Women in the Amish community were far less likely to have a C-section than national averages and they also had more positive outcomes with vaginal births.
The 17-year study by the University of Wisconsin School of Medicine and Public Health was published in the November/December issue of Annals of Family Medicine.
Data tabulated at the LaFarge Birthing Center in LaFarge, Wisconsin showed only 3.8 percent of 927 births required a cesarean. In addition, 95 percent of women who previously had a cesarean birth had a safe and successful vaginal birth.
“Practice at the Amish Birthing Center has demonstrated that low cesarean rates can be achieved with excellent maternal and neonatal outcomes,” said Dr. Lee Dresang, a co-author of the study, associate professor of family medicine and the departmental maternity care clinical coordinator.
The birthing center was opened in 1993 by Dr. Jim Deline to help pregnant Amish women, who normally give birth at home in the presence of family and unlicensed medical attendants.
“Dr. Deline noted positive outcomes with relatively few complications serving a high-risk population,” said Dresang. “Despite the low cesarean rate, maternal and neonatal outcomes were similar to elsewhere in the United States. Despite the unique setting of the Amish Birthing Center, many of the practices which led to the low cesarean and low complication rate in LaFarge are exportable to mainstream U.S. maternity care practice.”
Cesarean births, which involve major surgery to the abdomen and pelvis, are commonly required during breech births and other complications during labor, but there are many situations where C-sections are unnecessarily performed. The procedure can lead to major blood loss, infections, blood clots, and damage to the bladder and intestine.
Nearly one-third of all births were C-sections in the United States in 2009. A 2011 study predicted the percentage could rise to 56 percent in the year 2020.
The SMPH study cited a recent survey that indicated 29 percent of obstetricians were performing more cesareans due to malpractice concerns. However, most Amish do not have insurance or believe in litigation, and place their trust in clinicians who are willing to work with their beliefs concerning childbirth.
“The advantages of vaginal births include quicker recovery, fewer delivery risks and less danger with future deliveries,” said Dresang. “If a woman has a successful vaginal delivery, her subsequent deliveries are likely to be shorter and easier. Cesarean deliveries can be lifesaving for women and their babies, but unnecessary cesareans increase risks for both.”
Dresang added that cesarean deliveries place a greater financial burden on families and/or their insurance carrier as they often require additional operating room, nursing, and anesthesia costs and longer hospital stays.
Dresang said the results seen at the LaFarge Birthing Center could be a major influence for mothers who are contemplating the best way to give birth to their children.
“Cesarean delivery is the most common delivery in the U.S.,” he said. “As the U.S. grapples with health care costs during implementation of the Affordable Care Act, a focus on reducing the number of unnecessary cesareans will certainly be attractive to policy makers as well as individual women and their families.”
University of Wisconsin School of Medicine and Public Health