Too Many Caesareans

I couldn't help noticing the confluence of two stories about Caesareans in recent weeks.

First there was the one about the increasing number of late-pre-term Caesareans. Basically, an increasing number of babies in the U.S. are being born by Caesarean in the 34th to 37th week of gestation, rather than at full term. These aren't multiple births, either -- the numbers reflect only "single births." From 1996 to 2004, the number of premature deliveries increased 1 percentage point, up from 9.7% of births to 10.7% of births. Of the premature births, 92% were by Caesarean.

I couldn't picture the scenario, even though I believe the statistics. Are women increasingly likely to march into their doctors' offices between 34 and 37 weeks, screaming "Get this baby out of me now!" ?

In general, the number of Caesareans is at an all-time high. It had dropped a bit in the early to mid-1990s, but now it's back up over 30% of births. (Experts bandy about different numbers for the "ideal" Caesarean rate -- the rate that means women are getting a c-section when it is medically necessary, and not when it is for other reasons. The World Health Organization puts the percentage between 10 and 15, but others put it lower while others say it's not possible to put a number on it at all.)


VBAC, in case you don't know, stands for vaginal birth after Caesarean, which was increasingly encouraged as an option in the mid-90s, but has recently become almost impossible to do because hospitals and doctors are discouraging it for fear of its fairly rare complications. In effect, this loss of the VBAC option means that if a woman has a Caesarean, she will have to have a Caesarean for any future births ... which, of course, is part of what feeds the overall rate increase.

The second story I saw was in the New York Times. It told about a Colorado woman who applied for individual health insurance and was turned down because she had had a Caesarean. Basically, it counted as a pre-existing condition, and unless she was willing to be sterilized, the company (part of Minnesota-based United Health) wouldn't insure her.

Do you think the people who run the website www.ElectiveCaesarean.com have heard about this? I found their site while looking for information on the "ideal" Caesarean rate. Featuring a snazzy graphic of three blurry women dancing on what appears to be a beach, headlined with the words "Your Baby Your Body Your Choice," the site is in direct opposition to the stance taken by the College of Midwives, who point out quite reasonably that a Caesarean is major abdominal surgery with its attendant complication rates, that it delays mother-child bonding since the mother is recovering from surgery, and that it costs twice as much as vaginal birth. The Elective Caesarean site gives prominent placement to "celebrity caesareans" and talks a lot about "birth trauma."

Emergency c-sections are one thing, of course, but there is a high rate of elective c-sections as well, which I have to say I just don't understand. It seems akin to the idea of plastic surgery -- women who are willing to suffer to be beautiful. In the case of c-sections, I guess it's a willingness to suffer to control the birthing process.

If the women who elect to have c-sections knew that they might not be able to get health insurance because of it, I wonder if that would make them think twice. The Colorado woman pointed out that had she known the insurance company would not insure her, she would never have applied since being turned down for health insurance will go down on your permanent record, as the song says. Every time she applies for insurance in the future, she will be asked if she has ever been denied insurance, and she will have to say yes.

(A final note: I am not saying that the Caesarean is a bad technology in general, of course, but it's bad when it's misapplied.)