April 22, 2005 -- Birth by cesarean section is again on the rise, say doctors, as more women are choosing to have their babies delivered surgically.
Nearly 28% of all U.S. babies born in 2003 were delivered by C-section, according to a report in the March issue of Pediatrics. That's an all-time high, up 6% from 2002.
Now, a new study in April's issue of Obstetrics & Gynecology focuses on a key group of women: those having cesarean delivery (C-section) who had not first gone into labor. Those women have what is known as "elective C-sections."
Women who had their first elective C-sections rose nearly 44% from 1994 to 2001, according to the new report.
In 1994, these elective C-sections accounted for nearly one in five C-sections (19.7%). In 2001, the percentage had reached 28.3%.
What explains the rise? To find out, Susan Meikle, MD, MSPH, and colleagues tracked medical billing codes assigned to the C-section deliveries.
Why the Increase?
The study showed that there were more moms older than 40 years of age.
Between 1994 and 2001 there was a shift toward women who were older than 40, writes Meikle, who works at the federal government's Agency for Healthcare Research and Quality.
However, there was no change in payor status. That may argue against the idea that older, more financially stable mothers-to-be opted for elective C-sections, the study suggests.
The 2003 birth rate for women in their early to mid-40s was reported to be nine births per 1,000 people, an increase of 5% over the previous year. That includes all births in that age group, not just C-sections.
Though the researchers found that there was an increase in the rates of C-sections after 1997, they write that they did not see a big change in 12 indications for this procedure. These included:
- Malpresentation (baby not in a favorable position for birth)
- Antepartum bleeding (bleeding during pregnancy)
- High blood pressure
- Macrosomia (baby had grown too big)
- Maternal soft tissue disorder
Fetal heart rate abnormality, a new medical diagnostic billing code introduced in 1998, had a "rapid rise" in use, say the researchers. "Whether to accept this new code as a clinically appropriate indication is an important question," they write.
What 'Elective' Means
The term "elective" needs a little clarification, say Meikle and colleagues.
They don't want anyone to get the impression that "elective" C-sections were scheduled just for convenience's sake.
"Elective cesarean deliveries can include medically and obstetrically indicated procedures that generally occur before labor," write researchers. "Elective cesarean deliveries can also include procedures for which there is no clear medical or obstetric indication."
'Target for Reduction'
Once a woman has had a C-section, she's more likely to have another C-section in future pregnancies.
"Primary cesarean deliveries are an important target for reduction, because they lead to an increased risk for a repeat cesarean delivery," note the researchers.