Efforts to reduce C-sections make some progress

Doctors, hospitals have tried to educate parents to avoid procedure

BARRINGTON – Rebecca Everly didn’t really know what to expect after her first cesarean section.

She had planned on a vaginal delivery with her daughter, Penelope, but the baby was sideways and an emergency C-section was performed.

“It’s a long recovery,”
Everly said. “I was hoping six to eight weeks to recover. Then I was at six weeks, going, ‘Come on. I can do it. I’m young. I’m athletic. I can recover faster.’ Twelve weeks later, I’m like, ‘Wow, I’m still not 100 percent.’ ”

That’s why she would have preferred to go with a vaginal birth with her next child, a son.

“I think it’s best for the baby, and I think it’s an easier recovery as a mom,” Everly said.

But with the due date just 15 months after the birth of Penelope, her doctor recommended another C-section.

Many moms-to-be don’t know about the risks involved with cesarean sections, said Dr. David Crandall, an obstetrician at Advocate Good Shepherd Hospital in Barrington.

“[When medically appropriate], I encourage them to do a vaginal delivery because then we don’t have go through a surgical procedure,” he said. “The recovery is easier, you get to go home sooner, and there are inherent risks to any surgery.”

Cesarean sections – a method of surgically delivering a baby by creating incisions in the mother’s abdomen and uterus – are recommended for a variety of reasons, including if labor isn’t progressing, the baby isn’t getting enough oxygen or the baby is in an abnormal position, according to the Mayo Clinic.

Risks include bladder and bowel injuries, uterine ruptures and issues with placenta placement, which could result in the need for hysterectomy.

Over the past few years, doctors and hospitals nationwide have tried to reduce the number of C-sections through improved perinatal care and educating patients, according to the Centers for Disease Control and Prevention.

The American College of Obstetricians and Gynecologists issued an opinion in April recommending that if there is no medical reason for a C-section, women should plan for a vaginal birth.

Some women request C-sections for nonmedical reasons, including a fear of pain in childbirth, bad experiences with past labors, and the convenience of a scheduled delivery, said Dr. Binn Jatta, a obstetrician and gynecologist who started with Centegra Health System a few weeks ago.

“You always want to take the route of delivery that will give you a healthy mom and a healthy baby,” she said. “You want to make sure that particular pregnant patient is well-educated about delivery.”

The April opinion issued by the American College of Obstetricians and Gynecologists also said elective deliveries should not occur before 39 weeks, and some hospitals have instituted policies preventing elective deliveries before 39 weeks.

Waiting cuts down on the chances of the baby having respiratory problems, Crandall said.

Doctors also are getting better deciding whether labor should be induced, which also affects a woman’s chances of needing a C-section, he said.

Those changes have resulted in a 5 percent drop in C-sections performed before 39 weeks and an increase of 4 percent at 39 weeks, according to a CDC report issued this June.

About one in three deliveries is via cesarean section, the report said. The rate has hovered at that level since 2009, decreasing slightly from 32.9 percent in 2009 to 31.3 percent in 2011, after steadily climbing for 12 consecutive years.

The most recent low was in 1996, when 20.7 percent of deliveries were via C-section.

“Vaginal delivery is always, always the preferred route in the absence of any fetal or maternal indication,” Jatta said.

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