Jane’s Friday Thoughts are a collection of entries on the state of modern maternity from OB-GYN and Maven Medical Director, Jane van Dis.
Recently, in one of my call shifts, I assisted in seven cesarean sections. That's a lot of cesareans. Now, granted, the majority were indicated, meaning that they were for women who had had a prior cesarean section and did not elect to have a TOLAC (trial of labor after Cesarean), but a few were elective.
Why it matters
1 in 3 babies born in the US are born via cesarean (32%)—this includes repeat cesareans. The rate for first time moms is 1 in 4.
More cesareans means more complications in future pregnancies, including injury to bowel and bladder, hemorrhage, and a placenta that is morbidly adherent to the uterus—a life-threatening complication.
The WHO says the rate should only be around 10-15%.
There's likely never going to be consensus on what the perfect number is, but there's definitely consensus that 32% is too high (compare to 1970 when the rate was 5%).
In California, where I practice, the state set a goal of 23.9%, and has threatened to withhold reimbursements for hospitals that had rates greater than 23.9% starting January 1, 2019.
While one might think physicians make all the decisions regarding cesareans, data shows that, in addition to physician decision-making, the hospital and even nursing staff can play a role as to vaginal versus cesarean birth. Even the architectural design of labor and delivery rooms can affect rates.
Doulas and other types of support during labor can help lower cesarean rates.
Rates can vary from 12%-70%, depending on the county and hospital.
Staffing more nurses and doctors was also recently shown to affect rates.
How Maven helps
Maven helps patients get and stay informed about whether they will need a cesarean for maternal or fetal reasons. Through our practitioner network, Maven recommends in-person, in-network providers who use evidenced-based medicine and have low rates of unnecessary interventions during labor, including cesareans.
In addition to providing education, Maven also provides direct support through our Doulas, Childbirth Educators, Nurse Practitioners, OB-GYNs, and Certified Nurse Midwives.
Labor and birth are a BIG DEAL. The idea that a woman should go it alone is not good for women or families. Support—wherever it comes from—is always a good idea, and Maven is a key source of support and education for our clients. Patients who are supported in labor have lower rates of cesareans and complications of childbirth.
Optimising caesarean section use