Many of the recommendations and reasons used to encourage a reduction in C-sections are not justified or evidence-based.
That’s according to Baha M. Sibai, MD, University of Texas, UT Health Houston. Not all agree, however; D. Neel T. Shah, MD, MPP, Beth Israel Deaconess Medical Center, Boston, believes that much of the conventional wisdom about why C-sections are more common and necessary don’t bear out under more scrutiny, and the cesarean delivery rate can indeed be safely reduced.
Both will present their opinions and discuss the issue during “Cesarean Delivery Rate: Can it Be Safely Lowered,” this year’s Irvin M. Cushner Memorial Lecture, taking place from 1:10 to 2 pm Saturday in Ballroom D.
Dr. Sibai plans to show during the debate some of the unintended consequences of the reduction efforts.
“There’s little to no evidence, and there is a lot of emotion,” he said. “We’re not interested in targets for C-section rates. We’re interested in healthy mothers and babies.”
The increase in rate of cesarean is appropriate and necessary, Dr. Sibai said, as pregnancies with risk factors increase. More women are delaying pregnancy to a later age, and the average BMI, multifetal gestations are increasing, and obstetric and medical disorders are also increasing.
There’s a consent form for all the potential problems related to cesarean delivery, but Dr. Sibai advocates for a consent form for vaginal delivery. He said that women don’t hear enough about the risks involved with a vaginal delivery such as vulvo-vaginal lacerations, possibility of damage to the baby during labor, chorioamnionitis and neonatal infections, and issues that can come up later in life such as incontinence, sexual dysfunction, and pelvic organ prolapse.
“Women have the right to have unbiased, updated, and accurate information,” Dr. Shah said. “In 2018, what’s normal is that one in three Americans are getting major surgery to give birth, and one in ten of those babies go into the NICU. I think we can absolutely do better than that.”
Dr. Shah knows that he and other obstetricians do see more high-risk pregnancies today, but many have lost sight of understanding that a high-risk pregnancy isn’t the same as a high-risk labor. High blood pressure, for example, doesn’t necessarily mean a mother cannot have a normal labor and delivery.
While the immediate safety of the mother and child critical, Dr. Shah said. Long-term concerns must also be considered. Most mothers have more than one child, so a first-child C-section means each subsequent C-section becomes more complicated, and even life threatening as placenta accreta rates continue to rise.
“The majority of the C-sections are when we’re acting to prevent an emergency, not when we’re acting on an emergency,” he said. “This provides an opportunity to re-think our approach to labor management.”