C-Section Too Early Risks Baby's Health
Babies Born by Surgical Delivery Before 39 Weeks May Suffer Health Problems
When 37-year-old Alicia Cooney of Cleveland was pregnant with her first child in October 2007, her doctor expressed no concern about scheduling her Caesarian delivery, or C-section, just 38 weeks into the pregnancy.
But when Cooney became pregnant with her second child last April, her doctor was singing a different tune about when to schedule a C-section.
"I did notice a change within the hospital that they really wanted to make sure my C-section wasn't before 39 weeks," Cooney explained.
Cooney said that her doctor expressed concern about the increased risk of wet lung -- or an accumulation of fluid in the newborn's lungs -- in babies delivered by C-section before 39 weeks of gestation.
Cooney's doctor may not be alone in changing his practice in the face of these risks. On Wednesday, a new study published in the New England Journal of Medicine found that C-section delivery before 39 weeks of gestation is, indeed, linked to increased health problems for babies.
According to the National Institutes of Health, a pregnancy of normal gestation lasts about 40 weeks, with "normal" pregnancies ranging from 38 to 42 weeks.
A team of researchers lead by Dr. Alan Tita from the department of obstetrics and gynecology at the University of Alabama at Birmingham examined the results of 13,258 women who had a scheduled, repeat C-section that was planned for no other medical reason than the fact that the woman had previously had a C-section.
The researchers found that, compared to babies delivered by C-section at 39 weeks of gestation, those born at 37 or 38 weeks had a higher rate of breathing problems, blood sugar problems and serious infections. Moreover, those babies were more likely to be admitted to the neonatal intensive care unit.
"Early elected delivery is associated with adverse outcomes for the baby," Tita explained. "And the earlier you deliver, the higher it increases the risk."
These findings are in line with current recommendations by the American College of Obstetricians and Gynecologists (ACOG).
Yet despite the long list of potential complications associated with C-section delivery before 39 weeks, the study also found that a large number of the women studied -- 36 percent -- chose to schedule a C-section delivery before 39 weeks anyway.
"I have seen women induced or have a scheduled C-section because they have family scheduled to be in town, because they want the baby to be born on an anniversary or someone else's birthday, because they want the baby born prior to Jan. 1 for tax purposes, or because they are simply sick and tired of being pregnant," said Dr. Elaine St. John, associate professor of pediatrics in the Division of Neonatology at the University of Alabama at Birmingham.
Other experts say that the increase in C-sections before 39 weeks is due to a lack of understanding of the dangers associated with elective late pre-term birth.
"Most women think the risks to their babies are the same whether the babies are delivered four, three, two or one week before the baby is due," explained Dr. Sessions Cole, director of the Division of Newborn Medicine at the St. Louis Children's Hospital. "This study should help mothers understand that there are significant risks to their babies associated with elective late preterm
Patient Pressure Figures Big
Approximately 30 percent of all babies born in the United States are delivered by C-section. A study published in April 2005 in the journal Obstetrics and Gynecology found that elective C-sections accounted for about 28 percent of all C-sections performed in the U.S. in 2001.
However, many experts report a growing trend toward encouraging women not to schedule an elective C-section before 39 weeks at hospitals all over the country.
"The recommendations for years have been to avoid elective delivery of any kind until after 39 weeks," said Dr. Lisa Jones, a gynecologist at the New Bedford Community Health Center in New Bedford, Mass. "So all this study really does is reinforce what we already knew."
Still, some experts say that the power of maternal insistence in scheduling an early C-section is enough to convince many doctors to go along with their patient's wishes.
"I think the practice of early [C-section delivery] will only end if hospitals ban the practice," Holzman said. "There is little reason for [obstetricians] to stop since they are often pressured by patients."
The study also outlines some of the risks women must consider when opting to deliver by C-section after 39 weeks.
According to Tita, one such risk is having an unexplained stillbirth while waiting for the 39-week-mark to deliver. This risk is very small, but Tita said that it is still best for women to follow ACOG recommendations by waiting the full 39 weeks before delivering by C-section.
Early Surgical Delivery Sometimes Appropriate
There are, however, certain instances in which an early delivery is appropriate.
"If there [are] firm medical indications of risk to the mother's or fetus's ... health [such as] worsening maternal high blood pressure [or] lack of fetal responsiveness ... then delivery is indicated," Cole explained. "However, the risks of these conditions should be weighed against the risks described by this study."
Moreover, Holzman said, "For most of these [conditions], the risks to the fetus in delaying [delivery] are well known and predictable."
Many experts ultimately hope that this study will prove to the public that the risks of early C-section delivery greatly outweigh the benefits in most cases.
"Hopefully articles like this will help educate the general public and fewer babies will be placed at risk in the future," said Dr. Patricia Chess, associate professor of pediatrics at the University of Rochester Medical Center.
http://abcnews.go.com/Health/WomensHealth/story?id=6595888&page=1
http://abcnews.go.com/video/playerIndex?id=6596728
The mission of ICAN of Jackson, MS is to educate and empower women to prevent unecessary cesareans, support those who are healing emotionally and physically from a cesarean or traumatic vaginal birth and advocate for VBAC (Vaginal Birth After Cesarean). We meet monthly. Please email jackson.ms@ican-online.org if you are interested in attending a meeting.
Saturday, January 10, 2009
Wednesday, January 7, 2009
Early Maternity leave linked fewer C-sections and increased breastfeeding
Studies link maternity leave with fewer C-sections and increased breastfeeding
Berkeley -- Two new studies led by researchers at the University of California, Berkeley, suggest that taking maternity leave before and after the birth of a baby is a good investment in terms of health benefits for both mothers and newborns.
