February has been a busy month in our house (Baby Rónán is turning 6 months) and seems to have been just as busy for researchers publishing findings on C-Sections. It’s no secret that birthing vaginally is superior for both mother and baby’s health, but it is shocking how much information is kept from women about exactly how risky a cesarean is and how likely they are to have one. A cesarean section is major abdominal surgery, but pregnant mothers are often frankly bamboozled into thinking that it’s “no big deal” and that the medical interventions being imposed on them make it significantly more likely that they will have one.
Originally developed for high-risk pregnancies, the now common practice of continuous fetal heart monitoring (CTC- cardiotocography) has been linked to higher rates of cesareans, which are being used to resolve what are just safe fluctuations in the baby’s heart rate. According to Medical Express and Dr. Lee Learman, M.D. of the Indiana University School of Medicine
“We now know that this form of monitoring has not improved clinical outcomes,” he explained. “Instead, because of its inherent limitations, this form of monitoring leads to many ‘false alarms’ that are resolved by performing cesarean delivery.”
The cumbersome wires of the monitoring system (even with telemetry) make it very difficult for the labouring mother to move freely and bathe, which speeds labour along and can make it significantly less painful for the mother. If CTC is indeed increasing the likelihood of an unnecessary C-Section for the mother and simply causes her inconveniences which make the labour process more difficult, it begs the question of why so many women continue to be told that it’s “necessary” at all. The issue of continuous (rather than intermittent) fetal monitoring is a perfect time for a mother to exercise her right to say “no” to any procedure. All patients have the right to deny all or part of the recommended care at any point.
“Research by the March of Dimes and the Centers for Disease Control and Prevention in 2008 found that c-section deliveries accounted for nearly all of the increase in the U.S. singleton preterm birth rate between 1996 and 2004.”
That statement alone is worrying enough, but the article also raises the issue that babies born “small for gestational age babies delivered early by c-section had higher rates of respiratory distress syndrome than similar preterm babies who were born vaginally.” It used to be that doctors could genuinely say that cesareans carried no additional risk to mother and baby, but now we know it isn’t true. Aside from the problems it can cause with the establishment of breastfeeding, we now know that leads to a greater likelihood that baby will have respiratory issues. Every mother wants what is best for her baby and that clearly isn’t a c-section in most cases. On a recent visit to a hospital with a client, the nurse doing the tour casually answered my standard “what is your c-section rate” question with a cool 33% For reference, the World Health Organization says that the C-Section rate should be between 10-15%– less than half of what that hospital was doing. I was floored by that number and even more shocked that she didn’t seem at all ashamed and offered no reason why it should be so high. I look forward to the day when hospitals have to justify these numbers to patients and doctors don’t perform major abdominal surgery on mothers to suit anyone’s convenience. When a baby is born vaginally he receives a coating of microflora from the mother’s vagina, her body releases a rush of oxytocin to bond with her and causes her milk to drop, and the mother and child have the shortest recovery time. Preventing a c-section should be among the top priorities of birthing institutions and OBs.
More of the same, mostly, but including this interesting tidbit:
Preterm birth, which is delivery before 37 weeks of pregnancy, is a serious health problem that costs the United States more than $26 billion annually, according to a 2006 Institute of Medicine report.
It also elaborates that the above study took into account the usual suspects for discrepancy in maternal stats: “maternal age, ethnicity, education, primary insurance payer, pre-pregnancy weight, gestational age at delivery, diabetes and hypertension.”
VBAC (vaginal birth after cesarean) is a safe, viable option for many women. Unfortunately, most of them are scared off it by doctors who fear that the fraction of 1% chance of uterine rupture will happen to their patient on their watch. However, they seem to have no problems using Cytotec (misoprostol) to induce labour, even though it is definitely proven to be very dangerous to induce labour-especially in women with a prior cesarean section.
“Even though most women can achieve a vaginal delivery with trial of labor, less than 10 percent of them attempt to do so,” said Sarah Bernstein, MD, with St. Luke’s- Roosevelt Hospital Center, Obstetrics and Gynecology, in New York, and one of the study’s authors. “In fact, when patients perceived that their doctor preferred a repeat cesarean, very few chose to undergo trial of labor, whereas the majority chose trial of labor if that was their doctor’s preference.”
It is absolutely shameful that doctors should knowingly (or unknowingly- ignorance of best practice is not an excuse for poor practice) put mothers and babies at risk. Stand up for your rights and welfare, Mothers!
**Can you tell I love Medical Express? It’s a great one-stop source for research releases. LOVE IT.