I did write about this book in 2013 when it was first released but feel that even now, there are valid points to be made. Cut It Out examines the exponential increase in the United States of the
most technological form of birth that exists: the cesarean section. While c-section births pose a higher risk of maternal death and medical complications, can have negative future reproductive consequences for the mother, increase the recovery time for mothers after birth, and cost almost twice as much as vaginal deliveries, the 2011 cesarean section rate of 33 percent is one of the highest recorded rates in U.S. history, and an increase of 50 percent over the past decade. Further, once a woman gives birth by c-section, her chances of having a vaginal delivery for future births drops dramatically. This decrease in vaginal births after cesarean sections (VBAC) is even more alarming: one third of hospitals and one half of physicians do not even allow a woman a trial of labor after a c-section, and 90 percent of women will go on to have the c-section surgery again for subsequent pregnancies. Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19% of births in France, 17% of births in Japan, and 16% of births in Finland.
Author Theresa Morris systematically examines the reasons for the epidemic rise in cesareans as four pronged: women know very little about labor and birth and do not have complete access to unbiased, evidence-based information. The co-optation of childbirth classes in the 1980s is the reason for this. Yes, it may have been a "good idea" at the time to have childbirth classes move from the community to the hospital, but what many authors of the time feared would happen, has happened: hospital based childbirth classes, generally, are a commercial for what can be expected at that facility. Few mention broad options for childbirth, non-pharmacologic pain relief methods or informed decision making. Secondly, care providers are constrained by their tunnel-vision training and/or their employer's risk management rules and do not or can not practice evidence-based care. Thirdly, organizations take an inordinate amount of time to change policies, procedures and practice guidelines. This encompasses ACOG and hospitals. And finally, we live in such a litigious society that this hinders any type of movement forward in evidence-based quality of maternity care.
Morris points out that if our intervention rate (including cesarean sections) is rising, the maternal/infant mortality/morbidity rate should be dropping. It isn't. In other words, the more that is done to women, more mothers and babies are dying in America. But Morris doesn't leave you stranded. She thoughtfully points out a road map for change.
I suggest we all get on the road to change.
"Cut it Out: The C-Section Epidemic in America" is available through Amazon. Hardcover is $30 but for those of us who don't like to wait, it is $9.99 on Kindle. Happy reading!