The REDUCE Campaign: Research and Education to Decrease Unnecessary Cesarean Sections

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Women Urged to Proceed with Caution in Age of "Designer Deliveries"

Stories of cesarean sections performed for motivations other than maternal or fetal well-being are making the headlines. They report a rise in elective cesareans for reasons such as avoidance of labor pain, patient or provider convenience, legal concerns of the provider, and questionable assumptions about the origin of incontinence in women. These articles announce a sharp increase in the number of cesarean births in the United States and a decline in the number of vaginal births after cesarean.

In an Op-ed submitted for publication by former ACNM President Mary Ann Shah, CNM, MS, FACNM, and Executive Director Deanne Williams, CNM, MS, FACNM, the authors take aim at questionable claims that entice women into a surgical birth without a complete assessment of all risks involved. The list of reasons women must not think that surgical birth is as safe as a vaginal birth is long and ranges from the increased incidence of drug resistant infections, to the potential for life threatening complications from blood transfusions. Women risk permanent damage to abdominal and urinary tract organs, longer recovery times, little-to-no chance for a subsequent vaginal birth and a premature end to their ability to safely bear children.

The more recent focus on preserving continence in a woman's future by doing a cesarean section lacks complete and convincing data to support this position. The fact that women who have never given birth experience incontinence cannot be explained by those who support this theory. Even if one finds data to suggest that childbearing contributes to the incidence of incontinence, one must proceed with caution before offering an invasive procedure as the unproven cure. Episiotomies and tonsillectomies are two of several examples of surgical procedures widely promoted in the name of prevention that have subsequently been proven wrong.

There is no question that lives can be saved by judicious use of cesarean section, but in a nation with seemingly endless resources, easy access to information and multiple sites for clinical training as can be found in the United States, a national cesarean rate of 24% is not a sign of progress. According to the World Health Organization, no region in the world is justified in having a cesarean rate greater than ten to fifteen percent.

In the Op-ed, the authors issue a call for a return to common sense. Women should not value convenience over safety, health care professionals should understand that the majority of women are healthy and capable of giving birth with minimal interventions, and professional health care organizations must ensure that their members are qualified to differentiate between those women who need watchful waiting and those who need intensive intervention. Technology is an alluring panacea for ills, but blind devotion without critical evaluation, places women at great risk.

The ACNM Editorial was published in the Journal of Obstetrics, Gynecology and Neonatal Nursing May/June 2003.