1st time moms that have a c/b are more likely to have stillborns... - Mothering Forums

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#1 of 29 Old 11-28-2003, 02:44 AM - Thread Starter
 
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Has anyone else heard this. I heard on the news tonight that they did a study in Switzerland (I think) that showed that first-time moms that have c/bs are more like to have a stillborn at 34 weeks gst and later.

Has anyone else heard this?

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#2 of 29 Old 11-28-2003, 03:40 AM
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Racking my brain for what a c/b is.......
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#3 of 29 Old 11-28-2003, 03:55 AM - Thread Starter
 
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cesearian birth

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#4 of 29 Old 11-28-2003, 03:59 AM
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Interesting.....what would be the possible connection?
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#5 of 29 Old 11-28-2003, 12:15 PM - Thread Starter
 
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I have no idea. They didn't give one. It was just a 10 second blurb. Just enough to freak ppl out I guess.

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#6 of 29 Old 11-28-2003, 03:29 PM
 
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There was a post on the Midwifery Today Forums about this. The study showed a higher incidence of stillborns after a first c-birth, but didn't really give a reason why. Although I believe they mentioned higher probability of the placenta detaching too early, as well as uterine rupture during labor.
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#7 of 29 Old 11-29-2003, 12:29 AM
 
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I am doubting the validity of this study for sure.
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#8 of 29 Old 11-29-2003, 02:05 AM - Thread Starter
 
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Me too.... sounds kinda like every other study that have come out with about rupture and such.

You'd think they would come up with something new!

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#9 of 29 Old 11-29-2003, 04:37 PM
 
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#10 of 29 Old 11-29-2003, 04:38 PM
 
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I mean, we all know cesarean, when done unecessarily (which at least half are), greatly increases the chances of maternal/fetal injury and death. What makes this one study so shocking:
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#11 of 29 Old 11-30-2003, 02:46 AM
 
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http://customwire.ap.org/dynamic/sto...MPLATE=DEFAULT

This is a more comprehensive article.

Here is a relevant quote:

"The absolute risk of unexplained stillbirth at or after 39 weeks' gestation was 1.1 per 1000 women who had had a previous Caesarean section and 0.5 per 1000 in those who had not," the study said.

1.1 per 1000 women is still extremely small.

I haven't read the actual study, but from the associated press article I can't find any holes in the methodology--not to say they're not there.

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#12 of 29 Old 11-30-2003, 04:00 AM
 
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Caesarean Sections greatly complicate future pregnancies.

Complications as infertility from scar tissue and infections, placental abruption, placenta previa, drug sensitivity/allergy, bleeding problems, and simply psychological problems to be overcome with the poor mother.

As for stillborns, I do not know what the cause could possibly be unless it is the extra interventions as amniocentisis, chorion villi sampling and more ultrasound scans that doctors like to do to women with previous caesarean sections whom doctors like to deem as high risk.

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#13 of 29 Old 11-30-2003, 04:05 AM - Thread Starter
 
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Quote:
Originally posted by applejuice
poor mother.

As for stillborns, I do not know what the cause could possibly be unless it is the extra interventions as amniocentisis, chorion villi sampling and more ultrasound scans that doctors like to do to women with previous caesarean sections whom doctors like to deem as high risk.
Who is the "poor mother"

Never heard of some of those test so obvuiously I'm not high risk with one c/b....

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#14 of 29 Old 11-30-2003, 04:07 AM
 
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Since there are so many unnecessary Caesarean Sections, it is hard to say why.

If the first Caesarean was for a condition the mother had as diabetes or toxemia, perhaps this condition would complicate future pregnancies anyway, whether or not a Caesarean was done.

However if the Caesarean was done for 'failure to progress', it is hard to tell if the condition would repeat. Usually changing HCP's or location of the next birth would take care of this diagnosis.

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#15 of 29 Old 11-30-2003, 04:25 AM
 
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Quote:
Originally posted by applejuice
Caesarean Sections greatly complicate future pregnancies.

