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Wagner Says WHO Research on Cesarean Rates is Current

Dr. Marsden Wagner, former Director of Women’s and Children’s Health for the World Health Organization, stated via e-mail that the WHO’s 1985 recommendation that cesarean rates by country should not fall below 10% or above 15% remains “absolutely valid and not out-of-date.”

Additionally, Wagner reported that the WHO published a new study in 2007 supporting its original findings that as a country’s cesarean section rate rises above 15%, the maternal mortality too rises. According to Wagner, “[The] unnecessary c-section kills women.”

WHO researchers analyzed nationally representative data available from surveys or vital registration systems on the proportion of births by cesarean section. Their analysis suggests a strong inverse association between caesarean section rates and maternal, infant and neonatal mortality in countries with high mortality levels. There is also some suggestion of a direct association at lower levels of mortality.

Said Wagner, “In the past twenty years in the U.S., the maternal mortality rate keeps rising and rising while the rate of c-section continues to rise. It can now be reliably calculated that [the] c-section is the number one cause of maternal mortality in the U.S.--at least 45% of all maternal death is associated with a c-section.”

According to the CDC's National Center for Health Statistics, the U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004 for a total of 540. This amounts to 45 more maternal deaths than were reported in 2003 and for the first time since 1977, the maternal death rate rose above 10 per 100,000 live births.


View the study "Rates of caesarean section: analysis of global, regional and national estimates"


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Reader Comments (3)

Hi! Just wanted to say how much I liked your site! I found it through Kathy Peterson's "Woman to Woman Childbirth Education" blog. Keep up the good work!!

December 8, 2008 | Unregistered CommenterDiana Johnston

As an expectant father, I've been trying to get an understanding of why the c-section rates in the US have been rising and also trying to grasp what it means for us. In general, I'm finding reliable, unbiased information difficult to find. I followed the link you provided to the CDC report and I think you are misrepresenting the rise of maternal deaths. Here is the specific quote from the report:

In 2004, a total of 540 women were reported to have died of maternal causes (Tables 33 and 34), an increase of 45 deaths from the 2003 total. The increase largely reflects the use by an increasing number of states of a separate item on the death certificate indicating pregnancy status of the decedent; see ‘‘Technical Notes.’’

If you improve your data collection about maternal deaths (eg you collect more), then you find more.

May 2, 2009 | Unregistered CommenterDave N

Hi Dave,

Congrats on your partner's pregnancy!

In 2003, only California, Idaho and Montana changed their death certificate questions. I think it also says in the report (I'm having tech difficulties opening it with this connection), that the number of maternal deaths doesn't include *all* deaths of pregnant women, just those reported on the death cert as caused by or aggravated by pregnancy or obstetric management. When I have a better connection in a few days, I will check it out. Thank you for bringing it to my attention for further review.

I agree wholeheartedly that unbiased information on what the c-section rate means for a pregnant woman, especially a first pregnancy, is all but non-existent. ICAN has white papers posted on its web site at www.ican-online.org. I found during my first pregnancy when being bullied into an unnecessary c-section that I ultimately refused that I received unsound advice from the hospital staff (docs, CNMs) and accurate advice from a homebirth midwife whom I consulted in the final week of my pregnancy. Everything she told me checked out in medical journals (I went home and pulled studies that backed up everything she said about shoulder dystocia in particular). However, nothing the hospital staff told me had any basis in evidence-- just a fear of being sued. It was mind-boggling and insanely stressful. I gave birth in the hospital and then gave birth with midwives in a birth center the next time.

The media has notoriously grabbed onto the myth of the "too posh to push" phenomenon, which misrepresents why the c-section rate is climbing. Sometimes headlines cite fetal weight, maternal age and risk factors and more as the reasons why the c-section rate rises. It really comes down to figuring out why doctors are performing so many c-sections and if they're really helping.

If I can help you gather data in any way, let me know. I'm no expert but I know people that you could ask.

Good luck with your search.

unnecesarean (at) gmail (dot) com

May 2, 2009 | Registered CommenterJill
This blog is all done!
Thanks for wanting to comment. This is an archive of a blog that once was. Take care! Jill