C-Sections and V-Bacs
The C-section rate has risen dramatically in the U.S. averaging as many as 25% of all births. Whereas many women are led to beliveve that c-sections may be safer than natural, vaginal deliveries and planned births are more convenient, there is much evidence in the literature to indicate otherwise.The following studies are provided to increase your awareness about the risks of c-section and the links below will lead you to extensive resources on the subject.
Vaginal Birth After Cesarean (VBAC) Success Story.
The video on this link is inspirational and motivating for mothers who are attempting a VBAC. Sent over by the International Cesarean Awareness Network (ICAN), this clip give mothers hope and courage to take charge of their lives and their births. View the clip here: www.onetruemedia.com/otm_site/view_shared?p=2a4e81fbf0f66accb8afce
To read more about C-sections and VBACS visit: www.icpa4kids.org/research/pregnancy/csections.htm
Risk of death
to newborns delivered by voluntary Caesarean section is
much higher than previously believed
A recent study titled: Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk," found that the risk of death to newborns delivered by voluntary Caesarean section is much higher than previously believed.
In this study of almost six million infants, researchers found the neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000.
Their findings were published in this month’s issue of Birth: Issues in Perinatal Care. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1523-536X.2006.00102.x
The study included 5,762,037 live births and 11,897 infant deaths in the United States from 1998 through 2001, a statistically significant sample even though neonatal death is a rare event. There were 311,927 Caesarean deliveries among low-risk women in the analysis.
“Neonatal deaths are rare for low-risk women — on the order of about one death per 1,000 live births — but even after we adjusted for socioeconomic and medical risk factors, the difference persisted,” said Marian F. MacDorman, a statistician with the CDC and the lead author of the study. “This is nothing to get people really alarmed, but it is of concern given that we’re seeing a rapid increase in Caesarean births to women with no risks,” Dr. MacDorman said.
The researchers noted that vaginal birth is beneficial to the baby. During this process, hormones are released promoting healthy lung function. The physical compression of the baby moving through the vaginal canal also helps remove fluid from the lungs and helps infants in breathing. Other risks of c-section mentioned by the researchers, like cuts to the baby during the operation or delayed onset of breast-feeding, were also considered as reasons for the increased death rate.
Although there was no mention of the importance of cranial molding that happens in a vaginal delivery and not in a c-section, we do know that vaginal births allow for this process necessary for central nerve system function.
Dr. Michael H. Malloy, a co-author of the article and a professor of pediatrics at the University of Texas Medical Branch at Galveston, said “Despite attempts to control for a number of factors that might have accounted for a greater risk in mortality associated with C-sections, we continued to observe enough risk to prompt concern.” He remarked that doctors might want to consider these findings in advising their patients giving them the option of informed choice.
I think some women have been seriously misled into believing that c-sections are better and safer than normal, natural deliveries. What is not emphasized when they are being given the option for elective c-sections is that a c-section is a majory abdominal surgery! Just because the c-section rate is increasing, it does not make it safer for either the mother or baby.
In a previous FWF E-Newsletter: http://www.icpa4kids.org/wellness/0019.htm We discussed a study that sited the many risks of c-section to both the mother and baby. http://www.medscape.com/viewarticle/512946_4
Also, our web site has many studies listed on the dangers of c-sections: http://www.icpa4kids.org/research/pregnancy/csections.htm and the importance of natural birthing: http://www.icpa4kids.org/research/pregnancy/natural.htm
One interesting study on our site discusses whether OBs should even be seeing women with normal pregnancies, let alone offering elective c-section to low risk mothers! http://bmj.bmjjournals.com/cgi/content/full/312/7030/554
Our advice remains -- for all of your family decisions -- make sure you are informed before you choose what seems to be safe and accepted practices.
Soaring C-section Rates Cause for Alarm
Cesarean section rates are off the charts and women are being duped
into thinking that this is all right; in fact they are being enticed
to consider c-sections on demand based upon questionable promises.
A woman considering cesarean section should be told that, compared to
vaginal birth, she has an increased risk of infection, hemorrhage, damage
to abdominal and urinary tract organs, and complications from anesthesia/narcotics.