Complications as infertility from scar tissue and infections, placental abruption, placenta previa, drug sensitivity/allergy, bleeding problems, and simply psychological problems to be overcome with the poor mother.

As for stillborns, I do not know what the cause could possibly be unless it is the extra interventions as amniocentisis, chorion villi sampling and more ultrasound scans that doctors like to do to women with previous caesarean sections whom doctors like to deem as high risk.
For the record I am not a "poor mother". Also I dont know where you are getting your information but I am unaware and have not read anywhere that mothers with prior csections get more interventions in pregnancy. I am high risk with a prior csection and did not have an amnio or a CVS. i did have US, 3 actually and two were in the beginning when I had a threatened miscarriage that I insisted on. Nothing else extra because I had a prior csection. Also, I was not considered high risk due to a previous csection but for something different.

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#16 of 29 Old 11-30-2003, 04:28 AM - Thread Starter
 
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me too Kim...actually I'm not even high risk...as far as I know.

I was confused on the "poor mother" part. I don't consider myself poor at all....

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#17 of 29 Old 11-30-2003, 01:46 PM
 
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I am not sure what to think of the study, but I have always felt that c-births were not to be gone into lightly (which no one here would ), so I am not sure what good it does for any of us to worry about it, if they could give some reasoning, something constructive that those of us with no choice in our c-births could do, that might make this worthwhile, but I always hate to hear things like this with no answers, except the obvious- don't have an unnecessary c-birth.

FTR- I am also not considered high risk and I have had 2 c-sections, and this baby will be born the same way. I have had one u/s, just the routine one, and no other "interventions" have been recommended for me.

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#18 of 29 Old 11-30-2003, 02:49 PM
 
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If previous c-section is not considered a high risk pregnancy, why are many midwives now not allowed to care for a woman who has had a previous c-section? If women who have had a previous c-section aren't considered high risk, why do many areas of the country (including the one that I live in) not allow them to give birth vaginally anymore? Whether women who have had previous c-sections *should* be considered "high risk" I think is definately debatible; I personally think they aren't, in most circumstances. But ACOG isn't calling me on a regular basis to ask my opinion!!

C-section comes with many risks. Of course everyone knows that. There is much higher morbidity and mortality with c-section vs. vaginal birth; yet, for many instances, the risk of infection, hemorrhage, surgical complications, uterine rupture and adhesions do not outweigh the risk to mother and baby if a vaginal birth were to continue. A c-section is a wonderful means of saving the life of a mother and child, and of preventing long-term health complications in both mother and child. C-section rates of 25-30% or more is horrible, though, and it is completely unnecessary and is putting moms and their future babies at risk. This study shows one of those risks.



You can go to www.thelancet.com to read the abstract of the study. You have to register, but registration is free, and of course, you can be like me and register some completely bogus name and address, if you don't want to give your own.

Then you can judge the validity of the study and its methods for yourself, and come to your own conclusions.

My reading of the article doesn't lead me to believe that this risk is such that, if there is a present risk to a mom or baby, it should be a determining factor in deciding for a c-section or not. BUT, in elective c-sections, this is a risk that should be considered, and that the mom who is thinking about an elective c-section should be aware of this risk.

Because the fact of the matter is, women with a previous c-section experienced unexplained stillbirth at twice the rate of women who had no history of c-section (This from the abstract on the Lancet website):

" The absolute risk of unexplained stillbirth at or after 39 weeks' gestation was 1·1 per 1000 women who had had a previous caesarean section and 0·5 per 1000 in those who had not."

While the numbers are still small, that is a statistically significant (very significant) difference! And the numbers studied were not small (again, from the Lancet abstract):

" For 120 633 singleton second births, there were 68 antepartum stillbirths in 17754 women previously delivered by caesarean section (2·39 per 10 000 women per week) and 244 in 102879 women previously delivered vaginally (1·44; p<0·001). "

This isn't the study that definitively tells all....but I think that it points to yet another risk of c-section that needs to be weighed when a c-section is being considered.