One study found that women who started their leave in the last month of pregnancy were less likely to have cesarean deliveries, while another found that new mothers were more likely to establish breastfeeding the longer they delayed their return to work.
Both papers were part of the Juggling Work and Life During Pregnancy study, funded by the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration and led by Sylvia Guendelman, professor of maternal and child health at UC Berkeley's School of Public Health. The research takes a rare look into whether taking maternity leave can affect health outcomes in the United States.
"In the public health field, we'd like to decrease the rate of C-sections (cesarean deliveries) and increase the rate of breastfeeding," said Guendelman. "C-sections are really a costly procedure, leading to extended hospital stays and increased risks of complications from surgery, as well as longer recovery times for the mother. For babies, it is known that breastfeeding protects them from infection and may decrease the risk of SIDS (Sudden Infant Death Syndrome), allergies and obesity. What we're trying to say here is that taking maternity leave may make good health sense, as well as good economic sense."
The study on the use of antenatal leave - time off before delivery with the expectation of returning to the employer after giving birth - and the rate of C-sections is the first examination of birth outcomes in U.S. working women, the researchers said. It will appear in the January/February print edition of the journal Women's Health Issues.
The researchers analyzed data from 447 women who worked full-time in the Southern California counties of Imperial, Orange and San Diego, comparing those who took leave after the 35th week of pregnancy with those who worked throughout the pregnancy to delivery. Only women who gave birth to single babies with no congenital abnormalities were included in the analysis. They adjusted for sociodemographic factors such as income, age and type of occupation, as well as for various health measures such as high blood pressure, body mass index, amount of self-reported stress and average number of hours of sleep at night.
Using a combination of post-delivery telephone interviews and prenatal and birth records, the researchers found that women who took leave before they gave birth were almost four times less likely to have a primary C-section as women who worked through to delivery.
The study authors pointed out that the United States falls behind most industrialized countries in its support for job-protected paid maternity leave. The federal Family and Medical Leave Act provides for only unpaid leave of up to 12 weeks surrounding the birth or adoption of a child.
The bulk of studies on leave-taking and health outcomes from other countries suggest that taking leave prior to birth can be beneficial. The authors point to a macroanalysis of 17 countries in Europe that linked failure to take such leave with low birthweight and infant mortality. Rates of pre-term delivery were lower among female factory workers in France if the women took antenatal leave, and a study conducted in several industrialized countries found that paid leave, but not unpaid leave, significantly decreased low birthweight rates.
According to the U.S. Census, among working women who had their first birth between 2001 and 2003, only 28 percent took leave from their jobs before giving birth while an additional 22 percent quit their jobs. Twenty-six percent of women took no leave before birth.
"We don't have a culture in the United States of taking rest before the birth of a child because there is an assumption that the real work comes after the baby is born," said Guendelman. "People forget that mothers need restoration before delivery. In other cultures, including Latino and Asian societies, women are really expected to rest in preparation for this major life event."
The authors added that financial need may also deter women from taking leave in the last month of pregnancy. Only five states - California, Hawaii, New Jersey, New York, Rhode Island - and the territory of Puerto Rico offer some form of paid pregnancy leave, and none offer full replacement of the woman's salary.
The study on maternity leave and breastfeeding is in the January issue of the journal Pediatrics. Using data from 770 full-time working mothers in Southern California, researchers assessed whether maternity leave predicted breastfeeding establishment, defined in this study as breastfeeding for at least 30 days after delivery. Phone interviews were conducted 4.5 months, on average, after delivery.
In this study, women who had returned to work by the time of the interview took on average 10.3 weeks of maternity leave. Overall, 82 percent of mothers established breastfeeding within the first month after their babies were born. Among women who established breastfeeding, 65 percent were still breastfeeding at the time of the interview.
Researchers found that women who took less than six weeks of maternity leave had a four-fold greater risk of failure to establish breastfeeding compared with women who were still on maternity leave at the time of the interview. Women who took six to 12 weeks of maternity leave had a two-fold greater risk of failing to establish breastfeeding.
Having a managerial position or a job with autonomy and a flexible work schedule was linked with longer breastfeeding duration in the study. After 30 days, managers had a 40 percent lower chance of stopping breastfeeding, while those with an inflexible work schedule had a 50 percent higher chance of stopping.
Overall, the study found that returning to work within 12 weeks of delivery had a greater impact on breastfeeding establishment for women in non-managerial positions, with inflexible jobs or who reported high psychosocial distress, including serious arguments with a spouse or partner and unusual money problems.
"The findings suggest that if a woman postpones her return to work, she'll increase her chances of breastfeeding success, especially if she's got a job where she's on the clock and has less discretion with her time," said Guendelman. "Also, women who are in jobs where they have more authority may feel more empowered with how they use their time."
The American Academy of Pediatrics (AAP) recommends that babies be breastfed for at least the first year of life, and exclusively so for the first four to six months.
According to the AAP, increased breastfeeding has the potential for decreasing annual health costs in the U.S. by $3.6 billion and decreasing parental employee absenteeism, the environmental burden for disposal of formula cans and bottles, and energy demands for production and transport of formula.
The study authors noted that just having maternity leave benefits offered by an employer was not helpful in breastfeeding establishment unless the leave was actually used, indicating the importance of encouraging the use of maternity leave and making it economically feasible to take it.
"These new studies suggest that making it feasible for more working mothers to take maternity leave both before and after birth is a smart investment," said Guendelman.
###
Other co-authors of the paper in Women's Health Issues are Michelle Pearl and Steve Graham, senior research scientists at the Sequoia Foundation, a California-based non-profit organization focused on public health research; Alan Hubbard, UC Berkeley assistant professor of biostatistics; Dr. Nap Hosang, lecturer at UC Berkeley's Maternal and Child Health program and a practicing obstetrician; and Martin Kharrazi, research scientist supervisor in the California Department of Public Health Genetic Disease Screening Program.
