February 2005

US rate of cesareans exceeds WHO standards

Because of increased dangers and risks to mother and baby, cesarean procedures (C‑sections) are supposed to be reserved for cases in which normal births may be impossible or dangerous. Yet, according to a research report published in the British Medical Journal, the United States has seen a steep rise in cesareans among women with no reported medical risk.

Researchers analyzed information on four million births per year between 1991 and 2001, identifying mothers with no medical risk or labor and delivery complications noted on the birth certificate. From this group of mothers, they examined those cases where mothers had a first‑time cesarean. Results showed that cesarean rates increased by 67% among these mothers. First‑time mothers aged 34 and over were the most likely to have a 'no indicated risk' cesarean, with almost one in five giving birth by cesarean in 2001.

Cesarean births also rose steeply for 'no indicated risk' mothers under 30, increasing by 58% between 1991 and 2001. For first‑time mothers over 40, the odds of having a 'no indicated risk' cesarean were more than five times that for mothers aged 20‑24. In the US, 24 % of births are cesarean ‑‑ double the rate of many European countries. The World Health Organization says no country's C‑section rate should be higher than 10‑15%.

Undergoing cesareans where there is no reported medical indication raises serious questions, say the authors, not least for younger mothers who plan to have further children. Previous research has indicated that women who have vaginal birth after having cesarean deliveries are at increased risk for maternal morbidity and such serious complications as uterine rupture, endometriosis, transfusion or newborns who suffer brain injury from lack of oxygen.

Other studies show that women are five‑to‑seven times more likely to die when undergoing a C‑section, and are at greater risk for bladder or uterus problems, hemorrhage, infection and hysterectomy. Some mothers experience long‑term side effects such as hip pain, bowel problems and pain during sex.

SOURCES: "Rise in 'no indicated risk' primary caesareans in the United States,

1991‑2001: cross sectional analysis," British Medical Journal, November 19, 2004.

"Caesareans Have Drawbacks for Future Pregnancies," British Medical Journal, 14 January 2004.

International Cesarean Awareness Network, online FAQ.

NOTE: This article appeared in the World Chiropractic Alliance Health Watch electronic newsletter. To receive this free newsletter each week, sign up at www.wcanews.com