Anyhow, go to thelancet.com and read the abstract and judge for yourself!!

Lori

edited for clarity, though I don't know if it helped much!!!
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#19 of 29 Old 11-30-2003, 02:56 PM
 
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As for the "poor mother" comment, I think applejuice was commenting that the mothers who experience those complications were "poor mothers", not just any mom who had had a c-section.

Just my reading of it, anyhow.
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#20 of 29 Old 11-30-2003, 03:00 PM
 
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I apologize for the term "poor mother".

I was simply extending sympathy to women in general who have had major surgery after a difficult labor and maybe a difficult pregnancy who now must recover from that major surgery and go home to meet the needs of a newborn baby on top of it all.

I do know that many women go home to little or no assistance since many new mothers often lack a support group in their families. That is why doulas, CLC's, and home visiting nurses are now popular and used widely.

I did not have any support for myself. DH went right back to work. My MIL and mom were an alcoholics; my younger sisters were in school; my SIL lived out of state. I am glad that I had my babies as easily as I did and healed quickly. I was terribly depressed and tired however.

I never had any interventions in my pregnancies (4) or labors (4) since I had all of mine at home and I refused all offers to do an ultrasound since they were not really indicated.

With regards to interventions in future pregnancies, repeat Caesareans are also often scheduled based on the results of L/S stress tests, so that gestational age can be determined more accurately. Still, many repeat Caesareans have the added problem of prematurity and this adds more interventions despite the technology that is supposed to make things more predictable.

Sorry if I offended anyone. I know if I had major surgery and had to go home to recover from it AND meet the many needs of a newborn baby, I would have felt very sorry for myself. I was only extending sympathy to women in that position.

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#21 of 29 Old 11-30-2003, 03:16 PM
 
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Quote:
Originally posted by lorijds
If previous c-section is not considered a high risk pregnancy, why are many midwives now not allowed to care for a woman who has had a previous c-section? If women who have had a previous c-section aren't considered high risk, why do many areas of the country (including the one that I live in) not allow them to give birth vaginally anymore? Whether women who have had previous c-sections *should* be considered "high risk" I think is definately debatible; I personally think they aren't, in most circumstances. But ACOG isn't calling me on a regular basis to ask my opinion!!

Lori

edited for clarity, though I don't know if it helped much!!!
I think many midwives are allowed but they choose not to CYA in case anything happens. Actually I have not come across a CNM that wouldnt take a past csec birth experience and as for lay midwives, isnt that their choice???

AS for not allowed to have VBACs in a certain hospital, well that is CYA too and notmedically sound. Its unfortunate but that still does not qualify the pregnancy "high risk".
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#22 of 29 Old 11-30-2003, 10:41 PM
 
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I'm sorry, on the fence, but we'll have to agree to disagree on that one.

I am a nurse in a birth center and women's health clinic. We receive (and I read them, most of the time : ) 3 to 5 medical journals a month pretaining to obstetrics and gynecology.

The American College of Obstetricians and Gynecologists feel that a woman who has had a previous c-section is at risk for uterine rupture during labor, and it is too dangerous for her to labor in a facility that cannot do a c-section in less than 15 minutes. This is their official stand. For many small hospitals, that means an automatic c-section, as they do not have round the clock, in house anesthesia. Many large hospitals (including many in my area) are following suit, and not allowing VBACs. Only repeat c-sections. A c-section is major abdominal surgery, a high risk event for you and the baby, and I don't know of a midwife who performs c-sections. While a midwife *may* be able to provide you with prenatal care, she will not be involved in your c-section, unless the hospital let's her assist.

