Friday, October 24, 2008


Contact: Rae Davies, Executive Director Phone:
(888) 282-CIMS Fax: (904) 285-2120 E-mail:

The Coalition for Improving Maternity Services views with alarm a recent study showing that U.S. women having cesarean sections are four times more likely to die compared with women having vaginal births.1 Investigators reported a maternal death rate of 36 per 100,000 cesarean operations versus 9 per 100,000 vaginal births. This is the difference attributable to the surgery itself, not any complications that might have led to the need for surgery. Based on calculations of what constitutes a reasonable cesarean rate versus the actual U.S. cesarean rate,* 135 women die every year as a result of having surgery they did not need.
Moreover, the difference in mortality rates between cesarean section and vaginal birth is almost certainly larger than it appears. Investigators only considered deaths occurring up to 1 year after delivery. Some surgically-related deaths—scar tissue causing a twisted bowel, for example—may occur after the 1-year cut-off.
In a press release entitled “Weighing the Pros and Cons of Cesarean Delivery,” the American College of Obstetricians and Gynecologists offered the theory that cesarean section benefits mothers by protecting against pelvic floor prolapse as a counterbalance to the fact that it was associated with an increased maternal death rate.2 The research, however, does not support this theory. While some studies do report a short-term benefit with cesarean section for a few women,3 none find long-term differences in symptoms resulting from pelvic floor weakness or injury to maternal tissues.3-7 Other studies report considerable percentages of women with urinary or bowel problems in the early weeks and months after cesarean surgery.8-9
The finding that cesarean section offers no long-term advantages holds true even without taking into account that many features of standard obstetric management cause or contribute to weakness or damage, and the use of these features could be greatly reduced or eliminated. These include episiotomy, fundal pressure (pushing down on the woman’s belly to expel the baby), vacuum extraction, forceps delivery, and how and in what positions women are directed to push.10 Indeed, the ACOG press release acknowledges that vaginal instrumental delivery produces the worst results. Epidural analgesia also contributes indirectly by increasing the need for vaginal instrumental delivery and episiotomy.11-12 Had women birthing vaginally received optimal care, the incidence of pelvic floor laxity and genital injury would likely have been much smaller.
CIMS contends that reducing the use of injurious practices would do far more to improve maternal health and well-being than substituting major abdominal surgery. Increased risk of maternal death is but one of the many hazards of cesarean section. (See CIMS fact sheet, The Risks of Cesarean Delivery to Mother and Baby.)

*The 2002 cesarean rate was 26%. This means that about one million of the 4 million U.S. women giving birth every year have cesarean sections.13 The World Health Organization recommends no more than a 10% to 15% cesarean rate.14 If the U.S. cesarean rate were halved, 500,000 fewer women annually would have had cesarean sections. The death rate among them would have been 9 per 100,000 (45 women) rather than 36 per 100,000 (180 women) – a difference of 135 lives. {the present cesarean rate in the US is 33.1%}"

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