http://www.latimes. com/news/ opinion/la- oe-block24sep24, 0,6378847.
story?coll= la-opinion- center
*From the Los Angeles Times*
The C-section epidemic More women are dying in childbirth thanks to
the high
numbers of doctors and mothers who opt out of normal delivery.
By Jennifer Block

September 24, 2007

Pre-term births are on the rise. Nearly one-third of women have major
abdominal surgery to give birth. And compared with other industrialized
countries, the United States ranks second-to-last in infant survival. For
years, these numbers have suggested something is terribly amiss in
delivery
wards. Now there is even more compelling evidence that the U.S. maternity
care system is failing: For the first time in decades, the number of women
dying in childbirth has increased.

The Centers for Disease Control and Prevention last month released
2004 data
showing a rate of 13.1 maternal deaths per 100,000 live births. For a
country that considers itself a leader in medical technology, this figure
should be a wake-up call. In Scandinavian countries, about 3 per 100,000
women die, which is thought to be the irreducible minimum. The U.S.
remains
far from that. Even more disturbing is the racial disparity: Black
women are
nearly four times as likely to die during childbirth than white women,
with
a staggering rate of 34.7 deaths per 100,000.

These high rates aren't a surprise to anyone who's been investigating
childbirth deaths. Physician researchers who have conducted local case
reviews across the country consistently have found death rates much higher
than what the CDC has been reporting. In New York City between 2003 and
2005, researchers found a death rate of 22.9 per 100,000; in Florida
between
1999 and 2002, the rate was 17.6. Other reports by CDC epidemiologists
have
acknowledged that deaths related to childbirth are probably
underreported by
a factor of two to three.

What's to blame for the poor U.S. showing? True, we are the only
industrialized country without universal healthcare. But when it comes to
childbirth, we basically have it. Ninety-nine percent of women give
birth in
a hospital with access to all the bells and whistles -- high-tech machines
that continuously monitor the baby's heart rate, drugs that can
control the
speed of contractions like the volume on a stereo, instruments that
can coax
a reluctant head out of the birth canal, and surgeons at the ready to
perform the mother of all interventions, the caesarean section.

The C-section, now used to deliver 30% of American babies, is such a norm
these days that, in some places, doctors and women have taken to
calling it
"C-birth" or even just "having a 'C.'" Pet names aside, the procedure is
major surgery, and although it saves lives when performed as an emergency
intervention, it causes more harm than good when overused. Here's why:
Caesareans are inherently riskier than normal, vaginal birth. They
also lead
to repeat caesareans. And repeat caesareans carry even greater risks.

Placenta accreta is one of them. The placenta embeds into the uterine scar
from a previous surgery, causing a catastrophic hemorrhage at the time of
delivery. Most women with placenta accreta lose their uteri; as many
as 1 in
15 bleed to death. In 1970, accretas were so rare that most obstetricians
never encountered one in their career. Today, according to a University of
Chicago study, the incidence may be as high as 1 in 500 births. And
that is
all because of caesareans and repeat caesareans.

Obesity plays a part as well because obese women are more likely to have
health problems that make a caesarean more likely, and more likely to
suffer
surgical complications. Still, it all comes back to the "C," which could
easily stand for "culprit."

According to a sweeping 2006 study by the World Health Organization,
published last year in the medical journal Lancet, a hospital's caesarean
rate should not exceed 15%. When it does, women suffer more infections,
hemorrhages and deaths, and babies are more likely to be born
prematurely or
die.

Too many caesareans are literally medical overkill. Yet some U.S.
hospitals
are now delivering half of all babies surgically. Across the nation, 1
in 4
low-risk first-time mothers will give birth via caesarean, and if they
have
more children, 95% will be born by repeat surgery. In many cases,
women have
no choice in the matter. Though vaginal birth after caesarean is a
low-risk
event, hundreds of institutions have banned it, and many doctors will no
longer attend it because of malpractice liability.

American maternity wards are fast becoming surgical suites. We've become
dangerously cavalier about it, but the caesarean rate should be a major
public health concern. Universal care alone won't solve the problem; what
pregnant women need is entirely different care. They need doctors and
hospitals that promote normal labor and delivery. Of course, reducing
obesity belongs on the healthcare agenda, and so does curtailing the
scalpel.

Jennifer Block is the author of "Pushed: The Painful Truth About
Childbirth
and Modern Maternity Care."

--
Unfortunately, the role of obstetrics has never been to help women give
birth. There is a big difference between the medical discipline we call
"obstetrics" and something completely different, the art of midwifery.
If we
want to find safe alternatives to obstetrics, we must rediscover
midwifery.
To rediscover midwifery is the same as giving childbirth back to
women. And
imagine the future if surgical teams were at the service of the women and
the midwives, instead of controlling them." - Michel Odent, MD, French
Obstetrician, 2006.