British OB Nick Fisk is performing slow, gentle, family-centered cesareans. His method is a huge improvement over the typical non-emergency cesarean, though it does not address the urgent need to reduce our appalling national cesarean rate. While Fisk’s method cannot negate all of the risks, for the sake of the mothers and babies who do experience surgical birth, we can hope that it becomes the hot new trend among obstetricians.

This groundbreaking approach to surgical delivery - Fisk calls it a “skin-to-skin caesarean”, or “walking the baby out” - has been pioneered by him partly in response to the rising caesarean rate…

“What I realised was that caesareans were done a certain way because they’ve always been done a certain way, but in fact they can be done differently - and in a way that parents love,” says Fisk. Other doctors are sometimes shocked when they hear what he is doing. “They say, but surely you have to get the baby out fast so she can get oxygen straight away? And I say, when the baby is being born she’s still attached to the umbilical cord and is still getting oxygen from the placenta. Caesarean birth can be gentle, just as vaginal birth can be gentle.

“Obstetricians are too hung up on getting from the point of incision to the birth of the baby as quickly as possible: that’s been the benchmark of a skilled surgeon. But I’m challenging that because, from the baby’s and from the parents’ point of view, it’s not very helpful.”

This clickable chart from the New Jersey Star-Ledger is great, and I hope it will be imitated in other places. While not as detailed as the data from the Birth Survey will eventually be, it is a valuable tool that lets women quickly and easily compare different hospital’s cesarean rates — and those rates have incredible variation, with some hospitals near or even over 50% surgical births and others closer to 20%. By clicking on a hospital’s name, you get the cesarean and VBAC rates for ten years past; it is rather chilling to see the Cesareans swiftly climbing while the number of VBACs drops.

At a party yesterday, a co-worker of my husband’s admired my new baby, who was peacefully sleeping in a sling. “I became a great-aunt this morning,” my acquaintance informed me. “My niece had her first baby.”

She continued, “It was very ironic — a few weeks ago she was in the hospital to keep the baby from coming early. But when he was allowed to come, she didn’t go into labor, so she had to be induced. And then he didn’t come in 24 hours, so she needed a Cesarean.” She added, “Of course, she was very happy to be done!”

Stories like this are as common as baby announcements. This article looks at studies and statistics from the U.S. and Europe and comes to some troubling conclusions. In most developed nations, the combined total of cesarean deliveries and induced labors ending in vaginal birth outnumber vaginal births after spontaneous labor.

With less than half of all babies “coming in their own good time”, births drop dramatically on weekends and holidays, and fewer births happen at night — even though, as the article notes, “many studies have shown that women’s natural hormonal cycles tend toward labor starting at night.”

Despite the risks of inductions and cesareans, the article finds a way to put a positive spin on obstetric convenience. Having babies during “banker’s hours”, the article tells us, is actually safer. According to a recent Texas study, “Particularly among hospitals that delivered about 4,000 to 7,700 babies [in a 3-year-period], there was a 51 percent greater risk of death for a baby born on a weekend than on a weekday.”

Sounds alarming, doesn’t it? The Texas study article advises parents to be to “shop” for their hospital, choosing one that delivers more babies and has a better-staffed neonatal nursery just in case their baby needs special care.

At least parents weren’t advised to schedule their birth during the week to avoid weekend staff shortages. Induction increases the already high risk of Cesarean section, and non-emergency Cesareans increase neonatal mortality by 70 - 90%.

The issue of increased neonatal mortality on weekends has been debated for years, with conflicting findings in different studies. Reduced staffing on weekends is generally blamed for the “weekend effect”. However, some of these studies have noted that pre-term and low-birth weight births are over-represented in weekend births — probably because preterm births are least likely to be affected by obstetric practices which lead to the higher rate of births on weekdays. A 2003 study found that after adjusting for birth weight, the weekend increase in neonatal mortality was no longer statistically significant.

Expectant parents need more options than shopping for the best neonatal intensive care nursery and scheduling their induction for the most convenient weekday. In the hospital setting, the Midwives Model of Care has been shown to reduce inductions, cesareans, and preterm and low-birth-weight babies. As for me, I’ll stick with a CPM who makes house calls — even on weekends and holidays.

The National Center for Health Statistics released the birth data for 2006 today. Their press release focuses on the increase in births to teens and unmarried mothers, but buried near the bottom is this nugget of information:

“The cesarean delivery rate rose again in 2006, to 31.1 percent of all births, a 3 percent increase from 2005 and a new record high. The percentage of all births delivered by cesarean has climbed 50 percent over the last decade.”

At this link, you can access state-by-state preliminary data in pdf format. Ohio, Kentucky, and Indiana all experienced an increase in their cesarean rate. Ohio now stands at 29.3%, Kentucky at 34.5%, and Indiana at 29%.

In an emergency, Cesarean delivery can be life-saving. But in the United States today, the Cesarean rate is almost one in every three births — despite the overwhelming evidence that such high rates of surgical birth actually exposes mothers and babies to unnecessary risk of complications. This article cites a recent British Medical Journal study that warns of the risks inherent in non-emergency Cesareans.

“Overall, Caesarean delivery doubles the risk of severe maternal morbidity, and elective procedures add another 30% to the risk, they said. Caesarean delivery also doubles an infant’s risk of a prolonged stay in the ICU.”

“Any net benefit from the liberal use of Caesarean delivery on maternal and neonatal outcomes. . .remains to be demonstrated,” according to the study’s authors.