Hold the scapel - childbirth without surgery

American Demographics, Nov, 1997 by Berna Miller

Childbirth without surgery made a comeback in the early 1990s. The cesarean birth rate declined 8 percent between 1991 and 1995, to 20.8 per 100 births for a total of 806,722 cesarean births in 1995. This decline in cesarean birth rates follows a sharp increase in the 1970s and 1980s. During the peak years of cesarean deliveries , one-fourth of all births were surgical.

The U.S. Department of Health and Human Services established a goal of a national cesarean rate of no more than 15 per 100 births as one of its Healthy People Year 2000 Objectives. These new data from the National Center for Health Statistics suggest the U.S. may be on its way to reaching that objective.

High cesarean rates trouble health experts for two reasons. First, cesarean births are associated with higher risk of maternal morbidity and mortality, although this is partly a result of the fact that many cesareans are performed in high-risk cases. Even so, one-fourth of cesarean births in 1995 were not performed on the highest-risk mothers. Second, high cesarean rates have not contributed to declines in infant mortality in the past two decades. Preventing infant deaths is one of the primary reasons for doing a cesarean.

Even with progress in reducing the overall rate of cesarean birth, there is considerable variation in rates by age, race, and ethnicity. Cesarean birth rates increase with age of mother. The disparity in rates between older and younger women increased between 1991 and 1995, because cesarean rates fell faster for younger women. Non-Hispanic white women experienced the greatest decline in the cesarean rate at 9 percent, compared with less than 1 percent for non-Hispanic blacks and 6 percent for Hispanics. Hispanic women have the lowest overall cesarean birth rate, at 20.2, compared with 21.8 for non-Hispanic blacks and 21.0 for non-Hispanic whites.