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C-Sections Continue 12-Year Climb: U.S. Report

Posted Dec 20 2010 9:00am
But overall birth rate dips, possibly because of sagging economy, expert says

Monday, December 20, 2010
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MONDAY, Dec. 20 (HealthDay News) -- Continuing a 12-year climb, cesarean deliveries reached a record high in 2008, accounting for almost one-third of the births in the United States, a new report shows.

"Rates have been going up since 1996 across the board for all age groups and all ethnic groups," said Michelle Osterman, co-author of the study and an analyst with the National Center for Health Statistics. "The increase from year to year has been steadily declining since about 2002 and that's a good thing . . . but it's certainly not stopping."

Although cesarean delivery is clearly called for in certain cases (if the mother has preeclampsia or is diabetic), often it carries greater risks than vaginal delivery, Osterman said.

"Vaginal delivery should be preferred to cesarean, where the complication rate is way higher," said Dr. Mitchell Maiman, chairman of obstetrics and gynecology at Staten Island University Hospital in New York City. "And with [subsequent] C-sections, complications go dramatically higher, bleeding, hysterectomy, even death."

Reasons for the trend, which has increased 56 percent since 1996, range from mother preferences to doctors' fears of lawsuits, experts said.

Efforts to counteract the C-section boom have resulted in growing support for VBAC (vaginal birth after cesarean), whereby a mother is given the option of delivering vaginally, even though the previous birth was via C-section.

Meanwhile, the small baby boom seen earlier in the decade seems to have tapered off, with U.S. birth rates actually declining 2 percent between 2007 and 2008, to 4,251,095 births, according to the Annual Summary of Vital Statistics: 2008. The 2007 birth rate was the highest ever.

"I'm not surprised that birth rates are dropping in the U.S.," said Dr. Abdulla Al-Khan, section chief of maternal-fetal medicine and surgery at Hackensack University Medical Center in New Jersey. "We've been talking about this ever since the economic downfall, which occurred a couple of years ago. As a physician, I have no doubt that this is the result of the economic downfall."

A look at vital statistics records in the 50 states and the District of Columbia also revealed that while the birth rate among 15- to 39-year-old women declined by 1 percent (the first decrease since 1978), the rate among women 40 and older increased 4 percent from 2007 to 2008 and is now the highest rate seen in 40 years.

The report, compiled by the National Center for Health Statistics and the Johns Hopkins Bloomberg School of Public Health, is published online Dec. 20 and in the January print issue of the journal Pediatrics. Other findings include:

  • Births to teens aged 15 to 17 declined 2 percent from 2007 to 2008, after an increase from 2006 and 2007. That increase reversed a 14-year decline charted since 1991.
  • Births to unwed mothers rose almost 1 percent in 2008, representing 40.6 percent of all births that year, up from 39.7 percent the year before.
  • The proportion of babies born early went down 3 percent from 2007, and is now at 12.3 percent of all births.
  • Rates of multiple births stayed the same.
  • Infant mortality declined 2 percent between 2007 and 2008, from 6.75 per 1,000 live births in 2007 to 6.59 in 2008.
  • Accidents were the leading cause of death for 1- to 19-year-olds, but the rate dropped from 42.5 percent in 2007 to 38.8 percent in 2008.
  • Average U.S. life expectancy in 2008 was 77.8 years.

SOURCES: Michelle Osterman, M.H.S., analyst, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention; Mitchell Maiman, M.D., chairman of obstetrics and gynecology, Staten Island University Hospital, New York, N.Y.; Abdulla Al-Khan, M.D., section chief, division of maternal-fetal medicine and surgery, Hackensack University Medical Center, Hackensack, N.J.; Dec. 20, 2010 Pediatrics, online


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