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After falling modestly in recent years, cesarean delivery rates are again on the rise, with roughly one in four babies in the U.S. and the U. K. now delivered by C-section. There is also a trend away from offering vaginal deliveries to women who have had C-sections, says Flamm, who is a clinical professor at the University of California Irvine Medical School.
U.S. and world health officials want cesarean section rates to drop to no more than 15%, but Flamm says the chances of that happening anytime soon are "slim to zero." He says the driving force in the increase is the very real fear of lawsuits among practicing ob-gyns.
"The average obstetrician has been sued two to three times," he says. "If anything goes wrong and the baby isn't perfect, the doctor always has to be concerned about a lawsuit."
A smaller, but growing, factor in the rise is a trend among women to request elective cesarean deliveries, even when there is no compelling medical need for them. Women may choose to have planned C-sections to accommodate personal schedules because they believe it is safer for the baby, or to reduce the risk of pelvic injury.
But Flamm says women should think long and hard about asking for what he calls "cesarean on demand."
"Once a woman has a C-section, she is very likely to have to have another one if she has another child," he says. "You are leaving a big scar on the uterus, so having a vaginal birth after a cesarean carries the risk of having your uterus rupture. That is something to think very carefully about."