She needs to know that the incidence of drug resistant infections is
increasing and blood transfusions can lead to life threatening complications.
She should also be told that she will probably not be allowed to attempt
a vaginal birth in the future, and that the risk of complications from
cesarean section increase with each subsequent surgery. Recent studies
note higher rehospitalization and draw a direct link between chronic
pelvic pain and cesarean section. These complications can ultimately
limit her ability to have the number of children she desires.
The American College
of Nurse-Midwives
Cesarean Section Increase: Cause for Concern
In Great Britian, the number of women giving birth by c-section increased
once again in 2001. Hospitals in England and Scotland now have a 22%
rate and whales and Northern Ireland is up to 24%
The New Zealand Ministry of Health is concerned that a growing proportion
of c-sections in the country is done for the convenience of the mother
and/ or physicianIndividuals and organizations are speaking out against
these “social cesareans.” National maternity manager Barbara
Browne says, “The health sector needs to support women around the
time of childbirth to help them feel strong.” The C-section rate
in New Zealand has risen from 12% in 1988 to 20% in 2001. The WHO estimates
that the rate of C-section should be between 5 and 15% of all births.
Mode of delivery and asthma -- is there a connection?
The results of this study in Finland suggests that caesarean section
delivery may be associated with an increased prevalence of atopic asthma.
Kero J, Gissler M, Gronlund MM, Kero P, KoskinenP, Hemminki
E, Isolauri E Mode
of delivery and asthma -- is there a connection? Pediatr
Res. 2002 (Jul); 52 (1): 6-11
C-Sections may up risk of asthma.
Natural childbirth may prevent a baby from developing asthma later in
life, according to a just-published report.
Investigators followed 1,953 Finnish subjects from their birth in 1966
to their third decade of life in 1997. The 5.3% of subjects who were
delivered via Cesarean section were three times more likely to have
developed asthma by age 31, compared with subjects delivered vaginally.
However, delivery method did not influence risk of other allergic disorders.
Xu B, Pekkanen J, Hartikainen AL, Jarvelin MR Caesarean
section and risk of asthma and allergy in adulthood J
Allergy Clin Immunol. 2001 (Apr); 107 (4): 732-733
Babies delivered by elective cesarean have an increased risk of neonatal
respiratory distress syndrome (RDS), a life-threatening condition and
other respiratory problems that may require NICU care.
Levine EM, Ghai V, Barton JJ, Strom CM Mode of delivery and
risk of respiratory diseases in newborns Obstet Gynecol 2001;
97 (3): 439-442
Neonatal respiratory distress syndrome (RDS) is an important
complication of elective repeat cesarean section. Awaiting the onset
of spontaneous labor to determine the timing of repeat cesarean section
in women at term is an effective way to preventing iatrogenic neonatal
RDS.
Bowers SK, MacDonald HM, Shapiro ED Prevention
of iatrogenic neonatal respiratory distress syndrome: Elective repeat
cesarean section and spontaneous labor Am J Obstet Gynecol
1982 (May 15); 143 (2): 186-9
Iatrogenic RDS continues to occur in the setting of elective repeat
cesarean delivery and is associated with a failure to adhere to clinical
protocols.
Parilla BV, Dooley SL, Jansen RD, and Socol ML Iatrogenic
respiratory distress syndrome following elective repeat cesarean delivery
Obstet Gynecol. 1993 Mar;81(3):392-395
Neonatal respiratory morbidity and mode of delivery at term: influence
of timing of elective caesarean section.
Morrison JJ, Rennie JM, Milton PJ Neonatal
respiratory morbidity and mode of delivery at term: influence of timing
of elective caesarean section Br J Obstet Gynaecol. 1995 Feb;102(2):101-106
Influence of labor and route of delivery on the frequency of
respiratory morbidity in term neonates.
