Friday, December 08, 2006

Cesarean Sections

General Information
v The World Health Organization (WHO) states that, worldwide, c-sections should comprise a maximum of 8-15% of births.
v The US average for births ending in cesarean sections is 1 in 4, though in many areas it is now 30-35%. Some hospitals have reported cesarean rates in excess of 50%.
v The average reflects a 400% increase in less than 15 years. This increase in US c-sections has NOT led to an improvement in infant mortality or morbidity rates.
v WHO states that 50% of the cesareans performed in the US are unnecessary.
v The largest percentage of most c-sections are performed due to “failure to progress” or repeat cesareans.
v However, decisions to perform c-sections are often influenced by many non-medical factors such as: individual philosophies and training, convenience for doctor or patient, patient’s socioeconomic status, peer pressure, fear of litigation, and financial gain.

What Are the Benefits of Cesarean Sections?
v For those true medical emergencies, c-sections have saved lives of both moms and babies. These instances would include:
· Complete Placenta Previa—the placenta is covering the cervix and opening
· Transverse position of baby—side lying
· Prolapsed cord—cord is preceding baby in birth canal
· Placental Abruption— the placenta partially or completely detaches from the uterine wall before birth
· Eclampsia or severe Pre-eclampsia w/ failed induction of labor
· Large uterine tumor which blocks the cervix
· TRUE fetal distress confirmed with fetal scalp sampling or biophysical profile
· TRUE Cephalopelvic Disproportion (CPD)—baby is too large or pelvis is too small. This is very rare and only happens with a pelvic deformity.
· Initial onset of an active Herpes infection in mother
· Uterine rupture
v Often c-sections are performed for instances that are medically “questionable”. These instances would include:
· Previous cesarean sections—VBACS (with a low transverse uterine incision) are safer in most instances for mom and baby. Approximately 180 women in the US will die each year from complications of an elective repeat c-section.
· Many cases of diagnosed CPD or fetal distress (the latter without confirmation through scalp sampling or the biophysical profile)
· Dystocia
· Failure to Progress (many interventions and medications can interrupt labor and cause this diagnosis)
· Breech—depends on the type of breech and the skill/experience of the doctor or midwife. Often it is much safer to try different means to turn the breech baby.
· Multiple birth

What Are the Risks of a Cesarean Section?
v A cesarean section is major abdominal surgery with risks to both mom and baby. The risks of the circumstance should always be thoroughly weighed against the risks of the surgery.
v Mom’s risks (resulting both directly and directly from this procedure) can be markedly increased. Half of all moms can expect some type of complication from this procedure. Risks include:
· Infection
· Hemorrhage
· Transfusion
· Hysterectomy
· Pulmonary Embolism
· Injury to surrounding organs and tissues (bladder, veinous system, etc.)
· Anesthesia complications (aspiration, paralyzation, death, etc.)
· Psychological complications (post partum depression; post traumatic stress syndrome, etc.)
· Delay in family bonding due to separation
· Longer recovery time
· Higher incidence in breastfeeding problems/failure
· Blood clots
· Paralyzed Bowel
· Scar Adhesions—Complications stemming from adhesions would likely be chronic and consist of: pelvic pain, bowel problems, and pain during sexual intercourse.
· Increased problems in subsequent pregnancies or fertility issues
o Marked increase in placental problems in future pregnancies due to scar tissue, etc.
§ Placenta Previa—placenta covers cervix
§ Placenta Accreta—placenta embeds itself too deeply in the uterine wall extending to the muscle tissue. Often requires a hysterectomy.
§ Placenta Abruption—placenta prematurely detaches from uterine wall
o Stillbirths
o Infertility and/or miscarriages
o Ectopic pregnancies
o Uterine Rupture
· Death—Mortality is 4 times as great than that of a vaginal delivery.
v Increased risks to baby cannot be dismissed either. These can include:
· Premature birth—even if the c-section was planned.
· Respiratory Distress Syndrome (in premature AND mature infants)
· Pulmonary Hypertension—5 fold higher incidences than babies delivered vaginally
· Jaundice
· Lower APGAR scores—50% more likely than vaginal births
· 1-9% of babies are scarred or maimed by the scalpel

What are My Alternatives to a Cesarean Section?
v Preventative measures and education is the key
o Freestanding birth centers and homebirth w/skilled midwife c-section rates are at or below the WHO standards. They also have statistically lower rates of infant mortality and morbidity. (it is not just a negligent “trade off”)
o Doulas can decrease your need for cesarean sections by 50%.
o VBACS are considered safer though many doctors are afraid of them because of fear of litigation suits. Eighty percent of women who have had a previous c-section could safely and successfully give birth vaginally. VBAC's are a rare occasion locally. Most doctors do not support them in this area. Many mothers report that their doctor seems supportive with a "trial" run, but when it comes down to it--the doctors will most likely find a "need" to perform a repeat section--either before or after labor begins.
o For those moms nearing a CPD diagnosis in labor, the squatting birth position allows your pelvis to open an additional 33 percent.
o Breech babies can often be turned by external version, chiropractic techniques, etc. If unsuccessful, the type of breech and the experience/skill of the care giver should be considered; then, weigh the risks of the breech birth vs. the risks of the c-section.
o Avoid factors which could contribute directly or indirectly to the likelihood of a c-section.
· Use of Pitocin, etc. (increases the chances of uterine rupture)
· Epidurals—often will slow labor down or inhibit the ability to push
· Routine continual electonic fetal monitoring—have not increased the healthy outcomes of babies but HAVE increased the chances for mom “needing” a c-section
· Frequent vaginal exams—which could lead to infection, thereby making the doctors want to deliver soon—whether mom is “close” or not…..

...If We Do Nothing?
v If nature is let run its course without interventions, without time limits, etc. , 95% of babies and moms would birth with no “true” complications.

Helpful Links and Information:

WHO World Health Organization World Health Organization
What happens during a cesarean? International Cesarean Awareness Network

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