You’ve probably heard it before: C-sections are on the rise, accounting for more than 21 percent of births globally in 2015, up from just over 12 percent at the turn of the millennium, according to research from a little over a year ago published in The Lancet. Here in the U.S., about one out of every three babies—or about 1.3 million children—are delivered via C-section per year, according to data released in 2018 from the Centers for Disease Control and Prevention (CDC).
C-sections might be scheduled in advance for various pregnancy complications, such as breech presentation or maternal high blood pressure. On an emergency basis, they’re performed when the baby is in distress, the labor isn’t progressing normally, or the doctor detects a placenta problem (such as placenta previa). Certain risk factors might increase the odds of having a C-section, including pregnancy with multiples, sexually transmitted infections, and maternal medical conditions like heart disease, high blood pressure, or kidney disease.
But what is actually to blame for ballooning rates? According to a doctor who was interviewed recently on BBC Radio Scotland, older, heavier mothers’ “fat vaginal canals” are the problem.
Here’s what you need to know about the eyebrow-raising comments and how obstetricians are responding.
According to Grazia, the conversation took place yesterday during the Mornings, With Jackie Brambles show on BBC Radio Scotland. The show was exploring why the U.K. has seen a marked decrease in the number of women who are giving birth without an induction or Cesarean section. Dr. Marco Gaudoin, who is the medical director at a fertility clinic in the U.K., was asked to explain why older and heavier mothers have higher levels of intervention.
The comment has been met with international backlash. Milli Hill, author of Give Birth Like a Feminist, was on the radio show, as well, and told Grazia the following statement.
Is there any truth to this claim?
Obstructed labor occurs not as the result of fat tissue in the birth canal, but due to the baby’s position in the birth canal or a mismatch in the size of the birth canal and the size of the baby, consultant obstetrician Dr. Virginia Beckett, spokeswoman for the Royal College of Obstetricians and Gynecologists told The Sun.
Felice Gersh, M.D., a board-certified obstetrician and gynecologist and author of PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness, also refutes Gaudoin’s claims.
More likely the cause? Jennifer Celebrezze, M.D., a maternal fetal medicine specialist in Pittsburgh, points out that as a mom’s BMI goes up, so might her risk of issues like gestational diabetes, high blood pressure, and extreme fetal growth, which contributes to the rising C-section rate. Researchers at Seattle’s Swedish Medical Center found that women who were overweight when they got pregnant were twice as likely as lean women to have C-sections. Obese women had three times the risk.
David Lagrew, M.D., executive medical director of the Providence St. Joseph Health Women and Children’s Services Institute, explains, “Particularly with obese patients, many providers are more conservative and intervene sooner.” The reason: Doctors might feel that contending with a thicker abdominal wall and other surgical factors will make quick intervention for mom and baby more difficult. Obstetricians might also feel compelled to intervene sooner because of the worry that older women’s babies are last-chance babies, Dr. Gersh says.
Other Reasons for the Rising C-Section Rate
While age and weight might play a role in some cases, that’s far from the whole story when it comes to the uptick in C-sections. “Studies that have evaluated maternal age, weight, and ethnicity, have found that these factors do not account fully for the increase in the C-section delivery rates,” says Mia Di Julio, M.D., OB/GYN at Providence Saint John’s Health Center in Santa Monica, California.
Here are a few factors at play.
The most common reasons for primary Cesarean section include labor dystocia (difficult or abnormally slow to progress labor), abnormal fetal heart rate tracing (which can indicate fetal distress), fetal malpresentation (such as breech presentation), multiple gestation (twins, triplets, etc.), and suspected fetal macrosomia (a fetus that is significantly larger than average, or more than eight pounds, 13 ounces), says Dr. Di Julio.
While some experts might point the finger at more mothers asking for intervention, Cesarean deliveries by maternal request only account for 2.5 percent of births in the U.S.
2Financial and legal reasons
Dr. Di Julio also notes that financial and legal reasons might come into play. An analysis published in the journal Obstetrics & Gynecology echoes this assertion, noting, “Why providers are more apt to perform cesareans for subjective and elective indications over recent years is a complex issue. Medicolegal reasons, scheduling issues, economic pressures, provider- and patient-driven medicalization of birth, increased labor induction rates, and a broader perception of cesareans as safe have all been raised as possibilities.”
A bit of a more specific example of those economic pressures? In fact, a paper written by health care economists Erin Johnson and M. Marit Rehavi and published by the National Bureau of Economic Research found that doctors might be paid a few hundred dollars more for a C-section compared to a vaginal delivery, and a hospital might make a few thousand dollars more.
The Bottom Line
ACOG asserts that although Cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases, the rapid increase in the rate of C-section births without evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that C-section delivery is overused.
Given the variety of factors that account for this unnecessary rise in intervention, it’s alarming that a doctor would blame not only at the size and age of new moms but their “fat vaginas.” It’s heartening to see that Gaudoin’s comments were met with well-deserved backlash. Clearly, the reason intervention is on the rise is nuanced and complicated—not a case for shaming mothers.
This story originally appeared on Parents.com by Maressa Brown.