That seems odd. The baby is healthy, and from your research you know that around 90% of all babies can be delivered naturally. Your doctor hasn't said anything about a narrow pelvis (or maybe he has), but regardless, there is a 90% chance that you can deliver this baby properly. Why is the induction necessary? You might be puzzled at first, but your judgment and the plaque on your doctor’s wall tell you that he or she only has your best interest at heart, right?
The fact is that whenever labor is induced the probability of a cesarean delivery increases dramatically. The cervix hasn't naturally softened and prepared itself for labor, and lack of proper dilation at the time of induction means that it is less likely that a vaginal birth will occur. The baby will need to be retrieved quickly due to what physicians claim to be ‘fetal distress’, and it will likely be retrieved through your abdomen.
Well, certainly this only occurs in around 10% of women, doesn't it? That would be the logical assumption. Since only 10% of babies can’t be delivered naturally, then likewise about 10% of pregnancies should require delivery via cesarean section. In 1985 the World Health Organization stated that “There is no justification for any region to have cesarean section rates higher than 10-15%”, so yes, the cesarean numbers shouldn't deviate far from that standard. However, the rates of CS in the United States alone have consistently been over 30%. This means that one in three pregnant women will be advised to undergo CS during labor, despite the fact that only one in about seven actually needs to.
This discrepancy seems preposterous: more than twice as many women are receiving cesareans than actually should. What’s more is that the American cesarean rate has increased by 54% since 1996, despite the leaps in technological advancement that overall knowledge that has accompanied virtually every medical field since then. These numbers are simply incongruous with what both health officials and our own common sense tells us when it comes to pregnancy and delivery.
Obviously women aren't the ones who have changed. Over the course of 15 years it would be unrealistic to say that their bodies are just requiring the procedure more often out of anatomical necessity. The truth is that pregnant women have almost nothing to do with the rising trend of cesareans, the health system does. And it’s not only the American healthcare system, but healthcare systems among dozens of developed nations around the world that have been driving up CS rates over recent decades. The methods and motivations behind this growing trend are myriad, but here are a few that can help you understand why cesarean rates aren't what they should be:
From a cultural standpoint we have become very resilient to the idea of surgery—that is, we don’t take it as seriously as we used to. We may be putting our welfare in the hands of some very capable professionals when we undergo a surgical procedure, but people are putting their welfare into the hands of surgeons more and more often. One of the reasons for this could be the recent acceptance of cosmetic surgery as a lifestyle. Regardless of your position on the issue of cosmetic surgery, the field has made us much more tolerant of the notion of going under the knife. Likewise, the increases in technology and advancements in the medical field make us more confident with surgical procedures, despite the fact that there are still risks involved in any procedure. This mode of thinking has permeated the healthcare culture and allowed practicing professionals, administrators, and even insurance entities to regard surgery more casually. This casual view of surgery gets transmitted to patients, and results in a more cavalier consideration of surgeries like CS.
Lack of education
You might be surprised to see that insufficient information about a procedure is the reason that many women are convinced to undergo CS: researching everything that you can about pregnancy seems like standard protocol when you are expecting. Still, research shows that many women who had received a cesarean during labor wished they would have had adequate information on natural birth or vaginal birth after cesarean (VBAC). Despite the regret of these mothers, the healthcare system is still reluctant or at least slow to disclose informative content about these issues. Because of the dearth of proper delivery education, 90% of women who have already had a cesarean will be having additional ones for subsequent pregnancies. This lack of information also applies to women pregnant with a fetus in breech position and women carrying twins—physicians are eager to promptly schedule these women for CS because their pregnancies are just slightly irregular.
Some of the reasons for increased cesarean rates actually have to do with the delivery process. Many times a physician will insist that labor be induced to avoid excess growth of a baby that is (allegedly) too large. Induction will be scheduled at around 39 weeks (as mentioned before) to make sure that labor is predictable and happens before it’s too late. But if a woman is not anatomically prepared (i.e. cervical softening and dilation) for labor at the time that it is induced, the baby might need to be retrieved through CS. Additionally, premature deposit of an epidural into the mother has even been linked to increased likelihood for abdominal retrieval.
One of the most startling reasons for the cesarean trend might be the doctor’s own self-interest. In a perfect world physicians would be paragons of selflessness and goodwill who have nothing but the patient’s well-being in mind. In our world, however, physicians are people who are governed by the same desires for convenience and gratification that we are. There are certainly tremendously noble physicians out there who have authentic concern for their patients, don’t get me wrong, but sometimes a doctor’s decision for your health might be better for him than it is for you. We know that due dates are tentative, which, for the parents, can add to the excitement of pregnancy. Not knowing exactly when the baby will come adds to the romance of childbirth—not so much for the doctors, however. Doctors are busy, and whether they need to be with other patients, their own families, or on vacation, a predictable schedule is a luxury that many of them will strive for. Because of this, many gynecologists try to coerce their patients into cesareans so they can have at least one definite procedure on their list. Furthermore, a cesarean procedure will generate more revenue for a healthcare facility than will a vaginal birth; a national cesarean rate that is about two times what it should be likely garners a proportional profit for hospitals.
The best defense against an unnecessary cesarean is to listen closely during your routine checkups. If you feel as though the doctor is sensationalizing your baby’s size, position, your blood pressure, or your health status be sure that he or she isn't trying to disarm you for a CS proposition. A second opinion from a VBAC gynecologist is a great (and often necessary) option if you suspect you are being driven toward a procedure that you don’t actually need. Remember, only about 10% of births require CS, which means that you are about half as likely to need one as some physicians will tell you. Educate yourself, use discretion, and value alternative opinions before you make a decision about your delivery day.
Below are some details about the cesarean trend; the info-graphic can be shared from here.
Patrick O'Neill is a content writer and blogger for the Dallas-based website development company SEOTA.