April is Cesarean Awareness Month, an annual observance in the United States and around the world that brings focus to the extremely high number of cesarean deliveries in many areas of the globe. In 2021, the most recent year for full statistics, the cesarean rate in the United States was 32.1%. This is up one full percentage point from the 2020 statistics, and the second yearly increase in a row, after two years of declining in 2018 and 2019.  Black birthing parents have the highest cesarean birth rate of all US populations, with 36.8% of Black parents having a surgical birth. 

The World Health Organization states that “caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.” When examining cesarean rates worldwide, many places around the world, where access to immediate and safe surgical delivery options is limited, parents and babies are being harmed. In other locations, with a higher than necessary cesarean rate, there is increased mortality and morbidity rates for parents and babies. A proper solution will increase cesarean birth access where needed and reduce the use of cesareans for delivery where a vaginal birth is safe, appropriate and feasible.

WHO recommends some non-clinical actions that can reduce medically unnecessary use of cesarean sections, within the overall context of high quality and respectful care:

• Educational interventions that engage women actively in planning for their birth such as childbirth preparation workshops, relaxation programmes and psychosocial support where desired, for those with fear of pain or anxiety. Implementation of such initiatives should include ongoing monitoring and evaluation.
• Use of evidence-based clinical guidelines, performing regular audits of cesarean section practices in health facilities, and providing timely feedback to health professionals about the findings.
• Requirement for a second medical opinion for a cesarean section decision in settings where this is possible.
• For the sole purpose of reducing cesarean sections, some interventions have been piloted by some countries but require more rigorous research:
  • A collaborative midwifery-obstetrician model of care, for which care is provided primarily by midwives, with 24-hour back-up from a dedicated obstetrician 
  • Financial strategies that equalize the fees charged for vaginal births and cesarean sections.

International Cesarean Awareness Network (ICAN) is a non-profit organization whose mission is to “improve maternal-child health by reducing preventable cesareans through education, supporting cesarean recovery, and advocating for vaginal birth after cesarean (VBAC).” For Cesarean Awareness Month 2023, they have rallied around the theme of “You Have Options.”

ICAN would like expectant families to be aware of what their options are during pregnancy and labor. This includes the ability to:

• Change providers at any time. 
• Choose their provider (OBGYN, midwife (CNM, CM, CPM), family physician, etc.)
• Choose the birth setting (home, birth center, hospital)
• Decide between a VBAC and a repeat cesarean section (RCS).
• Choose informed refusal when there is no choice in provider or birth setting.

Childbirth educators can and should be spiraling these topics throughout their entire curriculum, rather than having a concentrated focus on cesarean delivery in one specific class. Be sure to discuss choosing a birth facility and provider, evidence based indications for a cesarean, statistics and trends on cesarean births, shared decision making, local statistics on cesarean rates, cesarean recovery, impact of cesarean surgery on fertility and future birth options, how to have a “family-centered” cesarean, actions and decisions to reduce interventions in labor, components of a positive birth experience and more.

Educators may want to utilize the Brilliant Activities for Birth Educators posts focused on cesarean topics for ideas on how to provide engaging content on this subject for their childbirth classes. Consider joining ICAN’s free webinar focused on the “You Have Options” theme that is scheduled for April 10th, at 8 PM CT. You can register here.

Childbirth educators are recognized by WHO as an effective means to reduce the cesarean rate. Educators can and should be intentional about covering this topic from the lens of supporting families to be able to avoid unnecessary cesareans and considering vaginal birth after cesarean for future deliveries.

How are you recognizing Cesarean Awareness Month in your childbirth classes and in the perinatal organizations you are affiliated with?  Share below in the comments section so that others can learn about ways to bring awareness to this important topic.

References

Betran AP, Ye J, Moller A, et alTrends and projections of caesarean section rates: global and regional estimatesBMJ Global Health 2021;6:e005671.

Osterman, M. J. K., Hamilton, B. E., Martin, J. A., Driscoll, A. K., & Valenzuela, C. P. (2023, January 31). National Vital Statistics Reports - Births Final Data for 2021. Retrieved April 5, 2023, from https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-02.pdf 

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