Natural birth? Nope, C-Section rates on rise

Docs, midwives cite concerns, dispute reasons

By Peter Korn

Pamplin Media Group, Feb 27, 2010 (1 Reader comment)

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Nearly one in three Oregon births comes via C-section — a number that has been steadily rising over the past 40 years despite the fact that Oregon has more births attended by midwives (about 15 percent) than most states.

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Portland obstetrician Duncan Neilson says that up until about 10 years ago, he had never had a healthy pregnant patient ask him to schedule a labor induction and Caesarean section for the birth of her baby.

“If someone had asked me to just do a C-section for no reason, I would have probably regarded them as nuts and done everything I could to talk them out of it,” says Neilson, chief of women’s services at Legacy Health Systems.

Now, Neilson says, it isn’t uncommon for women to want to schedule a C-section even though their pregnancies are going perfectly well. And obstetricians, he says, are less likely to try to talk women out of scheduled C-sections, because when they do, the women say they will simply find another obstetrician.

Pamela Echeverio, a Northeast Portland midwife, has a different take on the way doctors are dealing with maternity patients.

“We do obstetrics wrong in this country,” Echeverio says.

In Echeverio’s mind, obstetricians and the entire medical establishment are complicit in encouraging women to have C-sections rather than to deliver their babies through natural, vaginal births. Most C-section decisions aren’t made weeks or months ahead of time, she says, and are not initiated by pregnant women. They take place in the maternity room with a woman who has been in labor.

“All women, when they get to the end of their pregnancies, want to be done,” Echeverio says. “Naturally, when a doctor says to them, ‘Let’s get this baby moving,’ they trust their doctor to know what’s good for their babies and what’s good for them. What they don’t know is it’s not good for them, and it’s not good for their baby.”

Echeverio and Neilson have different perspectives, but both agree there is a problem with the way babies are being born in Oregon.

Forty years ago, about one of 20 babies born in this state was delivered by C-section. That number has been steadily rising so that today, nearly one in three Oregon births comes via C-section, despite the fact that Oregon has more births attended by midwives (about 15 percent) than most states.

Portland midwife Judith Rooks, former president of the American College of Nurse-Midwives and author of “Midwifery and Childbirth in America,” says fewer than half of induced labors, which frequently result in C-sections, were strictly the women’s choice. But that doesn’t mean the doctor is the one making the decision.

“It’s a dance between the woman and the doctor,” Rooks says. “The doctor says, ‘I’m going to be on vacation, and if you want me to be there, maybe we should just induce you now.’ ”

As evidence, she points to state birth statistics that show Saturday and Sunday are the most common days for natural births in hospitals, while Friday and Tuesday are the days when more C-sections are performed — before or after the weekend.

Northeast Portland resident Amy Poe’s obstetrician at a local hospital wasn’t concerned about an upcoming weekend when Poe gave birth four years ago. Still, Poe is convinced her C-section — which occurred on a Tuesday in late December 2006 — was unnecessary.

Poe says on her due date the obstetrician said her water was low and her labor needed to be induced. That induction, she says, initiated a “cascade of interventions” that led to a C-section later that day. But she says her physician never told her the truth about those interventions, or other options that were available, or how painful six weeks of recovery from the C-section would be.

And, Poe says, she never gave true informed consent to have her operation.

“The doctor said to me you can either have a C-section now or an emergency C-section later. It wasn’t really a choice,” Poe says. “I gave consent, but it was not informed.”

Now, Poe looks forward to the birth of her second child, which she plans as a home birth with a midwife attending. Having done extensive research about the situation surrounding her first birth, she has begun a Web site, birthmatters.info, intended to help women learn more about birth options. And she still isn’t sure what motivated her female obstetrician to push her along a path to a C-section without involving her in the decision making, or giving her more time to deliver naturally.

“The Christmas holiday is all I can figure,” Poe says. “Nobody wants to be in the labor ward after Christmas.”

Or, Poe says, maybe her physician just felt the need to take charge and do something quickly, and a technological solution seemed most logical to her.

High-risk pregnancies

Legacy’s Neilson says he doesn’t believe physicians are pushing C-sections for fear of working on weekends or holidays. But, he says, there is increasing pressure for physicians to induce labor because more women are coming in obese, diabetic or simply older than women in previous eras. All three are considered conditions indicating high-risk pregnancies, and high-risk pregnancies more often require C-sections.

Smaller families also mean a greater percentage of births are first births, Neilson says, which typically are more difficult than later births.

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