Hales KA, Morgan MA, Thurnau GR Influence
of labor and route of delivery on the frequency of respiratory morbidity
in term neonates Int J Gynaecol Obstet. 1993 Oct;43(1):35-40
Neonatal respiratory distress is a major complication of elective Cesarean
section. Awaiting the onset of labor appears to be beneficial in preventing
neonatal RDS for term neonates delivered by elective Cesarean section.
Yang JY, Fang LJ, Tsou Yau KI Labor
pain before elective cesarean section reduces neonatal respiratory distress
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1997 Jan-Feb;38(1):38-43
Study Links C-Sections, Stillbirths
Procedure May Put Subsequent Pregnancies at Risk, Study Says
Having a Caesarean delivery may increase the risk
of having a stillbirth in a
second pregnancy, researchers said. Doctors at the Rosie Hospital in
Cambridge, England, who studied data on 120,000 births in Scotland between
1992 and 1998, found that stillbirths were higher among women who had
previously had a child by Caesarean section.
"Delivery by Caesarean section in the first pregnancy could increase
the risk of unexplained
stillbirth in the second," Gordon Smith, who headed the research
team, said Friday in a report in The Lancet medical journal.
"Our best estimate is that for every 1,000 women with a previous
Caesarean section, there will be one additional stillbirth in comparison
if they hadn't had a previous Caesarean section," he added in an
interview.
Doctors are not sure why the surgery increases the risk of stillbirth
but they suspect that repairing the uterus after the surgery could affect
the function of the placenta, which nourishes the fetus, in a future
pregnancy.
Scarred tissue also works less well than unscarred tissue.
"This is a factor that women should take into account when deciding
to have a Caesarean section," Smith said. "Our results are
of relevance for women considering Caesarean delivery who are planning
future pregnancies."
Reuters Friday, November 28, 2003; Page A16 LONDON, Nov. 27
Additional Info
There is so much information available for women to read so they become
informed about the rising frequency, risks to themselves and their babies,
etc. Here are some links which offer the best compilation of information.
International Cesarean
Awareness Network
ICAN's Links
Pages
ICAN's
Choices in ChildBirth
Additional Articles of Interest:
C-Sections:
Are they Really a Safe Option?
Midwifery
Today Archives
Mothering
Magazine Archives
Elective C-Sections: the Cutting Edge of Modern Maternity Care.
The problem:The alarming rise in the c-section rate internationally has been receiving much press. From the obstetric point of view, c-sections are managed easier than a natural vaginal birth, decrease malpractice claims, are easier for scheduling and bring in higher monies. Unfortunately this perspective has now influenced many mothers to choose a c-section over a natural birth even without any medical justification! The imposed benefits are influencing more and more women and the elective c-section rate is rising dramatically.
Although "Most doctors agree on two important points: Vaginal births, as well as VBAC, are safer than a C-section, and 70 percent to 80 percent of women attempting a VBAC do so successfully", Dr. Benson Harer, 2000 president of the American College of Obstetricians states his personal opinion that even though there are problems with c-sections, women should be given the information and allowed the choice for elective c-section. Marsden Wagner, MD, former director of Women's & Children's Health for the World Health Organization strongly argues that if you really study the scientific literature carefully, you can see the truth. Additionally, "there is no scientific evidence that doing over 10 percent of births with a cesarean improves the outcome for the woman or improves the outcome for the baby."
Addressing the real motive, Dr. Wagner has this to say, "Anybody who thinks that those obstetricians that promote cesarean are promoting it because they suddenly discovered women's rights, well, I'm ready to sell some swampland in Florida to those people because that's extremely naive. Because there are compelling reasons why obstetricians prefer more cesarean. First of all, it means that there is convenience. You see, an obstetrician--the average birth is 12 hours, a cesarean is 20 minutes!"
View the entire transcript here: http://www.collegeofmidwives.org/news01/gma%20transcript00a.htm#Diane%20SAWYER
This informative article offers valuable insight into the debate as well. http://www.freep.com/news/health/vbac10e_20040810.htm
The facts:
Most women are not aware of the problems associated with this surgical procedure and are simply choosing c-sections because they seem to be easier all around.