In addition to Guendelman, Pearl, Graham and Kharrazi, the Pediatrics paper was co-authored by Jessica Lang Kosa, research associate, and Julia Goodman, former graduate student, both at UC Berkeley's School of Public Health.
The study published in Women's Health Issues received additional funding from the Center for Health Research at UC Berkeley. The paper in Pediatrics also received support from the UC Labor and Employment Research Fund and the UC Berkeley Institute for Research on Labor and Employment.
Source:
http://www.eurekalert.org/pub_releases/2009-01/uoc--slm122308.php
Berkeley -- Two new studies led by researchers at the University of California, Berkeley, suggest that taking maternity leave before and after the birth of a baby is a good investment in terms of health benefits for both mothers and newborns.
One study found that women who started their leave in the last month of pregnancy were less likely to have cesarean deliveries, while another found that new mothers were more likely to establish breastfeeding the longer they delayed their return to work.
Both papers were part of the Juggling Work and Life During Pregnancy study, funded by the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration and led by Sylvia Guendelman, professor of maternal and child health at UC Berkeley's School of Public Health. The research takes a rare look into whether taking maternity leave can affect health outcomes in the United States.
"In the public health field, we'd like to decrease the rate of C-sections (cesarean deliveries) and increase the rate of breastfeeding," said Guendelman. "C-sections are really a costly procedure, leading to extended hospital stays and increased risks of complications from surgery, as well as longer recovery times for the mother. For babies, it is known that breastfeeding protects them from infection and may decrease the risk of SIDS (Sudden Infant Death Syndrome), allergies and obesity. What we're trying to say here is that taking maternity leave may make good health sense, as well as good economic sense."
The study on the use of antenatal leave - time off before delivery with the expectation of returning to the employer after giving birth - and the rate of C-sections is the first examination of birth outcomes in U.S. working women, the researchers said. It will appear in the January/February print edition of the journal Women's Health Issues.
The researchers analyzed data from 447 women who worked full-time in the Southern California counties of Imperial, Orange and San Diego, comparing those who took leave after the 35th week of pregnancy with those who worked throughout the pregnancy to delivery. Only women who gave birth to single babies with no congenital abnormalities were included in the analysis. They adjusted for sociodemographic factors such as income, age and type of occupation, as well as for various health measures such as high blood pressure, body mass index, amount of self-reported stress and average number of hours of sleep at night.
Using a combination of post-delivery telephone interviews and prenatal and birth records, the researchers found that women who took leave before they gave birth were almost four times less likely to have a primary C-section as women who worked through to delivery.
The study authors pointed out that the United States falls behind most industrialized countries in its support for job-protected paid maternity leave. The federal Family and Medical Leave Act provides for only unpaid leave of up to 12 weeks surrounding the birth or adoption of a child.
The bulk of studies on leave-taking and health outcomes from other countries suggest that taking leave prior to birth can be beneficial. The authors point to a macroanalysis of 17 countries in Europe that linked failure to take such leave with low birthweight and infant mortality. Rates of pre-term delivery were lower among female factory workers in France if the women took antenatal leave, and a study conducted in several industrialized countries found that paid leave, but not unpaid leave, significantly decreased low birthweight rates.
According to the U.S. Census, among working women who had their first birth between 2001 and 2003, only 28 percent took leave from their jobs before giving birth while an additional 22 percent quit their jobs. Twenty-six percent of women took no leave before birth.
"We don't have a culture in the United States of taking rest before the birth of a child because there is an assumption that the real work comes after the baby is born," said Guendelman. "People forget that mothers need restoration before delivery. In other cultures, including Latino and Asian societies, women are really expected to rest in preparation for this major life event."
The authors added that financial need may also deter women from taking leave in the last month of pregnancy. Only five states - California, Hawaii, New Jersey, New York, Rhode Island - and the territory of Puerto Rico offer some form of paid pregnancy leave, and none offer full replacement of the woman's salary.
The study on maternity leave and breastfeeding is in the January issue of the journal Pediatrics. Using data from 770 full-time working mothers in Southern California, researchers assessed whether maternity leave predicted breastfeeding establishment, defined in this study as breastfeeding for at least 30 days after delivery. Phone interviews were conducted 4.5 months, on average, after delivery.
In this study, women who had returned to work by the time of the interview took on average 10.3 weeks of maternity leave. Overall, 82 percent of mothers established breastfeeding within the first month after their babies were born. Among women who established breastfeeding, 65 percent were still breastfeeding at the time of the interview.
Researchers found that women who took less than six weeks of maternity leave had a four-fold greater risk of failure to establish breastfeeding compared with women who were still on maternity leave at the time of the interview. Women who took six to 12 weeks of maternity leave had a two-fold greater risk of failing to establish breastfeeding.
Having a managerial position or a job with autonomy and a flexible work schedule was linked with longer breastfeeding duration in the study. After 30 days, managers had a 40 percent lower chance of stopping breastfeeding, while those with an inflexible work schedule had a 50 percent higher chance of stopping.
Overall, the study found that returning to work within 12 weeks of delivery had a greater impact on breastfeeding establishment for women in non-managerial positions, with inflexible jobs or who reported high psychosocial distress, including serious arguments with a spouse or partner and unusual money problems.
"The findings suggest that if a woman postpones her return to work, she'll increase her chances of breastfeeding success, especially if she's got a job where she's on the clock and has less discretion with her time," said Guendelman. "Also, women who are in jobs where they have more authority may feel more empowered with how they use their time."
The American Academy of Pediatrics (AAP) recommends that babies be breastfed for at least the first year of life, and exclusively so for the first four to six months.
