Time for some straight facts about cesareans:
- Cesarean operations are the most common surgeries performed in the United States
- More than a third (32%) of the nearly four million babies born every year in the United States are brought into the world by cesarean.
- Florida has the third-highest cesarean birth rate in the country at 37.3%, which is higher than the national average and just slightly less than Mississippi (38%) and Louisiana (37.5%).
Let’s be clear: cesarean surgery is a life-saving procedure. When there is no other way to safely birth a baby, a cesarean, hands-down, can protect the health and safety of a mother and/or her baby. The problem is that not all cesareans may be necessary, and perhaps with more time, patience, support, education, and fewer or no medical interventions, some could be avoided.
WHEN IS A CESAREAN NECESSARY?
According to the American College of Obstetricians and Gynecologists (ACOG), women who are high-risk and have certain known medical conditions, such as those listed below, may have a higher chance of having a cesarean birth:
- Pregnant with multiples (a vaginal birth is sometimes possible with twins)
- Breech presentation (this is where baby is not in a head-down position at birth)
- Problems with the placenta
- Cervix doesn’t fully open (“failure to progress”)
- Fetal distress in labor
- Baby suspected of being 10 pounds or more
- Maternal infections such as HIV or herpes
- Maternal medical conditions such as diabetes or high blood pressure
But according to the Centers for Disease Control (CDC), even low-risk women who have their babies in a hospital have a 25% chance — 31% in Florida — of having a cesarean birth (pages 9-10 of the CDC report). These are women who don’t have any known medical risk factors prior to labor, yet at some point in labor it’s determined that a vaginal birth isn’t possible and a cesarean birth is the safer way to bring baby into the world.
For comparison, just 7% of Breath of Life’s clients, who are all low-risk, have had cesarean births. That’s 70 cesareans out of 1,000+ births. If those same 1,000 low-risk women had labored at a Florida hospital, statistically, 310 of them would have had their babies by cesarean.
WHY CHOOSE A BIRTH CENTER?
Because of the high risk of having an unplanned cesarean birth in a hospital (and many other reasons), women who are healthy and low-risk are choosing to have their babies at birth centers and at home in increasingly higher numbers. According to the CDC, between 2007 and 2015, the out-of-hospital birth rate increased by 66% from 0.9% – 1.5% (see pages 9 and 55).
Granted, most women – 98.5% of them in 2015 – still opted to have their babies in a hospital, either by choice or because they don’t know their other options, but that same year, more than 61,000 decided to forego the hospital in favor of a natural birth setting where their chance of a cesarean birth and other medical interventions is very low. In the Tampa Bay area, of the 35,000 women who gave birth in 2015, about 162 opted to have their baby in a free-standing birth center, most here at Breath of Life.
WHAT ARE THE POST-CESAREAN BIRTH OPTIONS?
When a woman who had a cesarean birth gets pregnant again, she has two options for labor, a scheduled repeat cesarean, which carries medical risks for mothers and babies, or a Trial of Labor After Cesarean (TOLAC) in the hope of having a successful Vaginal Birth After Cesarean (VBAC).
Sometimes, despite the risks, a repeat cesarean is the safest option, depending on why the first cesarean was needed. But in some cases, such as when a cesarean was done because of a breech baby and not due to a medical condition, a TOLAC could be a strong option.
BREATH OF LIFE OFFERS CARE FOR TOLAC/VBAC
Even though ACOG supports the option for a TOLAC, finding a care provider who is willing to make the extra effort to do so can be difficult in the Tampa Bay area. And, because of the slightly increased health risks during a TOLAC, Florida law prohibits women who had a cesarean from having their babies at a birth center.
That’s why Breath of Life is now working together with the OB Hospitalist Group at Morton Plant Hospital to provide mutual care of low-risk women who had a cesarean. Breath of Life’s Certified Nurse-Midwives care for clients during their pregnancy and postpartum, and the hospitalist physicians and RNs provide the labor care. It is a unique arrangement and gives women who had a cesarean birth a fresh option for their pregnancy, labor and birth.
So there you have it, more awareness about cesarean births in the United States and here in Florida and the Tampa Bay area. For even more information about cesareans, visit VBAC Facts, ACOG, the Mayo Clinic, ICAN, the local chapter of ICAN, and the Tampa Bay Birth Network.