For women who are able to attempt a VBAC, the ACOG feels that that is a dangerous enough of a situation that these women must have constant fetal monitoring, and should only labor in a facility that is able to perform a section in less than 15 minutes. Many of these women are once again not able to be attended by midwives. If they are, most hospitals require that the covering physician be within 15 minutes of the hospital, preferrably within the hospital itself. Some hospitals also require that a woman who is attempting a VBAC have an epidural catheter in place (they don't have to have the medication going, just set up to run) so that a crash section can be performed.

Article after article in these journals discusses the risks of c-section, and the risks during subsequent pregnancies. You may not be considered high risk during your pregnancy (although most OBs would consider you at least at higher risk than moms with no previous uterine surgeries), but you are definately considered high risk durin labor, according to the American College of Obstetricians and Gynecologists.

That is the angle I am coming from, anyway, in labelling a mom with a previous c-section high risk. *I* don't necessarily think that you are, though a mom with a previous uterine surgery definately has a higher risk for certian complications. But, the american medical establishment does indeed consider you high risk.
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#23 of 29 Old 12-01-2003, 12:21 AM
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I think the medical establishment is wrong. All of these "precautions" for VBAC candidates are simply setting the woman up for a long, unpleasant, and unsuccesful labor. The risk of uterine rupture increases so slightly as to not be significant enough a risk to outweigh all the interventions hospitals are now requiring.

This is one of the primary reasons I'm choosing to have a HBAC (Home Birth After Ceasarean). I am getting my prenatal care from the countrie's largest homebirth practice. Interestingly, my dr. was telling us the practice's statistics the other day. They used to do VBAC's only in the hospital (for many of the reasons you sited). They had about a 55% success rate, which, in itself far outstripped any local competition. The practice, however, was not satisfied with the results, and continued to do research, read papers/studies, and educated themselves. They made the decision to start offering HBAC's. Suddenly their success rate jumped to 92%. I don't think that was just coincidence.

Now, in the case of an emergency, I have top rate paramedic service about 60 seconds away from when I pick up my phone, a great hospital 3 minutes away, not to mention the doctor that will be attending me. This is actually a quicker route to further medical attention than I had while in the hospital with my first child, where it took them over 10 minutes to arrive after a nurse was sent from our room in a panic!

And for the record, the only prenatal test I have had was the glucose test. Nothing else has been necessary, because I am not high risk.


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#24 of 29 Old 12-02-2003, 12:11 PM
 
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Quote:
Originally posted by bec
I think the medical establishment is wrong.

They made the decision to start offering HBAC's. Suddenly their success rate jumped to 92%. I don't think that was just coincidence.

I wouldn't disagree with you on statement number one. Not at all.

I work in a birth center, NOT a hospital. We continue to attend VBAC, because we feel that it is very safe (and frankly, also because our malpractice insurance allows us to. If they don't allow it, I'm not sure what we will do. You can't practice without malpractice insurance.). Certainly VBAC moms are still more at risk for uterine rupture than a mom without a history of uterine surgery; but like you said, that risk is small, and for many moms, the risk of the complications (short term and long term) far outweigh the risk of a VBAC.

As for statement number two, well, once again, I agree. It is most certainly NOT coincidence. Our VBAC rate over the last 6 years is over 95%.

I think the protocols at most hospitals are in place to protect in case of lawsuit. And to be honest, when people sue for everything, and win huge cases, the hospitals have been burned one too many times. I was once involved peripherally in a lawsuit in which a patient accused a nurse of sexual harrassment. The nurse and patient were male. The nurse did the same assessment and care that every other (female) nurse did; but when the male nurse did it, the (homophobic) patient accused the nurse of touching him inappropriately. It was totally bunk. Yet, the hospital spent alot of money defending itself and the nurse before the suit was dismissed. Yet another reason why I don't work in a hospital!

Sorry if the "high risk" label raises your hackles a little bit, though it should. It's not personal. And I'm not even saying I agree. What I was simply saying is, if you go to a traditional OB/hospital based practice, you will be considered high risk. That if the doctor is practicing according to the standards set by the ACOG, as most OBs do, then that is the label you are going to have, whether the doc informs you of that label or not.