According to the AAP, increased breastfeeding has the potential for decreasing annual health costs in the U.S. by $3.6 billion and decreasing parental employee absenteeism, the environmental burden for disposal of formula cans and bottles, and energy demands for production and transport of formula.
The study authors noted that just having maternity leave benefits offered by an employer was not helpful in breastfeeding establishment unless the leave was actually used, indicating the importance of encouraging the use of maternity leave and making it economically feasible to take it.
"These new studies suggest that making it feasible for more working mothers to take maternity leave both before and after birth is a smart investment," said Guendelman.
###
Other co-authors of the paper in Women's Health Issues are Michelle Pearl and Steve Graham, senior research scientists at the Sequoia Foundation, a California-based non-profit organization focused on public health research; Alan Hubbard, UC Berkeley assistant professor of biostatistics; Dr. Nap Hosang, lecturer at UC Berkeley's Maternal and Child Health program and a practicing obstetrician; and Martin Kharrazi, research scientist supervisor in the California Department of Public Health Genetic Disease Screening Program.
In addition to Guendelman, Pearl, Graham and Kharrazi, the Pediatrics paper was co-authored by Jessica Lang Kosa, research associate, and Julia Goodman, former graduate student, both at UC Berkeley's School of Public Health.
The study published in Women's Health Issues received additional funding from the Center for Health Research at UC Berkeley. The paper in Pediatrics also received support from the UC Labor and Employment Research Fund and the UC Berkeley Institute for Research on Labor and Employment.
Source:
http://www.eurekalert.org/pub_releases/2009-01/uoc--slm122308.php
103 out of 115 delivered VBAC after 2 Cesareans - How awesome if given the chance!
Author: Chattopadhyay-S-K. Sherbeeni-M-M. Anokute-C-C.
Title: Planned vaginal delivery after two previous caesarean sections
[see comments]
Source: Br-J-Obstet-Gynaecol. 1994 Jun. 101(6). P498-500. Comment:
Comment in: Br-J-Obstet-Gynaecol. 1995 Mar.102(3). P 262-3. Journal
Title: BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. Abstract:
OBJECTIVE: To determine the outcome of trial of labour after two
caesarean sections.
DESIGN: Prospective observational study.
SETTING: Maternity and Children's Hospital, Riyadh,Saudi Arabia.
SUBJECTS:Women with two previous caesarean sections considered
suitable for atrial of vaginal delivery.
MAIN OUTCOME MEASURES: The rates of vaginal delivery, scar
dehiscence, uterine rupture and associated complications among 115
women with two previous sections who underwent trial of labour were
compared with 1006 women with two previous sections who did not have
a trial of labour.
RESULTS: Trial of vaginal delivery was requested by 230 out of 1136
women (20%) who had two previous caesarean sections. Of the 115 women
accepted for the trial, 103 (89%)were delivered vaginally. Labour
started spontaneously in 78 (68%)of the 115 women and was induced
with prostaglandin (PGE2) in the remaining 37. Augmentation of labour
with oxytocin was required in 32(28%) of the trial labour group.
There were no scar dehiscences among the women delivered vaginally.
There was one scar dehiscence and one woman required hysterectomy
after failed trial of labour, a frequency comparable to the
occurrence of these complications in women who did not have a trial
of labour.
CONCLUSION: A trial of labour in selected patients with two previous
caesarean sections appears a reasonable option.
Title: Planned vaginal delivery after two previous caesarean sections
[see comments]
Source: Br-J-Obstet-Gynaecol. 1994 Jun. 101(6). P498-500. Comment:
Comment in: Br-J-Obstet-Gynaecol. 1995 Mar.102(3). P 262-3. Journal
Title: BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. Abstract:
OBJECTIVE: To determine the outcome of trial of labour after two
caesarean sections.
DESIGN: Prospective observational study.
SETTING: Maternity and Children's Hospital, Riyadh,Saudi Arabia.
SUBJECTS:Women with two previous caesarean sections considered
suitable for atrial of vaginal delivery.
MAIN OUTCOME MEASURES: The rates of vaginal delivery, scar
dehiscence, uterine rupture and associated complications among 115
women with two previous sections who underwent trial of labour were
compared with 1006 women with two previous sections who did not have
a trial of labour.
RESULTS: Trial of vaginal delivery was requested by 230 out of 1136
women (20%) who had two previous caesarean sections. Of the 115 women
accepted for the trial, 103 (89%)were delivered vaginally. Labour
started spontaneously in 78 (68%)of the 115 women and was induced
with prostaglandin (PGE2) in the remaining 37. Augmentation of labour
with oxytocin was required in 32(28%) of the trial labour group.
There were no scar dehiscences among the women delivered vaginally.
There was one scar dehiscence and one woman required hysterectomy
after failed trial of labour, a frequency comparable to the
occurrence of these complications in women who did not have a trial
of labour.
CONCLUSION: A trial of labour in selected patients with two previous
caesarean sections appears a reasonable option.
Wednesday, December 10, 2008
Facts about Birth in America
Note: All of the information here represents fact, not opinion, of birthing within the United States. If you don't believe it, check the references listed at the end of the article. That being said, you may want to sit down before reading further...
FACT
Each year, the U.S. spends over $50 billion dollars on childbirth. This is more than any other nation in the world. (This number does not include babies in the NICU or readmissions during the first month.)
FACT
Birthing is the largest source of income for American hospitals.
FACT
The U.S. ranks 37th in the world for the quality of its health care.
FACT
Over HALF of all hospital admissions in America are for maternity.
FACT
Hospitals are NOT the safest place to have a baby. 25 infectious strains exist that are resistant to ALL known antibiotics. These are found primarily in hospitals.
FACT
75 years of routine hospital birth have produced NO studies to show it is safer than having a baby at home with a skilled birth attendant.
