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“Patient Choice” Cesareans? Diversion from the Real Issues

For Immediate Release
March 29, 2006

Contact: Susan Hodges, President
Citizens for Midwifery
1-800-CfM-4880 or 706-549-7023

Athens, GA – The National Institutes of Health has just completed a conference on “Cesarean Section by Maternal Request,” but recently-released results of a new “Listening to Mothers” survey from Childbirth Connection indicate that it is extremely rare for a woman to ask for a cesarean section. Childbirth Connection found in a nationally representative sample of birthing mothers that only one (0.08%) out of 1300 women who could have asked for a primary (first) cesarean section actually requested it.

The current focus on the illusion of “patient choice” cesarean sections diverts attention from the very real and serious fact that the U.S. has the highest rate of cesarean section ever, at 29.1% of births in 2004 and increasing.  The U.S. rate is nearly twice the 10%-15% rate for cesarean section recognized as reasonable and safe by the World Health Organization (WHO).

Willa Powell, Citizens for Midwifery Board Member points out, “Although it may be interesting that Britney Spears got her “patient choice” cesarean section, keep in mind that nearly one-third of women having babies today get a cesarean section.  Many of them did not want this surgery, and about half of the cesarean sections were preventable.”

“Cesarean sections are associated with significant risks of immediate and long term harm to mothers and babies and cost much more than vaginal births – an economic burden on government, businesses and families,” stated Susan Hodges, President of Citizens for Midwifery. “Reducing the U.S. cesarean section rate by more than half to the WHO rate could spare 638,032 women the many risks and pain associated with cesarean sections outlined in “What Every Pregnant Woman Needs to Know About Cesarean Section” (Childbirth Connection, 2004  Such a reduction in cesarean sections also would save 1.5 billion dollars annually.”

Midwifery care in out-of-hospital settings demonstrates that safe birth outcomes with very low rates for cesarean section and other interventions can be achieved (see Citizens for Midwifery website In contrast, most vaginal births are managed in hospitals with practices and interventions that have been discredited as ineffective or harmful for low-risk women, but remain the standard of care. National cesarean section rates could be reduced by replacing these outdated methods with known “best practices.”

Susan Hodges, President of Citizens for Midwifery, wonders “Shouldn’t NIH be asking why “best practices” for vaginal births are not being used?”

Citizens for Midwifery suggests that NIH should recommend research to explore what is driving the wasteful and unconscionable increase in cesarean sections for no medical reason, and to determine strategies to decrease our nation’s dangerously high overall cesarean section rate.

References available on request.

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Citizens for Midwifery is a national, consumer-based non-profit organization that promotes the Midwives Model of Care, provides information about midwifery and childbirth issues, and speaks up for consumer interests regarding midwifery and maternity care.  The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes. The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma and cesarean section.  Find more information about Citizens for Midwifery at


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