no shock in elective c-section declaration from ACOG - Page 3

[Marlena]

You go, Jill!

(Tangent -- let's not forget, as Marsden Wagner so brilliantly pointed out -- ACOG is a trade union representing first and foremost the best interests of its members -- not women, not babies, but the doctors whose livelihoods rely on a constant supply of pregnant women whom they can categorize, measure, manage, deliver, and ultimately bill).

Bingo.

[Quirky]

Marlena, I'm on my sister's Mac, and I can't for the life of me figure out how to make this thing open a second browser window, or I'd link you to the page - but there was a study linked from ACOG's homepage (press releases) in the last few months that showed that c-section is associated with a 4x greater risk of maternal mortality (if I recall correctly, controlled for high risk pregnancies, etc. but I may be wrong on that). We had a thread about it - it was a huge study done in North Carolina, I think. Maybe someone else knows what I'm talking about and can post the link?

ETA: bingo! found the link

How on Goddess' green earth it can be "ethical" for OBs to do elective C-sections when the risk of death is 4x greater is beyond me....

[Marlena]

The link doesn't work.

It was on ACOG's site? I'll search for it...

Let's see...I found "Sex is better for some women after sterilization" (September 1, 2002), and "Home births double risk of newborn death" (July 31, 2002), but not the c-section study (funny, that...).

Ah, here we are. You might be looking for this?: http://www.acog.org/from_home/public...ng14505fla.htm

While the abstract there doesn't have the vaginal birth info, this summary does:

http://www.acog.org/from_home/public...erFriendly=yes

Mortality Risks -- Another study examined the association between pregnancy-related death and health care services, including maternity care coordination, nutritional services, sources of prenatal care (public vs private), the number of prenatal visits, and method of delivery. It found that a cesarean delivery significantly increased a woman's risk of experiencing a pregnancy-related death (35.9 deaths per 100,000 deliveries with a live-birth outcome) compared to a woman who delivered vaginally (9.2 deaths per 100,000). Pregnancy-related mortality rates were higher among women with cesarean delivery when all causes of death were analyzed. This study also found that women who received regular prenatal care significantly decreased their risk of death.

[Marlena]

Incidentally, the study cited IS just one study, using limited information from North Carolina. Then again, if I remember correctly, the home birth study is also just one study, using birth certificate info from Washington state (I'd have to go back and check that, though...it's been a few months since I looked at it). Interesting how the one is relatively quietly mentioned, while the other was trumpeted all over not merely on ACOG's site, but in numerous press releases that made the national newspapers.

[sohj]

Originally posted by applejuice
...that said, any woman who is stupid enough to fall for that dictum deserves what the consequences are. I am very sorry, but any woman, after all of the work that has been done to get midwives licensed and into hospitals, fathers in the delivery rooms, freestanding birth center, water births, ABC centers, child birth information classes and all of the studies and information out there, well, they just have to be dumb!

YOu have to make the decision you can live with. I know women who shop for hairdressers more intensively than they investigate the OB who will deliver their child.

The problem is that despite "all the work" that you mention, it is far from consistently available.

I did NOT have a c-section. But, I did have a totally hijacked birth which you can read about starting here, at this post on a thread in Birth and Beyond

The gist of it that pertains to your post is:

I am enraged by people who "choose" to have births at hospitals because they are creating the "market" for interventionist births and they, out of fear, created the hospital birth as a mainstream birth. If there were no obstetricians, we would have a large supply of midwives. And I could have had a bigger selection to make a choice from.

and, from a later post on the same thread:

Alison74: knowing there are "choices" isn't enough. The reason I ended up with the midwife I did is because there are only 7 (SEVEN!!!!!) homebirth midwives in New York City. We have 16 million people in the greater metro area and, how many was it again?, SEVEN homebirth midwives.

And the largest birthing center here, Elizabeth Seaton, closed its doors in the beginning of September because of insurance problems.

And, otherwise, if you are in a normal L&D at any of the hospitals here, you cannot have a water birth. You can labor in a tub, but you have to get out to give birth. That makes no sense to me from the point of view of a mother, but there you have it. It's the policy.

In the hospital where I ended up, there WAS a midwife in the room with me, but it was the doctor who was "in at the kill" so to speak. It was the doctor, who I had never met before (yet more to the story...not my decision and I'm not going into it here and, yes, I thought I had everything covered), who cut me open and ruined my health for a very long time.

[CanOBeans]

Here is a more concise statement on risks to mothers and babies which includes references. To access the original statement, go to http://www.ican-online.org/resources/wp_electivecs2.htm -- this is posted here with permission -- please feel free to pass along, taking care to include the copyright info on the bottom.

