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Sunday
Jun172007

Article to Read (About Cesareans)

By Marie McCullough / The Philadelphia Inquirer

This really well-balanced and well-written article needs to be read and distributed; the link is in the title above.


Snippets:

- 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!

Reader Comments (7)

Wow. That term "obstetrical terrorism" is a good one. I have been a victim of it 3 times, probably because I am fat. It is only because I had the rock solid support of my husband and the right education at just the right time that I avoided c-sections with all of them.

The last baby, the OB literally sat me down and said "You're baby is gigantic. There is a great likelihood that he will die or be damaged in a vaginal delivery, and that you will suffer 4th degree tears or worse". She didn't have much to say after I proved her entirely wrong.

In my circle of aquaintances, the C-section rate is more like 50-60%. Actually, I only know 3 other women personally who have had vaginal deliveries.

June 18, 2007 | Unregistered CommenterCappuccinoLife

From what I've read so far, I'm going to link this article in my blog, if blogger lets me in my blog today since I changed email addresses.

P.S. Did you get my email?

June 18, 2007 | Unregistered CommenterJennifer

this is very interesting, i'll have to check the whole thing out. but i have a ?, when she said overweight women have a failed vag-birth, then they have the c-sec, and have a higher risk of infection, and more blood loss, is this b/c she's labored or is obese, or both?

June 18, 2007 | Unregistered Commenterkris

Thanks for the info. I am type I diabetic and about 7 weeks pregnant. I have been told that diabetic moms often have C-sections, so the more info I have the better.

To that end, can you share any insight or stories about type I pregnant women?

I am keeping my blood sugars in tight control, I am taking my thyroid meds (I also have hypothyroid), I am trying to eat right (sometimes I fail at that--I am weak!!)... I am just trying to do what I am supposed to. I am overweight and had hoped to get a little more fit and in better diabetic control before I got pregnant, but whoops! :)

So, anything you can share, even just stories or anything, is REALLY appreciated!!

Thanks for sharing!!!

June 18, 2007 | Unregistered Commenterffbgirl

Jennifer: I did. Just been incredibly busy and haven't been able to do the survey yet. Sorry! I will when I can... realizing it will probably be too late. I am proud of you, though. Good girl!

June 19, 2007 | Unregistered CommenterNavelgazing Midwife

Barb,

Thank you! If at any time you want to look at the survey, let me know. I'd love to see what you thought of it.

Now, if only I could get back into my blogger account, then I could post this article. :-(

June 19, 2007 | Unregistered CommenterJennifer

Thanks for sharing this. As someone who actually performs sections I'm sure I can be accused of "Obstetric Terrorism" at some stage.
I know that I have saved many mother's lives.
I know that I have saved many babies lives.
And I know that I never make the decision to operate lightly. Things can and do go horribly wrong!

When my time comes to give birth, I plan for a natural birth but I know that a recent survey of female OB's showed that by far the vast majority chose to have a caesarian instead of natural birth. It's as if they've lost faith in their bodies' natural ability to deliver....and if they've choosing that for themselves it's no wonder that there's so much Obtsetrical Terrorism about.

June 24, 2007 | Unregistered CommenterAmanzi Down Under

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