 1990s. Those who’ve been tracking birth trends weren’t surprised to see this.
Recent years have seen a steady erosion of vaginal birth, largely due to a series of studies that narrowed the criteria for a “safe” vaginal birth. Breech birth was the first to be ruled out. Then the opportunities for VBAC (vaginal birth after Caesarean) were reduced with a finding that induction of labour is risky for VBAC moms. (In fact, it turned out that only treatment with prostaglandins significantly increases the risk, but that important distinction was not widely reported.) Guidelines encouraging routine induction of overdue labour at 41 weeks further boosted the chance of Caesarean birth, since induction when the cervix is not ripe may fail, leading to surgical delivery. Next we heard that Caesarean delivery led to less postpartum incontinence. Women could protect their pelvic floor (and, by implication, their sex lives) by avoiding vaginal birth.

What didn’t get reported was that by six months postpartum, differences in incontinence rates disappear. Recent research showing that Caesarean delivery increases the risk of placental problems in subsequent births didn’t get much coverage either. And the long-established risks of C-section, from wound infection to increased postpartum pain, are rarely given more than a passing mention.

It all adds up to a sustained push in favour of Caesarean birth. I’m sure individual research teams did not intend this, but the cumulative impression is that vaginal birth is dangerous, unpredictable and disfiguring. Caesarean, by contrast, appears neat, quick and convenient.

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