Lori
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#25 of 29 Old 12-02-2003, 12:30 PM - Thread Starter
 
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The bc I was using has a high success rate but I think the reason is that they seem to kick you to the curb for just about anything. Which is why I'm leaving because I doubt that I will have a textbook labor and I don't want to deal with it. I'd rather birth in a vbac friendly hospital where I know I will be and I know who will be there....

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#26 of 29 Old 12-02-2003, 03:09 PM
 
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I am sure that is the case for some practices and birth centers, Kim. I personally would not ever again birth in a hospital, knowing what I know. But, you have to do the best with what your personal circumstances and geography provide you.

That is not the case for our birth center, however. We have a very low transport rate. The last couple of years our intrapartum transport rate has been 2% or less. You can check our stats at www.topekabirthcenter.com if you like.

Birth centers are just like any other practitioner....you have to ask questions, check them out, be selective. You also have to jive with them. I know many midwives were rather scathing of the Illinios practice (where I suspect Bec is going) when Mothering did a story about them a couple of years back . I don't quite understand that. Even though it is run by docs, it still seems very holistic and woman-centered. I wish that every doc were like that! And every midwife, too. But they aren't. As pregnant moms, for better or worse you are consumers of health care, and you need to demand what you want. If you can't get it, then you need to go (and take your healthcare dollars) somewhere where you *can* get the services you want and need. The more women take control of and responsibility for their health care, hopefully the more women-based, holistic practices will abound, be they home-based, birth center based, or hospital based.

I'm not sure how this thread came from the original post to this point! But I think it is a good discussion. Of course, if those of us who participate on *these* boards were in charge of the birthing environments, the way women birth in this country would no doubt change greatly. I know we are an eclectic group, and don't all see eye to eye, but I think that the mamas here are very educated about their options in their health care and are good, strong advocates for themselves and their babies, and that makes for a completely different picture than what is accepted in the mainstream medical establishment today.

Lori
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#27 of 29 Old 12-02-2003, 10:53 PM
 
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Well, I work in a medical library and just pulled the article and read it in its entirety. The point of the study was not to place the blame for stillbirths in mothers who have previously had a c-section on abruption. There had been no previous studies linking a c-section in a first birth to a subsequent stillbirth.

In the discussion, the authors admit they do not know of a concrete cause for the statistics, but theorize that it may have to do with "intentional or inadvertent ligation of major uterine vessels at the time of first caesarean section could affect uterine blood flow in future pregnancies....The association between previous caeserean and stillbirth might be, therefore, another manifestation of abnormal placentatin caused by a uterine scar."

And another quote: "However if women are being counselled about caesarean birth with no clear obstetric advantage, such as caesarean section for maternal request, the pssible effect on the risk of unexplained stillbirth in future pregnancies should be discussed."

Source is The Lancet. Volume 362, Issue 9398, 29 November 2003. Pages 1779-1784.
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#28 of 29 Old 12-03-2003, 01:36 AM
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Quote:
Originally posted by lorijds
I know many midwives were rather scathing of the Illinios practice (where I suspect Bec is going) when Mothering did a story about them a couple of years back . I don't quite understand that. Even though it is run by docs, it still seems very holistic and woman-centered. I wish that every doc were like that! And every midwife, too.
It is the same practice. And it does have several midwives in the practice as well. And, you are correct, it is very holistic and woman-centered.

Unfortunately, midwifery is not politically smiled on in this state. This is not Homefirst's fault, but it may be that they are getting the backlash from it. All I know, is that it is fitting my needs as a consumer perfectly.


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#29 of 29 Old 12-03-2003, 12:59 PM
 
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Thanks, Kim, for pulling the article (I could only access the abstract).

Bec, let us know how your birth goes.

I love their practice's name--Homefirst. That is great!

Lori
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