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Re-activateI hope so. In 2007 nearly a third of babies in the U.S. were born by c-section. That's well above the rate recommended by the World Health Organization (about 15 percent), and almost double that of countries such as Norway and Sweden, where neonatal mortality is nearly half of that in the U.S. And less than 10 percent of women who've had a prior c-section attempt a vaginal birth, even though 60 to 80 percent of those who try are successful at it.
But encouraging more doctors and pregnant women to make the attempt won't be easy. Health-care providers are often slow to adopt new guidelines—and obstetricians have plenty of reasons to keep on doing lots of repeat c-sections.The fear of lawsuits, for example, can lead to defensive, high-intervention practices even when the risk of a more hands-off approach is low. Some doctors recommend c-sections because they are quicker and more convenient than waiting for a laboring woman to deliver. Profits are higher when they don't have to unexpectedly cancel patients in the office to deliver a baby in the hospital. And more scheduled deliveries means fewer hours spent working at night or during the weekend.
Some patients will resist the new guidelines, too. Penciling in a delivery date on the calendar means that family visits and time away from work can all be organized more efficiently.Of course, some repeat cesarean sections are necessary. And we need to celebrate healthy mothers and healthy babies whichever way they come. But health-care providers need to be vigilant about why they intervene. Schedules, finances, or malpractice risk should have no place in making that decision. The new ACOG guidelines offer more women the opportunity to opt for vaginal delivery for the right reason: safety for themselves and their babies.
—Joan Combellick, Certified Nurse MidwifeWhat do you think of the ACOG's new guidelines on making vaginal birth more of an option for women who've had a prior cesarean section? Is lowering the current high rate of c-sections a good thing?
—Aaron Bailey
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