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#1 of 49 Old 06-08-2006, 11:39 AM - Thread Starter
 
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I'm curious as to your opinions on this issue. Here are the basic details. Let's say you had a couple, Jim and Janet, who were infertile. Twelve years of failed IVF attempts, ovarian stimulation, tests, Progesterone, Lupron, you name it. They decide to ask "Jane" to carry a child for them, and after many failed IVF attempts, Jane gets PG on their very. last. embryo. ever.

Jane had a c-section before. Even if Pitocin or other drugs are not used, there is still a risk, however small, of uterine rupture should Jane attempt a VBAC. Jane, while she would prefer a VBAC herself, is willing to undergo an elective repeat C-section. Janet and Jim, fearing for a birth complication, would far, far prefer a c-section because there is comparatively less risk to the baby.

Your opinions?
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#2 of 49 Old 06-08-2006, 12:24 PM
 
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Are you asking as the surrogate or as the parents?

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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#3 of 49 Old 06-08-2006, 12:29 PM
 
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If *I* were Jane I would have a VBAC. The risk of u/r is small. The risk of complications from elective repeat c-section is greater. Also, thinking of later pgs, a VBAC after 2 c-sections is much harder to find a care provider to support you.
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#4 of 49 Old 06-08-2006, 01:57 PM
 
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VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.

If a 99% chance that the uterus will not rupture is not satisfactory for the parents they should seek a surrogate with no prior c/s, with the understanding that there is no such thing as a 100% guarantee that it won't happen no matter who their surrogate is.

How do they feel about the potentially lethal risks that have a greater chance of occuring than UR, for any pregnant woman? Cord prolapse, placental abruption, etc? If they are accepting of those risks, why are they more concerned about a risk that has a lower chance of happening?
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#5 of 49 Old 06-08-2006, 02:10 PM - Thread Starter
 
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Originally Posted by velcromom
VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.

If a 99% chance that the uterus will not rupture is not satisfactory for the parents they should seek a surrogate with no prior c/s, with the understanding that there is no such thing as a 100% guarantee that it won't happen no matter who their surrogate is.

How do they feel about the potentially lethal risks that have a greater chance of occuring than UR, for any pregnant woman? Cord prolapse, placental abruption, etc? If they are accepting of those risks, why are they more concerned about a risk that has a lower chance of happening?
Though Jane's health is by no means irrelevant to the issue, one factor here is the danger to the baby. One question to ask, then, is how dangerous c/s is for the baby vs. VBAC.
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#6 of 49 Old 06-08-2006, 02:11 PM - Thread Starter
 
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Originally Posted by velcromom
VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.
Jane doesn't want more kids.
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#7 of 49 Old 06-08-2006, 02:13 PM
 
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AFAIK, C/S is safer for the baby while VBAC is safer for the mother. If I were Jane, I'd push for VBAC. I can't even imagine being in Janet's position, so I can't say. If she cares about the baby more than she does about Jane, I'd assume she'd push for a cesarean.
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#8 of 49 Old 06-08-2006, 02:35 PM
 
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VBAC from both sides, but I'd let Jane decide.
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#9 of 49 Old 06-08-2006, 03:10 PM
 
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VBAC.

if the parents are unwilling to consider Jane's position/feelings on this that would creep me out. Jane is carrying their child yes and that should give her SOME consideration.

Jami (25) Roland (27) & Caleb (5), Jacob (3.5) , Kaitlyn (2)
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#10 of 49 Old 06-08-2006, 03:11 PM
 
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here is some info about the risks of repeat c/s from ICAN:


"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.

• 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


References are included if you view the paper at the ICAN site.
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#11 of 49 Old 06-08-2006, 04:44 PM
 
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Quote:
Originally Posted by velcromom
• 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.
They ARE underreported. In fact, in my case, the hospital lied about them. My dd came out screaming and screamed for HOURS after she was delivered by c-section. I'd cry too if my first introduction to this world was having a knife cut my head.

The hospital told me that it must have happened in utero when "her head was banging against my pelvis." I was a mess of hormones and drugs making me loopy so it didn't occur to me to question them at the time. Wouldn't she have had bruising if it happened in utero? Funny how cuts in utero can be so straight and even. :

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#12 of 49 Old 06-08-2006, 05:30 PM
 
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VBAC. No question. Safer for both short term. Safer for both long term.

-Angela
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#13 of 49 Old 06-08-2006, 05:57 PM
 
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Vbac.
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#14 of 49 Old 06-08-2006, 07:21 PM
 
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Vbac.
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#15 of 49 Old 06-08-2006, 07:25 PM
 
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I would have the operation because I could not handle the brain flooded with oxytocin thing if I was not the intended mother.
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#16 of 49 Old 06-08-2006, 07:32 PM
 
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vbac.

i agree that it would seem very disrespectful of Jim & Janet to not consider Jane's preferences for the birth of the baby she is carrying for them.

and while i agree that in some cases, a repeat cesarean is better for the baby while still carrying an increased risk for the mother, in many other cases it is not true. if it is a scheduled cesarean, they will likely not wait until the mother goes into labor and instead schedule it in advance, risking birth that is too early for the baby. the increase of incidence of respiratory distress for babies born via cesarean is also telling for me.

just as i would never coerce a person into donating their kidney to me if they were the only match for me in the world, i would not feel comfortable requesting a woman have major abdominal surgery with significant risks when she has offered the gift of allowing me to become a parent.

