When our oldest grandson was born in 2003, our older daughter had an emergency c-section as the umbilical cord was wrapped around his neck. Of course, we grandparents were relieved he was healthy and his mother was okay, but the general medical position was against C-sections, Caesarean section surgeries. This was the general belief at the time, as shown from this article in the Fort Lauderdale Sun Sentinel, January 27, 1989, which resulted in a discouragement of the procedure as the standard:
“Study: Half Of C-sections Not Needed”
“About half the Caesarean section surgeries in the United States in 1987 should not have been performed, according to a new report designed to focus attention on what it terms “an onslaught of unnecessary and dangerous surgery. The strongly worded report, made public on Thursday by the Washington- based Public Citizen Health Research Group, is likely to fuel the national debate over when the surgeries should be performed.”
In 1989, the authors said it was the most extensive compilation of Caesarean statistics “ever compiled.“ The report includes Caesarean rates for about 2,400 hospitals from 30 states, including 1986 statistics for California hospitals, and statewide figures for an additional 11 states. Caesarean rates varied from a high of 30.3 percent in the District of Columbia to a low of 17.9 percent in Alabama. The report`s list of 106 hospitals with the highest Caesarean rates — 35 percent and over — included 22 California hospitals, 18 Florida hospitals and eight New York Hospitals. The study in the late 1980’s said that the 475,000 “unnecessary“ Caesareans performed in 1987 resulted in 25,000 serious infections, 1.1 million extra hospital days, and a cost of more than $1 billion.
When our younger daughter delivered a nine and a half pound grandson vaginally in 2007, this Grandma was convinced that she did not receive a C-section because of the anti C-section medical “standard.” Our huge new grandson was injured in the birth, fortunately not with serious or long lasting consequences.
You can imagine my surprise when, Friday, December 4, 2015, in the Sun Sentinel, there was an article titled, “C-Section Rates Too Low, Study Says,” by Carolyn Y. Johnson, that starts off with, “increase in practice may cut mom and baby deaths.” She said that a new study by the American Medical Association that reviewed nearly 23 million C-section deliveries worldwide in 2012 showed “that mother and infant deaths continue to decline as the C-section rate reaches 19 percent of births. Only then do mother and infant deaths level off.”
This study apparently is contra to three decades of supposed public health wisdom that 10% was the recommended rate of caesarean section birth, and recommended that the World Health Organization’s recommended rate should be increased to 15% to result in fewer mother and infant deaths worldwide as the new “standard.”
This is a different finding than a report listed as done by the World Health Organization earlier in 2015 which found “conflicting evidence that the benefits to mother and child ceased above 10 percent.”This 10 to 15 percent target was just kind of created through expert consensus. A lot of things in policy come out this way, but we had some techniques and better data available now than in the past,” said Alex Haynes, a surgeon at Massachusetts General Hospital. But the study shows that the benefits of using the procedure flatten out as the rate exceeds 19 percent. The study also suggests that some countries don’t have enough access to C-sections – or at least the level of care that comes with the procedure.”
The study included 54 countries in 2012, the target year for the study. Look at the abstract of the study itself.
So, let’s talk about the United States. The study from the 1980’s concentrated on the United States. The new studies are worldwide. Some countries do not have enough access to C-sections or the level of care, but the United States should, and should have better medical procedures than in the 1980’s. Interestingly, an editorial about the worldwide study on the Journal of the American Medical Association on their website gives us more information about the United States, that nearly a third of all deliveries in 2013 were C-sections.
The editorial gives the reasons for the rise in C-sections in some countries and why it is discouraged in the United States. Maternal choice in England is part of a national guideline, that women in the United Kingdom have the right to decide their mode of delivery with appropriate counseling. Yet, many of the articles on line from U.S. news sources reporting on this study say that the recommendation of 19% on the study based on 54 countries means that the U.S. number at one third is just too many C-sections.
To this Grandma, it seems that the reporting on the worldwide study and applying this new 19% “standard” to the United States is mixing apples and oranges. The study acknowledges that some countries do not have enough access to C-sections or the level of care necessary for the procedure, based on 54 countries. A pregnant woman in the United States should not be looking at the 19% “standard” or want her doctor to make a decision based on percentages of 54 countries, or any percentage “standard. “
It is important to share the background, abstract, study and editorial to those we know so they can be educated as to what happens with studies. First, the pendulum swings so far that medical decisions seem to be made on mass studies which may not be applicable to the United States, which becomes a “standard” for medical decisions, including in the United States. When the underlying data is examined, one can question the basis of the “standard.”
Fast forward from C-Sections unnecessary and dangerous to not enough shows pendulum swings too far are dangerous and unnecessary. But are these pendulum swings real or is that just media hype?
There is little in the media or the study about emergency C-sections and how many of the C-sections are done on an emergency basis. Because I have had the experience of watching an emergency unfold during a delivery, I would recommend that grandmas talk to those pregnant about C-sections and have them talk to their doctors, just in case, to be knowledgeable and prepared to know when the doctor considers a C-section as an emergency procedure. We grandmas want healthy babies and healthy mothers, not a “standard” based on studies that have nothing to do with the parents of our grandchildren. We want the mother of our grandchildren treated as an individual, with individual medical needs and requirements, and decisions based on appropriate counseling. Those in the United Kingdom get that as a national guideline.
In this time of the internet, when a study is reviewed by the media, we have “google.” It is a simple click to get the actual study abstract and read it for yourself to come to your own conclusions, and then discuss the topic with ones medical professional. Being educated is being a powerful self advocate. And it protects our precious grandchildren.
Joy,
Mema