What is the Cascade of Obstetric Interventions?

When healthy, low risk women agree to obstetric interventions recommended by their doctors, it can set the stage for additional interventions, including cesarean surgery. Eugene Declercq, Ph.D, of Birthbythenumbers.org, has analyzed the reasons for the rising culture of obstetric interventions in the U.S. The common reasons given for the nearly 33% cesarean rate in the USA (bigger babies, older mothers, more mothers with obesity, diabetes and hypertension, more multiples and maternal request) just don’t hold water when examined closer.

Research shows that many women feel pressure from their healthcare provider to have a cesarean, either prenatally or in labor.

The leading indicators for cesareans are labor arrest (34%) and nonreassuring fetal heart tracings (23%). These interpretations are highly subjective, with poor reliability across and within providers.

The rise in cesareans is not a result of different indications.  Dr. Declercq quotes a 20 year old article’s title that could still grace the front pages today. “The Rise in Cesarean Section Rate: the same indications – but a lower threshold.”

When examining the distribution of cesarean births by states over time, it is clear that those states with the highest cesarean birth rate decades ago, still remain in those spots today.

“We are talking about cultural phenomena when we are talking about cesareans, not just medical phenomena.”

First time, low risk mothers who birthed at term and experienced labor had a 5% cesarean rate if they went into spontaneous labor and did not receive an epidural.  If they were induced and received an epidural, the cesarean rate was 31%.

The United States has the lowest VBAC (vaginal birth after cesarean) rate of any industrialized country in the world.

The United States also has the highest rate of maternal mortality among all developed countries. How much is that rate affected by over use of obstetric interventions?

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