Subscribe to The Atlantic and get 2 free issues

Labor, Interrupted

Getting to the root of the rising C-section rate for births in the U.S.:

"One clue may lie in what some experts call 'cascading interventions'—medical actions that lead to other medical actions that evolve into more invasive steps, including C-sections. Inducing labor, for example—in which a provider tries to stimulate a pregnant woman’s contractions through synthetic hormones or by stripping part of the membrane from her uterine wall—has been found to increase the likelihood of cesareans in first-time mothers.

"Continuous electronic fetal monitoring (CFM), which tracks a baby’s heart rate throughout labor, is also associated with higher cesarean rates. 'It was hypothesized,' Ecker explains, 'that [CFM, developed in the late 1960s] would reduce rates of cerebral palsy.' Based on this hypothesis, the technology became widely used. In the great majority of U.S. hospitals, CFM is standard care; a 2005 study found that 87 percent of laboring American women were attached to monitors most or all of the time. Meanwhile, Ecker adds, studies found that CFM had not reduced the incidence of cerebral palsy. But CFM did seem to increase C-section rates, he says: doctors were 'seeing these wiggles and squiggles'—changes in fetal heart rate—'that they weren’t seeing before.' They would get nervous and conclude, 'We’ve got to do something about it. Let’s do a C-section.'"
AUTHOR:Nell Lake
PUBLISHED: Nov. 27, 2012
LENGTH: 17 minutes (4323 words)