This really well-balanced and well-written article needs to be read and distributed; the link is in the title above.
- And while a dramatic decline in maternal deaths coincided with higher rates of Caesarean, that trend ended 20 years ago. Today, ill effects such as life-threatening placental problems are being linked to C-sections. Yet natural delivery is not enjoying a rebirth. Groups that have demonstrated the will and the way to reduce Caesarean — midwives, birthing coaches, lactation consultants, and other fans of natural birth — are far less influential than in the 1980s, when they led a modestly successful fight against rising Caesarean rates.
- Cesarean critics worry that doctors are frightening mothers into the surgery. “A woman who is given reason to be scared that something bad might happen to her unborn child will do anything to avoid it,” said Jose Gorrin Peralta, a University of Puerto Rico obstetrician. “If the doctor says, ‘Your baby could die unless I do a cesarean,’ what woman is going to say, ‘Don’t do it’? I call it obstetrical terrorism.”
- The American College of Obstetricians and Gynecologists decided to weigh in on the ethics of this controversial notion of “maternal choice” cesarean. It concluded that data on the risks and benefits were lacking. Therefore, the group said, performing one is ethical if the physician “believes” it promotes the patient’s health — and unethical if the physician “believes” it doesn’t.
- Study after study has found that obese women are more likely than thin ones to develop serious complications in pregnancy. They are also more likely to have babies born with debilitating spinal-cord defects, prematurely, or “macrosomic” — 10 pounds or more. These factors give an obese woman up to a 50-50 chance of cesarean, which, because of her weight, will not be easy. “I have huge anxiety for these women,” said Laura Riley, a high-risk obstetrician-gynecologist at Massachusetts General Hospital in Boston. “On one hand, I applaud them for wanting a vaginal birth. But I’m fearful because not only do you labor a long time, it’s a big baby, it’s hard to establish how big the baby is, then you end up with a failed vaginal delivery. And then the C-section is harder, there’s greater blood loss, greater danger of infection in the incision. In addition, there’s greater risk for a DVT (deep-vein blood clot) or pulmonary embolism than with someone who’s thinner and up and out of bed faster.” Prodded by Riley, the American College of Obstetricians and Gynecologists two years ago issued guidelines that say obstetricians should warn patients about these risks and encourage weight loss “before attempting pregnancy.” “We need to fess up that this is a medical problem,” Riley said. “It’s not about passing judgment on women who don’t look like they belong on the cover of Cosmo.” Yet for plus-size women, that’s too often exactly what it seems like.
- Many obstetricians argue that their patients are the ones who have developed an extreme, almost unreasonable, aversion to the tiniest risk. This pushes doctors to do more just-in-case cesareans. For example, to prevent one 10-pound baby from shoulder nerve damage during vaginal birth, they have to surgically deliver 3,700 macrosomic babies, according to a March editorial in the New England Journal of Medicine.
- These debates would not matter so much if it were clear that the surge in surgery was good for patients. But it is not clear. While studies find that a woman’s risk of death from cesarean is remote — not to say as low as with vaginal birth — the recovery time is much longer, and hemorrhage, infections, dangerous clots and rehospitalizations are more common. Cesarean also poses risks to future pregnancies. Evidence is growing that uterine scarring can cause placental abnormalities that endanger mother and baby, and that the risk of these abnormalities increases dramatically with each subsequent cesarean. Life-threatening situations have become so common, “you’d be hard-pressed to find an obstetrician who doesn’t know the terror of these near-misses,” said Carol Sakala, director of programs for Childbirth Connection.
- Newborns, meanwhile, are more likely to have temporary respiratory difficulties after a planned cesarean. Planned cesareans may even be contributing to the mysterious, dramatic increase in premature births. That’s because a baby who is estimated to be full term may actually be weeks younger. “We are foreshortening gestational age ... with a giant social experiment,” Sakala said.
Please read and pass it on!