A group of surgeons conduct a C-section.
About 32% of babies are born by C-section in the U.S., more than double the rate recommended by the World Health Organization. (For Spectrum Health Beat)

I recently visited my daughter in Virginia for the birth of our newest grandson.

After laboring for quite a long time, our daughter underwent a cesarean birth.

Our oldest daughter also had her first baby by cesarean section, in a breech presentation. Our middle daughter, too, had a cesarean section because of the baby’s positioning—the baby had her hand over her own head.

C-sections are quite common in the U.S.

In 2017, about 32% of moms had a C-section, down only slightly from a peak 33% in 2009, according to the CDC.

It’s one of the most common surgeries performed in this country.

In some countries, like Brazil, private hospitals have an 80-90% C-section rate. Israel and the Netherlands have a 15-17% cesarean surgery rate.

So it’s quite a huge difference depending on where you live.

The World Health Organization puts the ideal C-section rate at about 10-15%, a standard it has kept in place for the past three decades.

About five years ago, the World Health Organization rolled out a program—the Robson classification system—to help health care providers standardize C-section data. This allows for a widespread comparison of C-section trends, definitions, outcomes and other information across different populations, cultures and institutions.

It effectively sets a global standard for the study and analysis of C-section rates.

Whenever possible, health care providers in Michigan have made it a goal to reduce C-section rates for first-time deliveries, called primary C-sections. It’s one of many tasks the Alliance for Innovation on Maternal Health has set out to accomplish in this state.

Michigan is also working to achieve this through the Obstetrics Initiative.

The initiative particularly focuses its efforts on reducing C-sections in first-time deliveries for women who give birth at 37 weeks or later, with the baby in a head-down presentation.

These conditions, known as “NTSV deliveries,” account for 30-35% of the approximately 110,000 deliveries that occur annually in Michigan.

While we know that C-sections can be necessary, they also introduce more complications than a vaginal delivery.

Risks and complications

C-section complications for the mom can include infection, excessive blood loss, future pregnancy issues, blood clots, reaction to anesthesia, injury to internal organs, extended recovery time and more.

For the baby, risks can include a lower apgar score, essentially a measure of a newborn’s physical condition. This measurement is obtained by adding points (2, 1, or 0) for breathing, heart rate, muscle tone, reflexes and skin color.

A score of 10 represents the best possible condition.

C-sections will always be necessary and available for some situations, but health care providers generally try to avoid it when it’s not necessary.

In my opinion, vaginal birth should be chosen whenever possible.

We encourage moms to use upright positions in labor, which helps the baby get in the most ideal position for delivery. We also encourage upright positions for delivery itself.

A key element in all this is patient education. Health care providers want patients and families to remain engaged and well-informed about consent, shared decision-making and all aspects of pregnancy and birthing.