The cesarean rate is alarmingly high in many industrialized countries, causing unnecessary risks to both mother and baby. In United States the cesarean rate in 2007 was 32% one of the highest among the industrialized countries. In California is as high as 37% and in some hospital it reaches 45%. This is a crime.
Most natural childbirth experts agree that there is an epidemic of medical interventions like induction or cesarean surgery all over this planet. When otherwise healthy women are exposed to the risk of cesarean surgeries or induction without a distinct medical need, these women also will have an increased risk of death and injury in childbirth.
“For a nation that’s spending more on maternity care than any other nation in the world, the U.S. trend line on mothers’ health is going in the absolute wrong direction,” said Sharon Dalrymple, president of Lamaze International. “The irony is that too much medical care may be fueling the growing number of women being injured or dying in childbirth.”When doctors suggest a cesarean
Birth can be a slow and unpredictable process, which requires little or no technology. Yet, surrounded by all the gadgets and the gismos of modern technology, the industry of birth tends to want to use them. Many reasons given for a cesarean, especially prior to labor, can and should be questioned. A cesarean section is major abdominal surgery; the infant is delivered through an incision in the mother’s abdomen and uterus.
There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth. Some cesareans occur in critical situations, some are used to prevent critical situations. Scheduled cesarean due to the size of the baby, done for convenience of the patient or doctor, the “too posh to push” trend, is mostly accepted by most mom due to lack of detail information on the consequences for both mom and babe of such procedure.
Berna Diehl, in her article Despite International Decline, Maternal Deaths a Growing Concern in U.S., for Lamaze International, tells us: “While better record keeping may account for part of the increased rate of maternal deaths in the United States, many experts agree that these data indicate a real increase in the number of women dying in childbirth. The Centers for Disease Control and Prevention identified a 27 percent increase in maternal injuries, which were primarily related to cesarean surgeries. Additional res earch also showed that for every 5 percent increase in the cesarean surgery rate, there are an expected 14-32 more maternal deaths and a total of 5,000-24,000 more surgical complications.
The risk of death following cesarean surgeries is more than three times higher than for vaginal births. According to an Amnesty International report, American women have a higher risk of dying from pregnancy-related complications than those in 40 other countries and cesarean surgeries are performed in nearly one third of all deliveries in the United States – twice as high as recommended by the World Health Organization (WHO).”
From the latest document by the Coalition for Improving Maternity Services here’s what we learned:
Compared with vaginal birth, women who have a cesarean are more likely to experience:
· Accidental surgical cuts to internal organs
· Major infection.
· Emergency hysterectomy (because of uncontrollable bleeding)
· Complications from anesthesia.28
· Deep venous clots that can travel to the lungs (pulmonary embolism) and brain (stroke).
· Admission to intensive care.58
· Readmission to the hospital for complications related to the surgery.
· Pain that may last six months or longer after the delivery. More women report problems with pain from the cesarean incision than report pain in the genital area after vaginal birth.
· Adhesions, thick internal scar tissue that may cause future chronic pain, in rare cases a twisted bowel, and can complicate future abdominal or pelvic surgeries.
· Endometriosis (cells from the uterine lining that grow outside of the womb) causing pain, bleeding, or both severe enough to require major surgery to remove the abnormal cells.
· Appendicitis, stroke, or gallstones in the ensuing year.
· Gall bladder problems and stroke may be because high-weight women and women with high blood pressure are more likely to have cesareans.
· Negative psychological consequences with unplanned cesarean. These include:
· Poor birth experience, overall impaired mental health, and/or self-esteem
· Feelings of being overwhelmed, frightened, or helpless during the birth.
· A sense of loss, grief, personal failure , acute trauma symptoms, posttraumatic stress, and clinical depression.
· Death.Potential Harms to the Baby
Compared with vaginal birth, babies born by cesarean section are more likely to experience: Read the whole document by following this link.
• Accidental surgical cuts, sometimes severe enough to require suturing.
• Being born late-preterm (34 to 36 weeks of pregnancy) as a result of scheduled surgery.
• Complications from prematurity, including difficulties with respiration, digestion, liver function, jaundice, dehydration, infection, feeding, and regulating blood sugar levels and body temperature.25,26 Late-preterm babies also have more immature brains, and they are more likely to have learning and behavior problems at school age.
• Respiratory complications, sometimes severe enough to require admission to a special care nursery, even in infants born at early term (37 to 39 weeks of pregnancy). Scheduling surgery after 39 completed weeks minimizes, but does not eliminate, the risk.
• Readmission to the hospital.
• Childhood development of asthma,3,78 sensitivity to allergens,61 or Type 1 diabetes.
• Death in the first 28 days after birth.
Prematurity is the leading cause of death in the first month of life, and even late preterm infants have a greater risk of respiratory distress syndrome (RDS), feeding difficulties, temperature instability (hypothermia), jaundice and delayed brain development.
Inductions may contribute to the growing number of babies who are born “late preterm,” between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term (37-42 weeks).
A baby's lungs and brain mature late in pregnancy. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with:
It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby's health.
We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The “due date” we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves “overdue” and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because “that’s the way it’s always been done”. Read more about the lie of your estimated due date by Misha Safranski.
The Coalition for Improving Maternity Services (CIMS) is concerned about the dramatic increase and ongoing overuse of induction of labor. The U.S. induction rate has more than doubled since 1989, rising from one woman in ten to one woman in five in 2001. This may, however, grossly undercount the true incidence of labor induction. Nearly half of women in a 2002 survey reported that some effort had been made to start labor artificially. The World Health Organization recommends no more than a 10 percent induction rate. Despite modern techniques, induction of labor still introduces considerable risk compared with natural onset of labor, and many, if not most, inductions are done for reasons that are not supported by sound medical research.
In some hospital nearly 50% of all women are either induced to start labor or augmented to speed up the process, in some practices here in Los Angeles the induction and augmentation rate is as high as 90%. That is a staggering number. Read more about the hazards of inductions.
I used to tell my clients remember there is no ‘induction police” no one can force you to be induced. Ask the right questions and participate in your care. I also want to remind you that it is better to ask for support than permission, so instead of saying “Unless it is an emergency can we wait to induce at 42 weeks’ I would suggest you use a more proactive tone something like, “Unless there is a medical emergency I would like not to be induced before the 42 week of gestation and would love your support on that.” Here are some questions:
· Is this an emergency? If not, I would like to wait a little longer? If it isn’t an emergency NEGOTIATE ask for the whole 42 and inch your way toward a compromise. Be willing to go and do as many non-stress tests as the provider require (where they listen to the baby’s heart beat), use that time to talk to your baby and tell her she is welcome.
· Is there a problem with my health or the health of my baby that may make me need to have my baby early? Use studies and statistics about prematurity. Bring flyers with you. March of Dimes is a great place for info so it’s CIM. Also get specifics on the medical reasoning behind the induction. Often the amniotic levels are cited as a reason. Amniotic fluids at 5ccm or less can be a reason for induction. More than 5ccm usually is O.K.
· I would like to wait for as long as it is safe (even 42 weeks if all is well) before we consider other alternatives to a natural birth
· Can you tell me how low the
· Can we discontinue the induction if things aren't progressing? At what point?
· How long will I be able to labor before a cesarean delivery becomes necessary?
What you can do
• Let labor begin on its own
• Walk, move around and change positions throughout labor
• Bring a loved one, friend or doula for continuous support
• Avoid interventions that are not medically necessary
• Avoid giving birth on your back and follow your body's urges to push
• Keep mother and baby together; it's best for mother, baby and breastfeeding
[ii] March of Dimes
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