FACT
Both homebirth and birth centers have been scientifically proven to be as safe or safer than hospitals with a skilled labor attendant (i.e. midwives, not doctors).
FACT
The more technology used in childbirth, the more dangerous it becomes.
FACT
The larger the hospital, the greater the risks to both mother and baby.
FACT
Of the 4.3 million babies born annually in the U.S., a mere 5% represent natural childbirth.
FACT
America has the 40th highest infant mortality rate in the entire world.
FACT
The U.S.A. has the 14th highest maternal mortality ratio among developed nations.
FACT
Over 90% of all infants in the U.S. are born with drugs (e.g. narcotics from epidurals, pitocin, acetaminophen, etc) in their systems. NONE of these drugs have been tested for safe use in infants.
FACT
A 24-hour hospital stay, uncomplicated delivery in the U.S.A. costs anywhere from $8,000-10,000. This cost DOUBLES for a c-section.
FACT
ALL families in the U.S. are charged newborn nursery charges, even if the baby NEVER leaves the mother's room. This "routine" charge amounts to about $1.3 billion dollars annually, for services that are NOT rendered. (I'm not quite sure why this doesn't constitute insurance fraud - billing for services not rendered.)
FACT
Every year, 1 million, or about 20%, full-term, healthy infants are sent to the NICU for "observation" for an average stay of 3 days, totaling a whopping $6,000.
FACT
For newborns suspected to have serious medical conditions, the same NICU stay totals $20,000.
FACT
1 in 3 American women has an episiotomy. Episiotomies are medically indicated for less than 10% of all women. Over 1 million unnecessary episiotomies are performed annually in the U.S.
FACT
1 in 5 births in the U.S.A. are induced. 44% of women surveyed in 2002 reported their doctor wanted to induce. Only 16% reported medically-indicated reasons.
FACT
American women who elect epidurals are FOUR times as likely to have cesarean sections.
FACT
31.1% of American babies (nearly 1 in 3) in 2006 were delivered by cesarean section. The World Health Organization recommends a c-section rate of less than 10-15% as acceptable.
FACT
U.S. hospital policies for routine tests, practices, policies and procedures are based on financial considerations, which include malpractice insurance costs. They are not based on evidence, research, or appropriateness of care.
I truly hope you found these statistics disturbing. If they don't speak to the medicalization of childbirth in this country, I don't know what does.
The true horror comes in the fact that these views are being exported across the world. As the U.S. is such a powerhouse of marketing, more impressionable regions are adapting to these customs, despite the overwhelming evidence that the U.S. approach to childbirth IS SERIOUSLY FLAWED!
American obstetricians are taught to view birth as "a disaster waiting to happen." The average delivery in the U.S. is neither natural nor healthy. We have embraced a cascading system of successively more intense, unneeded interventions termed "active management" or the "standard of care".
So what do we do? How can we change the system?
We as a country need to reach beyond our own boundaries to embrace an effective model of maternity care. We, as women, mothers, and families, must educate ourselves as to the true process of labor and childbirth.
We must regain our faith in our bodies' perfect ability to have a baby. We must look at what the research is already telling us - that nature has it right!
In short, we must take back our birthing!
And if you're still not convinced, check these out:
http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf
http://www.motherfriendly.org/Downloads/induct-fact-sheet.pdf
Deneux-Tharaux D, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P. Underreporting of Pregnancy-Related Mortality in the United States and Europe. Obstet Gynecol 2005;106:684-92.
http://www.who.int/whr/2005/en/
Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Lohr KN (2005). "Outcomes of routine episiotomy: a systematic review". JAMA 293 (17): 2141–8. doi:10.1001/jama.293.17.2141. PMID 15870418.
(2006) "ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 71, April 2006". Obstet Gynecol 107 (4): 957–62. PMID 16582142.
http://www.unicef.org/publications/index_18108.html
http://www.cdc.gov/nchs/fastats/obgyn.htm
http://www.bmj.com/cgi/content/full/330/7505/1416?ehom
Macfarlane A, McCandlish R, Campbell R.
Choosing between home and hospital delivery. There is no evidence that hospital is the safest place to give birth.
British Medical Journal. 2000 Mar 18;320(7237):798.
Home versus hospital birth.
Cochrane Database Syst Rev 2000;(2)
The cost-effectiveness of home birth.
Journal of Nurse-Midwifery. 44(1):30-5, 1999 Jan-Feb.
http://www.kff.org/womenshealth/upload/whp061207othd.pdf
http://www.childbirthconnection.org/article.asp?ck=10401
http://www.bmj.com/cgi/content/full/318/7189/995
Peck P. Preinduction cervical ripening significantly increases risk of cesarean. Medscape Medical News, 2003
Goer H. The Thinking Woman’s Guide to a Better Birth. New York: Perigee Books, 1999, p 228-9.
Fullerton JT and Severino R. In-hospital care for low-risk childbirth: comparison with results from the NationalBirth Center Study. J Nurse Midwifery 1992;37(5):331-340.
FACT
Each year, the U.S. spends over $50 billion dollars on childbirth. This is more than any other nation in the world. (This number does not include babies in the NICU or readmissions during the first month.)
FACT
Birthing is the largest source of income for American hospitals.
FACT
The U.S. ranks 37th in the world for the quality of its health care.
FACT
Over HALF of all hospital admissions in America are for maternity.
FACT
Hospitals are NOT the safest place to have a baby. 25 infectious strains exist that are resistant to ALL known antibiotics. These are found primarily in hospitals.
FACT
75 years of routine hospital birth have produced NO studies to show it is safer than having a baby at home with a skilled birth attendant.
FACT
Both homebirth and birth centers have been scientifically proven to be as safe or safer than hospitals with a skilled labor attendant (i.e. midwives, not doctors).