Position Statement: Elective Cesarean Sections Riskier than Vaginal Birth for Babies and Mothers
by Jill MacCorkle, ICAN Clarion Editor

Recently, a few physicians have claimed that elective primary cesareans and elective repeat cesareans are safer for babies, and even for mothers, than vaginal birth.1,2 While selective use of the medical literature might seem to back up this claim, a review of the studies which consider short- and long-term risks of cesareans does not. Elective cesareans put babies and mothers at risk, use valuable and limited healthcare resources, have negative psychological and financial consequences for families, and substantially increase serious risks in subsequent pregnancies. The high rate of cesarean in the United States has not resulted in improved outcomes for babies or mothers. Additionally, vaginal birth after cesarean (VBAC) is still less risky for mothers and babies than cesarean section, despite recent claims to the contrary. ICAN is opposed to cesarean sections performed without true medical indication.

Risks to the baby from elective cesarean section

Babies delivered by elective cesarean have an increased risk of neonatal respiratory distress syndrome (RDS), a life-threatening condition,3-7 and other respiratory problems that may require NICU care.
Babies delivered by elective cesarean have a five-fold increase in persistent pulmonary hypertension (PPH) over those born vaginally.6
Babies delivered by elective cesarean are at increased risk of iatrogenic (physician-caused) prematurity, usually related to failure to conform to protocols for determining gestational age prior to delivery, or errors in estimating weeks of gestation even with the use of clinical data.7,8 Prematurity can have life-long effects on health and well-being, and even mild to moderate preterm births have serious health consequences.9
Babies delivered by elective cesarean are cut by the surgeon’s scalpel from two to six percent of the time.10 Researchers believe these risks to be underreported.


Risks to the mother from elective cesarean section

Up to 30% of women who have a cesarean acquire a postpartum infection. Infections are the most common maternal complication after cesarean section and account for substantial postnatal morbidity and prolonged hospital stay.11
Other serious complications for women undergoing cesarean include massive hemorrhage,12 transfusions,13 ureter injury,14 injury to bowels,15 and incisional endometriosis.16,17
Women who undergo cesarean report much lower levels of health and well-being at seven weeks postpartum than women who have vaginal births.18
Women who undergo cesarean section have twice the risk of rehospitalization for reasons such as infection, gallbladder disease, surgical wound complications, cardiopulmonary conditions, thromboembolic conditions, and appendicitis. Rehospitalization has a negative social and financial effect on the family.19
Women who undergo cesarean section report less satisfaction than women having vaginal births.20,21
Women undergoing cesarean are at increased risk of hysterectomy in both the current and future pregnancies.22,23
The maternal death rate is twice as high for elective cesarean as for vaginal birth.24
In subsequent pregnancies, women with a prior cesarean have higher rates of serious placental abnomalities which endanger the life and health of the baby and the mother.25-27 Women are rarely told that a cesarean places future babies at higher risk.
After cesarean section, women face higher rates of secondary infertility as well as higher rates of miscarriage and ectopic pregnancy.28,29


