Reducing C-sections: What First-Time Moms Need to KnowHealth Hub
For some first-time mothers, the choice to have their baby delivered surgically by cesarean section (C-section) for nonmedical reasons can pose more risks than benefits.
C-sections are intended to prevent injury and death in women who are at higher risk of complicated deliveries or have unexpected complications, says Nancy Travis, R.N., director of Women and Neonatal Services at Lee Health’s Women Care Center.
“C-sections can also prevent injury and death in their newborns. But C-sections are linked to increased risk of infections and blood clots, and many women who aren’t at higher risk for delivery complications get unnecessary C-sections,” Nancy says. “There’s much evidence to support that primary, or first-time, C-sections in the U.S. don’t lead to healthier maternal outcomes. Our commitment toward ensuring a mother and her baby’s safety and comfort is a significant reason behind our participation in the PROVIDE initiative.”
PROVIDE, short for Promoting Primary Vaginal Deliveries, is an initiative of the Florida Perinatal Quality Collaborative (FPQC), a group of professionals dedicated to the advancement of perinatal healthcare.
(More specifically, low-risk, first-birth cesarean rate represents the percentage of cesarean deliveries among first-time mothers delivering a single baby in a head-down position after 37-weeks gestational age. The technical term for this measure is the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate.)
“The PROVIDE Initiative aims to improve maternal and newborn outcomes by implementing evidence-based strategies to promote primary vaginal deliveries at Lee Health and other Florida delivery hospitals,” Nancy explains. “Our nurses, midwives, and physicians are all in this together. Our goal is to safely reduce primary C-sections rates for low-risk pregnancies.”
There’s the matter of economics, as well, for safely reducing primary C-sections. Costs associated with the procedure are significant for insurers, the government, taxpayers, and consumers. Studies have shown each C-section costs $5,000 to $10,000 more than vaginal birth. Based on Florida reports, maternal hospital cost savings for each Medicaid and private insurance cesarean delivery runs about $4,000.
Primary cesarean deliveries are a significant factor behind the increasing C-section rates in the past two decades. The concerning trend sparked the Department of Health and Human Services to set a national goal of reducing the number of C-sections among low-risk women with no prior births by 23.6% over the next year.
This figure doesn’t include C-sections considered necessary for the health of the mother or the baby.
But the task of lowering primary C-section births remains considerable, not only in Florida but across the country. According to a recent report by the Centers for Disease Control and Prevention, babies born via C-section delivery rose to 32.1% in 2021, up from 31.8% in 2020.
In Florida, 1 out of 4 women is having an unnecessary C-section. At Lee Health Cape Coral Hospital, the rate is lower—1 out of 5—an impressive rate considering that nationally, the rate is 1 out of 3 women. That’s a coup for the Lee Health Cape Coral Hospital’s maternity services, Nancy says.
“Our reduced C-section rate at our hospital is incredible, considering the goal is 23.6%,” Nancy says. She cites patient education and specialized care services that support women and their babies during labor, delivery, recovery and postpartum.
Risks of C-section births for mother and baby
For many expecting moms, labor and delivery can be the scary part of having a baby.
“Some expectant mothers may elect to have C-section surgery because it gives them more control in deciding when their baby is born,” Nancy notes. “Fear of childbirth among first-time mothers is cited as a common reason for C-section preference.”
While cesarean deliveries are needed and can be lifesaving at times, doctors say they do have a longer recovery and a higher risk of infection, for example. When deciding the safest way to deliver the baby, doctors consider a few things like the baby’s position, if there are fetal indications requiring immediate birth, and how the mom is progressing during labor.
“There’s much research to support that the maternal mortality rate is lower with vaginal deliveries than C-section surgeries,” says Dr. Rachel Wykes, an obstetrician/gynecologist with Lee Physician Group.
“The healing and recovery are much faster with vaginal delivery. There’s also a bonding component that happens, from the neonatal side, when a baby passes through the vaginal canal that kind of pressure and stress really helps with their lung development,” Dr. Wykes notes.
Maternal health experts say ensuring a woman can deliver vaginally whenever possible could help prevent childbirth-related complications that are more likely to happen if she has multiple C-sections.
“A C-section is major abdominal surgery, with all the risks associated with any surgical procedure,” Nancy says. “It typically has a longer recovery than a vaginal delivery.”
C-section risks include:
- Blood loss
- Blood clots
- Injury to bowel or bladder
- Allergic reaction to anesthesia
- Higher risk of postpartum depression
- Longer recovery time
- Respiratory issue for the baby
- In future pregnancies, increased risks include placenta problems, rupture of the uterus, and hysterectomy.
“We do perform C-sections for women who need them, of course,” Nancy adds. “But we’re trying to prevent that first C-section if it’s unnecessary to prevent later complications.”
The Family Birth Suites at Cape Coral Hospital and HealthPark Medical Center are recognized by Baby-Friendly USA for excellence in care for ensuring a mother and her baby’s safety and comfort during labor, delivery, and recovery.
Studies show giving moms more time and support during labor can improve their chances of delivering vaginally.
“The nurses play a huge part in supporting the patient through labor, and we are very proud of our nursing staff. They have been on staff with us for so long it’s like a family up there,” Dr. Wykes says.