~claudia
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#17 of 49 Old 06-09-2006, 04:20 PM
 
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Quote:
Originally Posted by alegna
VBAC. No question. Safer for both short term. Safer for both long term.
:
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#18 of 49 Old 06-09-2006, 06:07 PM
 
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Quote:
Originally Posted by Kleine Hexe
If *I* were Jane I would have a VBAC. The risk of u/r is small. The risk of complications from elective repeat c-section is greater. Also, thinking of later pgs, a VBAC after 2 c-sections is much harder to find a care provider to support you.
charles baudelaire,

, to what kleinehexe said to you about this.
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#19 of 49 Old 06-09-2006, 06:09 PM
 
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Quote:
Originally Posted by velcromom
VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.

If a 99% chance that the uterus will not rupture is not satisfactory for the parents they should seek a surrogate with no prior c/s, with the understanding that there is no such thing as a 100% guarantee that it won't happen no matter who their surrogate is.

How do they feel about the potentially lethal risks that have a greater chance of occuring than UR, for any pregnant woman? Cord prolapse, placental abruption, etc? If they are accepting of those risks, why are they more concerned about a risk that has a lower chance of happening?
charles baudelaire,

, to what velcromom said to you as well.
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#20 of 49 Old 06-09-2006, 06:11 PM
 
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VBAC! As a surrogate I might also add that even though she says she is willing to undergo a section for the IPs, if her real choice is to vbac she may possibly regret doing the section. I am speaking from experience (Although my c-section was not a repeat, it was a first)

Sarah loving wife to Scot...joyous mama to...
Emilee and Elaina and our newest addition Elliot Bell 9/15/10
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#21 of 49 Old 06-09-2006, 06:13 PM
 
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Quote:
Originally Posted by velcromom
here is some info about the risks of repeat c/s from ICAN:


"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.

• 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


References are included if you view the paper at the ICAN site.
charles baudelaire,

Another , to what velcromom said to you.
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#22 of 49 Old 06-09-2006, 06:15 PM
 
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Quote:
Originally Posted by dlm194
They ARE underreported. In fact, in my case, the hospital lied about them. My dd came out screaming and screamed for HOURS after she was delivered by c-section. I'd cry too if my first introduction to this world was having a knife cut my head.

The hospital told me that it must have happened in utero when "her head was banging against my pelvis." I was a mess of hormones and drugs making me loopy so it didn't occur to me to question them at the time. Wouldn't she have had bruising if it happened in utero? Funny how cuts in utero can be so straight and even. :
Dana,

, to what happen to you with your c-section and the hospital you had at.
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#23 of 49 Old 06-09-2006, 06:20 PM
 
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As a VBAC mom, I can't say that I'd recommend anything else. I still can't fathom that physicians who take the hippocratic oath seriously wouldn't push for the same, if they actually looked at the evidence. (faulty studies not included!)
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#24 of 49 Old 06-09-2006, 06:30 PM
 
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My opinion is to leave it up to the birth mother. The risks either method are not enough to try to tell her which to choose. She has done such a generous thing to carry the baby, since they are both within the realm of standard practice I would leave the choice up to her. If it were me I would probably, of course, want the VBAC, but I couldn't butt in and tell someone else what to do especially in this case. If she asked my opinion I would tell her but I wouldn't try to pressure her to chose an option she was uncomfortable with.

Good point about the surgery and avoiding some of the oxytocin effects. Especially if I didn't want any more kids in the future, maybe that would be something I would consider.
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#25 of 49 Old 06-09-2006, 06:57 PM
 
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The risks are basically irrelevant to me since they are both pretty low - the real issue to me is that it's her birth, her choice. If she wanted a C-section and the parents wanted VBAC, I'd say the same thing.
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#26 of 49 Old 06-09-2006, 07:01 PM
 
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VBAC. My body, my choice. I'd go with the odds that VBAC is safer and healthier for mum and baby. If the intended parents didn't agree I wouldn't carry a baby for them.
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#27 of 49 Old 06-09-2006, 07:21 PM - Thread Starter
 
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Quote:
Originally Posted by mara
My opinion is to leave it up to the birth mother. The risks either method are not enough to try to tell her which to choose. She has done such a generous thing to carry the baby, since they are both within the realm of standard practice I would leave the choice up to her. If it were me I would probably, of course, want the VBAC, but I couldn't butt in and tell someone else what to do especially in this case. If she asked my opinion I would tell her but I wouldn't try to pressure her to chose an option she was uncomfortable with.

Good point about the surgery and avoiding some of the oxytocin effects. Especially if I didn't want any more kids in the future, maybe that would be something I would consider.
It is up to Jane, and other than Janet and Jim feeling that a c-section is safest for the baby and not a substantial risk for Jane, they're not "insisting" or forcing her to choose one way or another: it really is her decision. They're just afraid that their one-and-only baby will die. However, what's at stake for Jane is that she wants the birth choice to be the one that's safest for the baby, but not at the expense of her life (reasonably speaking -- NO form of birth is without risk, and Jane is well aware of this).