FACT
The more technology used in childbirth, the more dangerous it becomes.
FACT
The larger the hospital, the greater the risks to both mother and baby.
FACT
Of the 4.3 million babies born annually in the U.S., a mere 5% represent natural childbirth.
FACT
America has the 40th highest infant mortality rate in the entire world.
FACT
The U.S.A. has the 14th highest maternal mortality ratio among developed nations.
FACT
Over 90% of all infants in the U.S. are born with drugs (e.g. narcotics from epidurals, pitocin, acetaminophen, etc) in their systems. NONE of these drugs have been tested for safe use in infants.
FACT
A 24-hour hospital stay, uncomplicated delivery in the U.S.A. costs anywhere from $8,000-10,000. This cost DOUBLES for a c-section.
FACT
ALL families in the U.S. are charged newborn nursery charges, even if the baby NEVER leaves the mother's room. This "routine" charge amounts to about $1.3 billion dollars annually, for services that are NOT rendered. (I'm not quite sure why this doesn't constitute insurance fraud - billing for services not rendered.)
FACT
Every year, 1 million, or about 20%, full-term, healthy infants are sent to the NICU for "observation" for an average stay of 3 days, totaling a whopping $6,000.
FACT
For newborns suspected to have serious medical conditions, the same NICU stay totals $20,000.
FACT
1 in 3 American women has an episiotomy. Episiotomies are medically indicated for less than 10% of all women. Over 1 million unnecessary episiotomies are performed annually in the U.S.
FACT
1 in 5 births in the U.S.A. are induced. 44% of women surveyed in 2002 reported their doctor wanted to induce. Only 16% reported medically-indicated reasons.
FACT
American women who elect epidurals are FOUR times as likely to have cesarean sections.
FACT
31.1% of American babies (nearly 1 in 3) in 2006 were delivered by cesarean section. The World Health Organization recommends a c-section rate of less than 10-15% as acceptable.
FACT
U.S. hospital policies for routine tests, practices, policies and procedures are based on financial considerations, which include malpractice insurance costs. They are not based on evidence, research, or appropriateness of care.
I truly hope you found these statistics disturbing. If they don't speak to the medicalization of childbirth in this country, I don't know what does.
The true horror comes in the fact that these views are being exported across the world. As the U.S. is such a powerhouse of marketing, more impressionable regions are adapting to these customs, despite the overwhelming evidence that the U.S. approach to childbirth IS SERIOUSLY FLAWED!
American obstetricians are taught to view birth as "a disaster waiting to happen." The average delivery in the U.S. is neither natural nor healthy. We have embraced a cascading system of successively more intense, unneeded interventions termed "active management" or the "standard of care".
So what do we do? How can we change the system?
We as a country need to reach beyond our own boundaries to embrace an effective model of maternity care. We, as women, mothers, and families, must educate ourselves as to the true process of labor and childbirth.
We must regain our faith in our bodies' perfect ability to have a baby. We must look at what the research is already telling us - that nature has it right!
In short, we must take back our birthing!
And if you're still not convinced, check these out:
http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf
http://www.motherfriendly.org/Downloads/induct-fact-sheet.pdf
Deneux-Tharaux D, Berg C, Bouvier-Colle MH, Gissler M, Harper M, Nannini A, Alexander S, Wildman K, Breart G, Buekens P. Underreporting of Pregnancy-Related Mortality in the United States and Europe. Obstet Gynecol 2005;106:684-92.
http://www.who.int/whr/2005/en/
Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Lohr KN (2005). "Outcomes of routine episiotomy: a systematic review". JAMA 293 (17): 2141–8. doi:10.1001/jama.293.17.2141. PMID 15870418.
(2006) "ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 71, April 2006". Obstet Gynecol 107 (4): 957–62. PMID 16582142.
http://www.unicef.org/publications/index_18108.html
http://www.cdc.gov/nchs/fastats/obgyn.htm
http://www.bmj.com/cgi/content/full/330/7505/1416?ehom
Macfarlane A, McCandlish R, Campbell R.
Choosing between home and hospital delivery. There is no evidence that hospital is the safest place to give birth.
British Medical Journal. 2000 Mar 18;320(7237):798.
Home versus hospital birth.
Cochrane Database Syst Rev 2000;(2)
The cost-effectiveness of home birth.
Journal of Nurse-Midwifery. 44(1):30-5, 1999 Jan-Feb.
http://www.kff.org/womenshealth/upload/whp061207othd.pdf
http://www.childbirthconnection.org/article.asp?ck=10401
http://www.bmj.com/cgi/content/full/318/7189/995
Peck P. Preinduction cervical ripening significantly increases risk of cesarean. Medscape Medical News, 2003
Goer H. The Thinking Woman’s Guide to a Better Birth. New York: Perigee Books, 1999, p 228-9.
Fullerton JT and Severino R. In-hospital care for low-risk childbirth: comparison with results from the NationalBirth Center Study. J Nurse Midwifery 1992;37(5):331-340.
Monday, November 24, 2008
Free Legal help for a VBAC
An attorney interested in working on VBAC ban lawsuits is considering using MS as a test state. Do you have any VBAC ban affected women up your sleeve right now? The criteria for the WA lawyer is:
-currently pregnant
-no complications in current pregnancy
-no VBAC options around including homebirth either because homebirth VBAC isn't allowed in your area or because the individual woman finds homebirth not to be an option for her
-no involvement in social services (child custody, neglect charges, etc.)