Women who undergo cesareans are at an increased risk of many complications compared with a natural birth. These include:
• Increased risk of mortality
• Infection to various organs including the uterus, bladder or kidneys
• Increased blood loss
• Increased risk of complications in future pregnancies
• Decreased bowel function
• Respiratory complications
• Longer hospital stay and recovery time
• Adverse reactions to anesthesia
• Risk of additional surgeries such as hysterectomy or bladder repair
One of the complications of a C-section that is hardly ever addressed is the problem that the resulting surgical scar has on the mother. It frequently blocks the proper flow of energy through the autonomic nervous system and seriously impairs her ability to stay healthy. Fortunately, this block is relatively easy to repair with a simple injection of procaine into the scar, however very few physicians are aware of this issue and do not check for it.
Cesareans also have a psychological effect on women. As written in “Having a Baby, Naturally,” which is an excellent resource for all mothers-to-be, “Most women who have cesarean sections reported that the experience was traumatic.” Women are also less able to care for the newborn immediately after childbirth and therefore may miss out on bonding opportunities.
http://www.mercola.com/2003/sep/27/cesarean_section.htmMaking "Informed Choices" based on Myths and Fear.
Women are led to believe that vaginal birth is more dangerous than a surgical procedure. They are often erroneously informed that their baby is too big or that vaginal birth will cause sexual and or incontinence problems. What they are not told, however is the documented truth that most babies are not too big and that the damage to their perineums in vaginal births are caused by the medical procedure: episiotomy.
From the leading OB/GYN test book we read that the assumption that most women's pelvises are not large enough to deliver their babies is a "tenuous diagnosis because greater than 2/3rds of women diagnosed and given c-sections deliver even larger infants vaginally on subsequent births."
As for the damage to the perineum causing sexual and or incontinence, these are largely due to the obstetric procedure of episiotomy, not tearing in natural birthing. In fact, most natural births attended by skilled midwives have a low incidence of tearing because of perineal exercises advised during pregnancy and perineal support in labor.
So unfortunately, when leaving the decision up to women as advised by some, myths rather than facts become the basis of choice.
Finally, there are those women who are told that once they have a c-section they must always have a c-section. There is a rampant fear of uterine rupture in subsequent deliveries even though the literature says otherwise. A recent editorial in BMJ says: Once considered unthinkable, vaginal delivery after a previous caesarean section remains a safe option for many women. Uterine rupture after c-section remains a rare occurrence.http://bmj.bmjjournals.com/cgi/content/full/329/7462/359?ecoll
Some of perinatal specialists believe that advocates of cesareans may be scaring women into believing that vaginal birth (not to mention natural childbirth) is more dangerous than it really is. "I've seen less and less confidence among women in their ability to give birth vaginally and more worry about what can go wrong," says Nicette Jukelevics, who is a childbirth educator in California and has served on many cesarean awareness committees, including ICEA.
Perinatal specialists who have been practicing for a while know that there is a pendulum that swings back and forth between the medical model and the non-medical model of birth. Ensure your clients get the best, most objective information you can possibly give them. Help them make decisions based on their knowledge of all alternatives. This will give them the confidence to keep normal birth normal and less of a surgical event. http://www.birthsource.com/proarticlefile/proarticle46.html
The ethical debate:Conscientious OB/ GYNS are aware of these risks and there is controversy and concern within their profession about the right to choose a procedure not medically necessary, especially when the procedure poses greater risk for the mother and baby.
The Society of OB/Gyns in Canada has concerns expressed in this article: http://www.cbc.ca/news/background/csection_births/
The American College of Ob/ Gyns states there opinion as well: http://www.azstarnet.com/dailystar/printDS/30288.php
Get the Facts- Restore the Confidence:
Ask your Doctor of Chiropractic for birth care providers an support groups in your community who support the natural process of birth and offer the facts, not fears about natural birthing.
Visit our web site: http://www.icpa4kids.org/research/wellness.htm for numerous articles on pregnancy and birth to make informed decisions.Visit our links page for additional associations that support the natural process of birth: http://www.icpa4kids.org/links/birth.htm
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