Do me a favor, you study-knowledgeable mamas:

In terms of a percentage, what is the percentage of births that go wrong in a VBAC (unmedicated) and result in serious, permanent fetal injury?

In terms of a percentage, what is the percentage of births that go wrong in a VBAC (unmedicated) and result in death for the baby?

In terms of a percentage, what is the percentage of mothers who experience serious, permanent injury from a C-section or its complications?

In terms of a percentage, what is the percentage of mothers who die from a C-section or its complications?

Thanks again.
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#28 of 49 Old 06-09-2006, 07:47 PM
 
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Perinatal mortality rate - babies that die:
3 per 1000 for planned vbac
4 per 1000 for elective cesarean


Maternal mortality rate - moms that die:
2.8 per 10,000 with a trial of labor
2.4 per 10,000 with an elective cesarean


The risk of a mother dying from a cesarean is small but is still considerably higher than with a vaginal birth:
Maternal death with cesarean: 4 in 10,000
Maternal death with all vaginal births 1 in 10,000
Maternal death with elective cesareans 2 in 10,000
Maternal death with all normal vaginal births 0.5 in 10,000

Countries with some of the lowest perinatal mortality rates in the world have cesarean rates under 10%. The World Health Organization says, "Clearly there is no justification in any specific region to have more than 10-15% cesarean section births."

The infant mortality rate in the US is currently 6.9/1,000. This report states "The United States continues to rank poorly in international comparisons of infant mortality."

The maternal mortality rate in 1996 (the last year statistics were available) was 12 per 100,000 births. There has been no decrease in maternal mortality in the US for 20 years according to a Mortality and Morbidity Weekly Report.*



Sources:
Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-1999
National Vital Statistics Reports, Volume 49, Number 13, December 27, 2001
A Guide to Effective Care in Pregnancy and Childbirth, Chapter 38, Labor and birth after previous cesarean, M. Enkin, M.J.N.C. Keirse, J. Nielson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. Oxford University Press, 2000
Annual Summary of Vital Statistics: 2000, Hoyert DL, Freedman MA, Strobino DM, Guyer B. Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA
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#29 of 49 Old 06-09-2006, 08:00 PM - Thread Starter
 
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Thank you so much!

Quote:
Originally Posted by velcromom
Perinatal mortality rate - babies that die:
3 per 1000 for planned vbac
4 per 1000 for elective cesarean


Maternal mortality rate - moms that die:
2.8 per 10,000 with a trial of labor
2.4 per 10,000 with an elective cesarean


The risk of a mother dying from a cesarean is small but is still considerably higher than with a vaginal birth:
Maternal death with cesarean: 4 in 10,000
Maternal death with all vaginal births 1 in 10,000
Maternal death with elective cesareans 2 in 10,000
Maternal death with all normal vaginal births 0.5 in 10,000

Countries with some of the lowest perinatal mortality rates in the world have cesarean rates under 10%. The World Health Organization says, "Clearly there is no justification in any specific region to have more than 10-15% cesarean section births."

The infant mortality rate in the US is currently 6.9/1,000. This report states "The United States continues to rank poorly in international comparisons of infant mortality."

The maternal mortality rate in 1996 (the last year statistics were available) was 12 per 100,000 births. There has been no decrease in maternal mortality in the US for 20 years according to a Mortality and Morbidity Weekly Report.*



Sources:
Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-1999
National Vital Statistics Reports, Volume 49, Number 13, December 27, 2001
A Guide to Effective Care in Pregnancy and Childbirth, Chapter 38, Labor and birth after previous cesarean, M. Enkin, M.J.N.C. Keirse, J. Nielson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. Oxford University Press, 2000
Annual Summary of Vital Statistics: 2000, Hoyert DL, Freedman MA, Strobino DM, Guyer B. Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA
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#30 of 49 Old 06-09-2006, 08:49 PM
 
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Quote:
Originally Posted by Charles Baudelaire
It is up to Jane, and other than Janet and Jim feeling that a c-section is safest for the baby and not a substantial risk for Jane, they're not "insisting" or forcing her to choose one way or another: it really is her decision. They're just afraid that their one-and-only baby will die. However, what's at stake for Jane is that she wants the birth choice to be the one that's safest for the baby, but not at the expense of her life (reasonably speaking -- NO form of birth is without risk, and Jane is well aware of this).

Do me a favor, you study-knowledgeable mamas:

In terms of a percentage, what is the percentage of births that go wrong in a VBAC (unmedicated) and result in serious, permanent fetal injury?

In terms of a percentage, what is the percentage of births that go wrong in a VBAC (unmedicated) and result in death for the baby?

In terms of a percentage, what is the percentage of mothers who experience serious, permanent injury from a C-section or its complications?

In terms of a percentage, what is the percentage of mothers who die from a C-section or its complications?

Thanks again.

charles baudelaire,

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