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Number of caesarean sections reaches record high in the US

Personal choice, vaginal birth risk, fear of suits cited

ATLANTA -- The rate of caesarean sections in the United States has climbed to an all-time high, despite efforts by public health authorities to bring down the number of such deliveries, the government said yesterday.

Nearly 1.2 million caesarean sections were performed in 2004, accounting for 29.1 percent of all births that year, the National Center for Health Statistics reported. That is up from 27.5 percent in 2003 and 20.7 percent in 1996.

The increase is attributed to fears of malpractice lawsuits if a vaginal delivery goes wrong, the preferences of mothers and physicians, and the risks of attempting vaginal births after caesareans.

The caesarean section rate increased for all births, even those that involved healthy, first-time pregnancies with a full-term, single child.

In 2000, the government announced a national public health goal of reducing the caesarean section rate for such births to 15 percent by 2010, but the rate now is about 24 percent and rising.

The government also reported that more than a half-million infants were born preterm -- at less than 37 weeks' gestation -- in 2004, which is another record. And the proportion of infants with a low birth weight rose to 8.1 percent in 2004, from 7.9 percent the year before.

Increases in multiple-fetus pregnancies and in preterm caesarean sections seem to help explain the preterm and low birth weight numbers, said Joyce Martin, an epidemiologist who co-wrote the report.

The risks of the surgery include infection and, in rare cases, death. The recovery time is longer than with a vaginal delivery. Doctors often perform a caesarean when the fetus lacks oxygen or is in some other kind of life-threatening distress.

For decades, caesarean sections were done in only a small fraction of births. In 1970, the national rate was 5 percent. Then it rose, surpassing 20 percent by the mid-1980s.

Specialists say many factors drove the rise: Mothers increasingly preferred the convenience of caesarean sections, which could be scheduled. Technological innovations let doctors better see problems before birth.

The trend temporarily reversed in the early 1990s, partly because health maintenance organizations pressured doctors to curtail unnecessary procedures.

By the late 1990s, however, health insurers had cut back their efforts to control the number of caesarean sections.

Also, doctors became worried by studies showing that about 1 percent of women who deliver vaginally after having had a caesarean section previously suffer a ruptured uterus -- a potentially lethal complication for both mother and child.

Some hospitals have banned vaginal births after caesarean sections, said Tonya Jamois, president of the International Cesarean Awareness Network, an advocacy organization.

''Women are struggling to avoid unnecessary surgery, but the medical system has abandoned them. For many, they have to submit to major surgery in order to get medical care," she said.

The rate of vaginal births after caesareans has dropped to 9.2 percent of births in 2004, compared with 28.3 percent in 1996.

Dr. Sarah Kilpatrick, the head of a practice committee for the American College of Obstetricians and Gynecologists, said that 20 years ago, virtually no women asked for caesarean sections. But nowadays, she said, ''the public gets the sense that it's like a zipper; they open you and then close you back up."