--------------------------------------------------------------------------------

1. Harer WB Jr. Patient choice cesarean. ACOG Clinical Rev 2000;5(2).
2. Greene MF. Vaginal delivery after cesarean section - Is the risk acceptable? N Engl J Med 2001; 345(1): 54-5.
3. Bowers SK, MacDonald HM, Shapiro ED. Prevention of iatrogenic neonatal respiratory distress syndrome: Elective repeat cesarean section and spontaneous labor. Am J Obstet Gynecol 1982;143(2):186-9.
4. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: Influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102:101-6.
5. Hales KA, Morgan MA, Thurnau GR. Influence of labor and route of delivery on the frequency of respiratory morbidity in term neonates. Int J Gynaecol Obstet 1993; 43(1):35-40.
6. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001;97(3):439-42.
7. Parilla BV, Dooley SL, Jansen RD, and Socol ML. Iatrogenic respiratory distress syndrome following elective repeat cesarean delivery. Obstet Gynecol 1993; 81(3):392-5.
8. Hook, B et al. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 1997; 100(3):348-53.
9. Kramer MS, Demissie K, Yang H, Platt RW, Sauve R, Liston R. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. J Amer Med Assoc 2000; 284(7):843-9.
10. Smith JF, Hernandez C, Wax JR. Fetal laceration injury at cesarean delivery. Obstet Gynecol 1997; 90(3): 344-6.
11. Henderson EJ & Love EJ. Incidence of hospital-acquired infections associated with cesarean section. J Hosp Infect 1995; 29: 245-255.
12. van Ham MA, van Dongen PW & Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74: 1-6.
13. Naef RW III, Washburne JF, Martin RW et al. Hemorrhage associated with cesarean delivery: When is transfusion needed? J Perinatol 1995; 15: 32-35.
14. Eisenkop SM, Richman R, Platt LD & Paul RH. Urinary tract injury during cesarean section. Obstet Gynecol 1982; 60: 591-596.
15. Davis JD. Management of injuries to the urinary and gastrointestinal tract during cesarean section. Obstet Gynecol Clin North Am 1999; 26: 469-480.
16. Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O. Endometriosis in abdominal scars: A diagnostic pitfall. Am Surg 1996; 62(12):1042-4.
17. Wolf GC, Singh KB. Cesarean scar endometriosis: A review. Obstet Gynecol Surv 1989; 44(2):89-95.
18. Lydon-Rochelle MT, Holt VL, Martin DP. Delivery method and self-reported postpartum general health status among primiparous women. Paediatr Perinat Epidemiol. 2001 Jul;15(3):241-2.
19. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. J Amer Med Assoc 2000; 283(18):2411-2416.
20. Fawcett J, Pollio N & Tully A. Women’s perceptions of cesarean and vaginal delivery: Another look. Res Nurs Health 1992; 15: 439-446.
21. Waldenstroem U. Experience of labor and birth in 1111 women. J Psychosom Res 1999;47: 471-482.
22. Stanco LM, Schrimmer DB, Paul RH, Mishell DR Jr. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol 1993; 168(3 Pt 1):879-83.
23. Bakshi S, Meyer BA. Indications for and outcomes of emergency peripartum hysterectomy. A five-year review. J Reprod Med 2000; 45(9):733-7.
24. Bewley S. Maternal mortality and mode of delivery. Lancet 1999; 354: 776.
25. Zaideh, SM et al. Placenta praevia and accreta: Analysis of a two-year experience. Gynecol Obstet Invest 1998; 46(2):96-8.
26. Ananth, CV et al. The association of placenta previa with history of cesarean delivery and abortion: A meta-analysis. Am J Obstet Gynecol 1997; 177(5):1071-78.
27. Miller DA, Chollet JA & Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210-214.
28. Hemminki, E and Merilainen, J. Long-term effects of cesarean sections: Ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996; 174(5):1569-74.
29. Hall MH, Campbell DM, Fraser C & Lemon J. Mode of delivery and future fertility. Brit J Obstet Gynecol 1989; 96: 1297-1303.

This material may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All rights reserved.

[Marlena]

knowing there are "choices" isn't enough. The reason I ended up with the midwife I did is because there are only 7 (SEVEN!!!!!) homebirth midwives in New York City. We have 16 million people in the greater metro area and, how many was it again?, SEVEN homebirth midwives.

The regulation of direct-entry midwifery in New York state is largely responsible for this. It is virtually impossible for anyone other than certified nurse-midwives to practice in the state. The matter has been litigated from here to there. And the DNMs lost.

The issues Jill and others are raising about the medical research comparing vaginal births versus cesareans are highly important. However, one cannot forget the legal issues that prevent so many women who know about homebirth or birth in birthing centers with midwives and want such a birth from having one, because direct entry midwifery is either illegal in their state or is regulated such that it's either virtually impossible to practice direct entry midwifery or very legally risky, at best, to do so.

[CerridwenLorelei]

ugh people like my dh's coworker

will jump for joy

My Sec was legit but hers..
she asked dr to schedule for 3 weeks before due date so "I won't gain any more of that ungodly weight"
also put cereal in formula when the baby was 7 days old so she wouldn't have wrinkles or dark eyes due to lack of sleep...

Ughhhhhhh
and this makes it easier for that type of sec it sounds like ...

[applejuice]

Greaseball:

A Woman In Resdience by Dr. Michelle Harrison is an excellent book. I truly advised all of my childbirth students to read this book when it first came out.

Another book is Labor and Delivery by Constance Bean in which a CCE simply writes down every thing she observes as an observer on the OB floor.

Th information is out there. My mom was no one special, but she did have four home births in the 1950's. How did someone so ordinary manuever that? In those days, mothers stayed in the hospital for a week or more and got the rest they needed. It was also more affordable. Fewer people had health insurance.

You can get anything you want . Everything is negotiable. Vote with your $$$$ and your feet.

[kama'aina mama]

applejuice, I have to disagree with you. It sounds to me like your mom was very special. At the very least she was thinking way outside the cultural norms and had the guts to act on her ideas... and she raised you to do the same!

[applejuice]

No, I have known the woman for fifty years and she is very ordinary.

Everyone can learn from that.

The common acts of the common person have always changed society.

Unfortunately, they do not write the history books.