I'm a lawyer with the Northwest Women's Law Center in Seattle. I'm investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states - Alaska, Idaho, Montana,
Washington and Oregon. If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and whether it is medically necessary, and are willing to consider working with a lawyer on this, we'd like to talk with you. Please email us at vbacbanhelp@ican-online.org Our services will be provided free of charge.
http://www.nwwlc.org/
Mailing Address:
Northwest Women's Law Center
907 Pine Street, Suite 500
Seattle, WA 98101
Phone:
Legal Information & Referral ( 206 ) 621-7691
* Toll Free ( 866 ) 259-7720
* TTY ( 206 ) 521-4317
Administration ( 206 ) 682-9552
-currently pregnant
-no complications in current pregnancy
-no VBAC options around including homebirth either because homebirth VBAC isn't allowed in your area or because the individual woman finds homebirth not to be an option for her
-no involvement in social services (child custody, neglect charges, etc.)
I'm a lawyer with the Northwest Women's Law Center in Seattle. I'm investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states - Alaska, Idaho, Montana,
Washington and Oregon. If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and whether it is medically necessary, and are willing to consider working with a lawyer on this, we'd like to talk with you. Please email us at vbacbanhelp@ican-online.org Our services will be provided free of charge.
http://www.nwwlc.org/
Mailing Address:
Northwest Women's Law Center
907 Pine Street, Suite 500
Seattle, WA 98101
Phone:
Legal Information & Referral ( 206 ) 621-7691
* Toll Free ( 866 ) 259-7720
* TTY ( 206 ) 521-4317
Administration ( 206 ) 682-9552
Tuesday, November 4, 2008
Refusing a Cesarean
Today I sat in a NJ court to listen to a case argued regarding DYFS vs [Parents whose names have been withheld, even during the hearing]. (DYFS = Division of Youth and Family Services; NJ's Child Protection Services)
Apparently 2.5 years ago a woman in her early 40s entered St Barnabas Hospital in Livington, NJ to deliver her first baby. She was asked to sign a consent form for a potential c-section [note; there was no medical indication for a c-section]. She refused and the staff got mad. They repeatedly tried to get her to sign. Mother signed the consent for IV fluids, fetal monitoring, an episiotomy and an epidural.
Let's get something straight here.... St Barnabas does nearly 7000 births a year. They are by far, the largest maternity hospital in NJ. They also have a nearly 50% cesarean rate which CANNOT be justified.
Staff claimed that the woman became argumentative. [I guess that's why the word "labor" is a misnomer; it should be called "picnic"]. Male judges and male lawyers even entertained a short debate on what is appropriate behavior for a laboring woman.
So DYFS found the woman and her husband (who agree with his wife and her refusal to sign this consent form) to be guilty of abuse and neglect. That was the original basis for the argument though DYFS tried to change it in the hearing to make it more about the fact that the woman had a history of pyschological problems (not well defined) and has been in the care of a therapist for years. Quite frankly, there would be a heck of a lot more kids in the foster care system if "under the care of a therapist" disqualified someone from parenthood. They also talked about the mother's refusal to consent to scalp stimulation (whatever the heck that is); but it constituted abuse and neglect. There was mention of the woman having a history of Post Traumatic Stress Disorder. NEWSFLASH: Here's a good way to re-ignite PTSD: force a laboring woman into an unnecessary c-section. She also "went off her meds" in 2005 [which would be about the time she got pregnant, so perhaps - just perhaps - she was trying to protect her baby]. It was stated that the mother was never arrested and never caused harm to others. One lawyer tried to claim that the mom only consented to the non-invasive procedures. Luckily, one of the judges called him out on that; the judge knew that an episiotomy and an epidural needle are invasive.
In the end, the woman delivered a healthy baby without complication. Vaginally. The potential for c-section was unncessary. St Barnabas was just trying to bully this woman into consent so that they could have their way with her.
This woman obviously wanted to have a normal birth. I won't even call it a natural birth with all the interventions. She didn't want a c-section and didn't want to give the staff the free will to do one. And she paid for it by losing her baby. Why does a woman have to consent to surgery the moment she arrives at the hospital? In a true life-threatening emergency, isn't consent implied?
This is a dangerous precedent that could be set by our state's largest maternity hospital. There were arguments surrounding a woman's right to refuse any kind of testing whether it's invasive or non-invasive (even talk about the implications of refusing a sonogram).
The National Advocates for Pregnanct Women filed an amicus brief on behalf of the rights of the birthing mother. They submitted (and were given the opportunity to argue) that refusal of a c-section CANNOT play a role in this issue. They questioned whether mom's refusal to sign this blanket consent form led the staff to believe that everything she did after that was "crazy?" Medical professionals MUST lay out the costs of benefits of invasive and non-invasive medical procedures.
http://romancathanachronism.typepad.com/ican_somerset/2008/11/disgusted-nj-dyfas-takes-a-baby-from-a-mom-who-refused-a-cesarean.html
Apparently 2.5 years ago a woman in her early 40s entered St Barnabas Hospital in Livington, NJ to deliver her first baby. She was asked to sign a consent form for a potential c-section [note; there was no medical indication for a c-section]. She refused and the staff got mad. They repeatedly tried to get her to sign. Mother signed the consent for IV fluids, fetal monitoring, an episiotomy and an epidural.
Let's get something straight here.... St Barnabas does nearly 7000 births a year. They are by far, the largest maternity hospital in NJ. They also have a nearly 50% cesarean rate which CANNOT be justified.
Staff claimed that the woman became argumentative. [I guess that's why the word "labor" is a misnomer; it should be called "picnic"]. Male judges and male lawyers even entertained a short debate on what is appropriate behavior for a laboring woman.
