1. Among singleton preterm births, the largest percentage increase in C-section rates occurred among late preterm births (34-36 weeks gestation). Source: “The Relationship Between Cesarean Delivery and Gestational Age Among US Singleton Births,” by Bettegowda VR. et al. Clinics in Perinatology, Vol. 35.

2. Another way to say this is that C-sections account for nearly all – 92 percent – of the increase in U.S. singleton preterm births.

3. We need research to determine how many C-sections that result in preterm babies are not medically indicated and place both mother and baby at potential risk for little or no medical benefit.

4. The March of Dimes call for hospitals to voluntarily review all C-sections and inductions performed before 39 weeks gestation is designed to fill this information gap.

5. With careful dating of pregnancies, and strict adherence to current ACOG guidelines, the March of Dimes believes that it might be possible to reduce the number of C-sections, and as a result slow the increase of preterm birth.

6. Babies born even a few weeks early are at greater risk of serious problems such as respiratory distress, delayed brain development, Sudden Infant Death Syndrome, jaundice, re-hospitalization, and feeding problems.

7. The World Health Organization and Healthy People 2010 have both set goals for C-section rates at 15 percent.  However, C-section rates vary widely among developed nations of the world and among states in the U.S. 

8. The national C-section rate in the United States is currently 30 percent of all live births (MMWR, September 19, 2008).

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9. Virtually all European countries have lower C-section rates than the U.S., ranging from 14 percent in the Netherlands and 18 percent in Sweden to 24 percent in the UK.

10. When is a Cesarean section medically indicated?  Maternal and fetal complications during pregnancy may result in the need for a c-section. C-sections can be life-saving and life-enhancing for women and babies, but they also pose real risks for women and consequences for their future reproductive lives (such as need for repeat C-sections).  Every doctor and patient must weigh the medical circumstances and make a decision in the interests of the woman and her baby.

11. When contemplating early delivery for non-medical reasons, women and doctors must remember that if the baby has not yet reached 39 weeks gestation, it will be born early and may unnecessarily suffer the problems caused by prematurity.  

12. The March of Dimes is asking hospitals and health professionals to voluntarily assess C-sections and inductions that occur prior to 39 weeks gestation to ensure that all of those were medically necessary and followed the guidelines of the American College of Obstetricians & Gynecologists (ACOG).  These guidelines clearly state that that C-sections and inductions should not be done before 39 weeks gestation unless medically necessary.

13. The issue is not how many C-sections should be performed in the U.S., but rather that every C-section should be performed after an informed discussion of the risks and benefits by the doctor and patient.

14. Good dating of the pregnancy by early ultrasound also can help ensure that a decision to induce or to have a C-section is made with the best information. 

15. If all hospitals and health care providers in this country followed ACOG guidelines, and we had better data collection to allow us to monitor the results, we would find out what the best rate is for the U.S.
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16. Nationally, ACOG has a special program to help individual hospitals perform a “Voluntary Review of Quality of Care” (see Obstet Gynecol Clin North Amer, March, 2008).

17. In recent years, the most important observation from these reviews has been the problem of inappropriate early inductions that result in late preterm births (ACOG Today, August, 2008).

18. More information on C-sections and inductions can be found at: marchofdimes.com/csection  or marchofdimes.com/induction.

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