[DaryLLL]

They do not write the history books--

Sometimes they do! Read the Seven Voices, One Dream, by one of the Founders of LLL. Just a group of 7 nice Catholic ladies, homebirthing and ebfing in the dark ages of the 1950's, the first ones to start a support group for almost anything, not to mention for doing something considered disgusting and embarrassing at the time!

Not a history book, a herstory book.

[Little Bear's Mama]

So true,DaryLLL!

On the note of homebirth,my Grandmother gave birth to seven children. All but one(her youngest,my mother) were born at home. Her first baby was 10lbs! The doctor didn't make it,and my Great Grandmother(who birthed all of her nine at home,including a almost 3 pound premie) helped deliver the baby.
My paternal Grandmother gave birth to all but one of her 4 children at the hospital. My Dad was the lone homebirth,she couldn't afford to go to the hospital.
All nursed their babies.
My mother had two breech births. My sister was a footling,myself a complete breech. She gave birth to both of us vaginally,but the doctor tore her up trying to get me out. He actually cut the inside of her vagina. In more than one place!! As well as episiotomy and several tears! On both births,forceps were used to pull us out! Years later,my mother had to have surgery for all the damage that was done. There was TONS of scar tissue. She would have been better off with a c-section. Remember though,when I say this that she was bedridden,not given food or water,tied down(yes,I said tied down!!!)and made to birth flat on her back. I'm SO glad that women today have choices. I'm so glad if a woman whose baby is breech can opt for a c-section,as she probably wouldn't have any choice but to be bed ridden and made to birth flat on her back. It just makes it too difficult to get a baby out in that position,regardless. Not to even mention a baby is folded in half!
I would rather NOT see a mom have a c-section. Yes,I think choosing a MAJOR surgery over patiently waiting for the baby come is beyond ridiculous! Yes,I think a mom should think about her health and the health of her baby and forget about convienence. BUT,I also think that there are necessary c-sections. AND I also think a mother should be able to choose the best birth for her. If she is having a breech baby,she should be able to choose a vaginal birth(with no restricted movement)or a c-section. So,basicly,it comes down to having that option available if she *needs* it,not just for cosmetic or convienence reasons.

[Greaseball]

I'm so glad if a woman whose baby is breech can opt for a c-section,as she probably wouldn't have any choice but to be bed ridden and made to birth flat on her back.

It's the intervention in breech birth that causes the problems, not the baby's position. MDC member laurashanley delivered her own footling breech with no interventions, a quick labor, no tearing, and in a standing position. And she's not the only one...

If a woman wants to have a breech baby she probably has to do it at home, unless it arrives too quick for a section. If she's not comfortable being at home, she will most likely have a section or a huge episiotomy.

If I have a breech I will most definitely stay home.

I was planning to post some quotes from A Woman in Residence, just a little at a time.

"When a patient begins to make a lot of sound, the nurses talk her into an epidural anesthetic. Then, once the anesthesia is in, they put a 'smiley face' on the blackboard next to the patient's name. The goal is to get 'smiley faces' next to every name on the board."

"...the vagina is defined as dirty...some surgeons also change their gown after touching the vagina."

"[The residents] seem to be depressed, talking mostly about work and suicide."

"What do we lose by being kind to a baby who has just been born?"

"...I learned to screw a monitor into the scalp of a baby not yet born...Was the baby smiling before I screwed the electrical lead into its head? Was the baby frightened? Is this baby curious anymore? Does this baby still want to be with us? What have we taught this new person about what life is like?"

[Little Bear's Mama]

Greaseball,that was sortof the point I was making. In most hospitals,a woman wouldn't get a choice of birthing position(the doctor needs to see what he's doing,donchaknow). She would most likely be classified as "high risk" and be confined to bed throughout her labor and denied food and drink "in case she needs an emergency c-section". So,in this circumstance,no doubt that she could be better off choosing a c-section if the choice were available.
I have no doubts that a woman can birth her breech baby at home,if she chooses to do so or if that option is even available to her.

[crazy_eights]

Originally posted by Marlena
My understanding is that maternal mortality is increased, maternal morbidity issues are different (not comparable, ie, though likely also significantly increased in all cases other than cases of 3rd and 4th degree tears in vaginal birth and so forth), and that fetal mortality and morbidity are decreased with c-sections. But I'll see what the data show.

I'm not sure if the stats will give you an accurate picture. It is very, very rare to do a c/sec, even a repeat, for a known stillbirth, (even one that died before labor). So the vag. stats on mortality are artificially elevated. And I think it would depend on how you define "morbidity" to see if there is a real decrease. Lowered APGARS? Breathing difficulty (TTN)? NICU/ SCN stays? It could be quite interesting b/c there is quite a lot of room to finagle the stats.