So DYFS found the woman and her husband (who agree with his wife and her refusal to sign this consent form) to be guilty of abuse and neglect. That was the original basis for the argument though DYFS tried to change it in the hearing to make it more about the fact that the woman had a history of pyschological problems (not well defined) and has been in the care of a therapist for years. Quite frankly, there would be a heck of a lot more kids in the foster care system if "under the care of a therapist" disqualified someone from parenthood. They also talked about the mother's refusal to consent to scalp stimulation (whatever the heck that is); but it constituted abuse and neglect. There was mention of the woman having a history of Post Traumatic Stress Disorder. NEWSFLASH: Here's a good way to re-ignite PTSD: force a laboring woman into an unnecessary c-section. She also "went off her meds" in 2005 [which would be about the time she got pregnant, so perhaps - just perhaps - she was trying to protect her baby]. It was stated that the mother was never arrested and never caused harm to others. One lawyer tried to claim that the mom only consented to the non-invasive procedures. Luckily, one of the judges called him out on that; the judge knew that an episiotomy and an epidural needle are invasive.
In the end, the woman delivered a healthy baby without complication. Vaginally. The potential for c-section was unncessary. St Barnabas was just trying to bully this woman into consent so that they could have their way with her.
This woman obviously wanted to have a normal birth. I won't even call it a natural birth with all the interventions. She didn't want a c-section and didn't want to give the staff the free will to do one. And she paid for it by losing her baby. Why does a woman have to consent to surgery the moment she arrives at the hospital? In a true life-threatening emergency, isn't consent implied?
This is a dangerous precedent that could be set by our state's largest maternity hospital. There were arguments surrounding a woman's right to refuse any kind of testing whether it's invasive or non-invasive (even talk about the implications of refusing a sonogram).
The National Advocates for Pregnanct Women filed an amicus brief on behalf of the rights of the birthing mother. They submitted (and were given the opportunity to argue) that refusal of a c-section CANNOT play a role in this issue. They questioned whether mom's refusal to sign this blanket consent form led the staff to believe that everything she did after that was "crazy?" Medical professionals MUST lay out the costs of benefits of invasive and non-invasive medical procedures.
http://romancathanachronism.typepad.com/ican_somerset/2008/11/disgusted-nj-dyfas-takes-a-baby-from-a-mom-who-refused-a-cesarean.html
Monday, November 3, 2008
ICAN RESPONSE TO CCA
ICAN Responds to the Coalition for Childbirth Autonomy's Statement on the Cesarean Rate
Date:
Oct 28 2008
The Coalition for Childbirth Autonomy (CCA) released a statement today questioning the World Health Organization’s recommended cesarean rate of 10 - 15%. CCA suggests that a woman should be able to request a cesarean without medical indication. While ICAN supports both updated research on this topic and an increase in patient education and autonomy, we maintain that many women who are choosing a cesarean are making that decision without full informed consent.
Research shows that cesareans introduce additional risk in dozens of areas when compared to a vaginal birth. For the mother, these increased risks include death, hysterectomy, bood clots, increased pain & recovery time, infection, and post-partum depression(1). For the infant, additional risks include respiratory problems, breastfeeding problems, asthma in childhood(1), and type 1 diabetes(2). In addition, there are increased risks in future pregnancies, such as infertility, ectopic pregnancy, placenta abnormality, uterine rupture, preterm birth, and stillbirth(1).
ICAN does not believe that cesarean should be the typical solution for fear of childbirth. With appropriate counseling, most women who fear childbirth are comfortable attempting a vaginal birth (3, 4). Most show long-term satisfaction with their decision to change modes of delivery (4), and with intensive therapy, labor times were shorter (3).
ICAN will continue to work to improve maternal-child health and to protect a woman’s right to ethical and evidence-based care during pregnancy and childbirth.
(1) Maternity Center Association. 2004. What Every Pregnant Woman Needs to Know about Cesarean Section. New York: MCA. www.maternitywise.org.
(2) Cardwell, CR et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia. 2008 May;51(5):726-35.
(3) Saisto, T et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol. 2001 Nov;98(5 Pt 1):820-6.
(4) Nerum, H et al. Maternal request for cesarean section due to fear of birth: can it be changed through crisis-oriented counseling? Birth. 2006 Sep;33(3):221-8.
Date:
Oct 28 2008
The Coalition for Childbirth Autonomy (CCA) released a statement today questioning the World Health Organization’s recommended cesarean rate of 10 - 15%. CCA suggests that a woman should be able to request a cesarean without medical indication. While ICAN supports both updated research on this topic and an increase in patient education and autonomy, we maintain that many women who are choosing a cesarean are making that decision without full informed consent.
Research shows that cesareans introduce additional risk in dozens of areas when compared to a vaginal birth. For the mother, these increased risks include death, hysterectomy, bood clots, increased pain & recovery time, infection, and post-partum depression(1). For the infant, additional risks include respiratory problems, breastfeeding problems, asthma in childhood(1), and type 1 diabetes(2). In addition, there are increased risks in future pregnancies, such as infertility, ectopic pregnancy, placenta abnormality, uterine rupture, preterm birth, and stillbirth(1).
ICAN does not believe that cesarean should be the typical solution for fear of childbirth. With appropriate counseling, most women who fear childbirth are comfortable attempting a vaginal birth (3, 4). Most show long-term satisfaction with their decision to change modes of delivery (4), and with intensive therapy, labor times were shorter (3).
ICAN will continue to work to improve maternal-child health and to protect a woman’s right to ethical and evidence-based care during pregnancy and childbirth.
(1) Maternity Center Association. 2004. What Every Pregnant Woman Needs to Know about Cesarean Section. New York: MCA. www.maternitywise.org.
(2) Cardwell, CR et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia. 2008 May;51(5):726-35.
(3) Saisto, T et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol. 2001 Nov;98(5 Pt 1):820-6.
(4) Nerum, H et al. Maternal request for cesarean section due to fear of birth: can it be changed through crisis-oriented counseling? Birth. 2006 Sep;33(3):221-8.
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