Overmedicalization of Birth: Why Are Cesarean Section Rates so High in the U.S.?

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Some view the rate of Cesarean sections as ubiquitous, others scarce. Either way, rates that deviate far from the WHO’s recommended rate of 15 percent are undesirable and pose health risks to both moms and babies. To highlight this fact, the birth story of the MHTF’s very own Kate Mitchell was recently featured in PRI’s article, “Why are Cesarean sections so common when most agree they shouldn’t be?” From the PRI story:

Kate’s birth story

“‘I constantly meet women who have very similar experiences to me,’ says Mitchell, ‘where they were committed to having a low-intervention vaginal birth, and their providers were also committed to support them in that, and somehow they still ended up having a C-section. That’s the mystery to me. I don’t understand how that happens… The evidence suggests that a C-section is a more risky route of delivery than a vaginal birth,’ she says. ‘So why are we delivering more and more babies in a risky way?’”

Lack of clear clinical guidelines

“One problem, experts say, has been a lack of clear guidelines specifying the circumstances under which a C-section is medically necessary, leading to a wide variation in the prevalence of Cesareans across hospitals. A study published in March of last year found that the C-section rates across Massachusetts ranged from 14 to 39 percent, with no differences in the condition of the patients that might explain the variation. ‘It really comes down to a difference in styles across hospitals,’ says Sakala. ‘We need to rein in those differences.’

In an attempt to do that, this February the Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists issued joint guidelines that call on doctors and hospitals to avoid Cesarean sections, even if it means letting first-time mothers remain in labor longer and push harder. The guidelines recommend letting first-time mothers push for three hours or more during labor. They also recommend using forceps to get the baby out vaginally.”

Kate’s story is not uncommon. While the under medicalization of birth is a problem in many countries, so is over medicalization. A combination of legal, clinical, and cultural factors have brought us to a dangerous new normal for birth. To review the implications of an increase in Cesarean sections on maternal health and rights, see our previous post.