Now I am not really keen with the idea of calling it a "natural" cesarean (compassionate or humane might be a better choice) but if you need a cesarean for medical reasons (i.e. vaginal birth would most likely bring greater harm to mom/baby then cesarean birth) shouldn't your cesarean look like this?*
*Thanks to The True Face of Birth for sharing this link. Check out her blog for a great compilation on recent blogging/news on VBAC and cesarean birth.
Here is a great piece on rising U.S. national cesarean rates from Childbirth Connection.
A report on a very sad study appeared in my in-box from www.orgyn.com the other day. Here is a link to the abstract: http://www.greenjournal.org/cgi/content/abstract/110/6/1256. In the study, "cesarean delivery was associated with a significantly reduced probability of a second birth." That is sad, very very sad. I for one can say that I had decided that if I had a cesarean for my second, I was absolutely not going to have a third. Thankfully I had a VBAC (vaginal birth after cesarean) and we are now happily pregnant with number three. My heart aches for those moms whose first birth experiences put an end to their childbearing.
As the years go on and the cesarean rates rise, I predict we will see more and more research unearthing the adverse affects of cesarean birth and the pendulum will swing back towards vaginal birth. At least that is my hope. Here is a good article from BBC news on some of the potential risks of elective cesarean. Please note that babies born by emergency cesarean had fewer lung problems then those born by elective cesarean. If you must have a cesarean for medical reasons, don't schedule it unless absolutely necessary for the health of mom/baby, wait until your body goes into labor naturally, then have the cesarean.
BBC NEWS
Caesareans 'may harm lung growth'
Babies born by elective Caesarean section are much more likely to
develop breathing problems, a Danish study examining 34,000 deliveries
suggests.
Researchers found they were up to four times more likely to have
respiratory problems than those born naturally, or by emergency
Caesarean section.
The babies may miss out on hormonal and physiological changes during
labour which help mature the lungs, they say.
The University of Aarhus study features in the British Medical Journal.
Major operation
Almost a quarter of UK births are now estimated to be Caesarean
sections - far above the 10% to 15% rate recommended by the World
Health Organization.
"A lot of woman are completely unaware of the fact that a planned
Caesarean section can negatively impact on their baby." Dr Maggie Blott
Consultant obstetrician
More than half of these were emergency Caesareans, but despite this
experts have been calling for measures to reduce numbers of elective
Caesareans, warning it is a major operation.
A recent Oxford University study found that women could be four times
more likely to die in childbirth if they opted for a Caesarean instead
of natural birth.
The Danish team examined data on over 34,000 deliveries, adjusting to
take account of factors such as the mother's age, weight, and whether
she smoked or drank alcohol during pregnancy
They found that babies born by elective Caesarean section had an
increased risk of general respiratory problems.
The risk was higher the earlier the Caesarean was performed.
A nearly fourfold increased risk was found at 37 weeks gestation, a
threefold increase in risk at 38 weeks gestation, and a doubling of
risk in infants delivered at 39 weeks gestation.
For example, at 37 weeks, one in 10 babies delivered by elective
Caesarean section developed respiratory problems, compared with 2.8%
of infants delivered naturally or by emergency Caesarean section.
At 38 weeks, the proportion was 1.7% compared with 5.1% and at 39
weeks, 1.1% compared with 2.1%.
The risks of serious respiratory problems showed the same pattern.
The researchers conclude that significantly fewer babies would develop
breathing problems if elective Caesareans were put off until 39 weeks
gestation.
They said: "It is plausible that hormonal and physiological changes
associated with labour are necessary for lung maturation in neonates
and that these changes may not occur in infants delivered by elective
Caesarean sections."
Lung fluid
Dr Maggie Blott, a consultant obstetrician at King's College Hospital,
London, said obstetricians in the UK were advised not to carry out
elective Caesareans before 39 weeks.
She said part of the problem might be that doctors had to switch
support lines to the baby very quickly during a Caesarean, and it was
possible that lung fluid is not drained away as well as it should be.
She said: "Some babies do develop transient breathing problems, they
usually recover from them, but occasionally a baby can be very sick
indeed.
"A lot of woman are completely unaware of the fact that a planned
Caesarean section can negatively impact on their baby.
"Any research which reinforces the fact that Caesareans are not
necessarily in the best interests of the baby is welcome."
Mervi Jokinen, of the Royal College of Midwives, said Caesarean
section rates were too high in the UK.
She said it was a major operation, which had health implications for
the mother, as well as the baby.
"The decision to opt for a Caesarean section should not be taken
lightly and should be based on good medical grounds," she said.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7137945.stm
Published: 2007/12/12 01:17:41 GMT
© BBC MMVII
Regarding better outcomes with cesarean delivery for breech birth, I would have to add, based on my studies and conversations with midwives, that to ensure successful outcomes for vaginal breech birth, you need to be experienced (your average doctor has little experience delivering breech) AND you need to know your client (and how do you get to really know your client in 10-20 minute prenatal visits). I wonder how outcomes are affected if you factor in the skill of the attending care provider and the length of prenatal visits.
Ok, I am being lazy but I really do need to get my studies done and ORGYN.com always encourages sharing their digests with colleagues so I will oblige. The below article is just one of many recent articles in ORGYN.com's daily email service, a service designed to keep practitioners abreast of recent developments in obstetrics and gynecology.
Previous cesarean may raise perinatal death risk
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 132: 51-7Comparing the rate of perinatal death after a previous cesarean and vaginal delivery.
© 2007 Current Medicine Group Ltd, a part of Springer Science+Business Media
Below is a great cesarean birth plan written by Barbara Stratton. Barbara Stratton started the Baltimore chapter of the International Caesarean Awareness Network (ICAN) and had a successful VBAC at home. Even if you think you will never have a cesarean, please read the below plan and think about what you would like to see happen if you needed a cesarean. It isn't fun to be in the operating room thinking, wait a minute, this wasn't supposed to happen. I know, I've been there....
Cesarean Birth Informed Consent /Refusal for Barbara Stratton And Her Newborn
We realize that cesareans and other surgeries are a common event at hospitals. However, we ask that the staff respect that this individual surgery is a unique and never to be repeated event in the life of our family. For us, it is neither common nor routine, but rather is an event that will have effects lasting a lifetime. It is my goal that should a cesarean become necessary for this birth, that the entire process be treated as the joyful, celebratory, respectful event that birth was meant to be.
*I strongly wish to be the person to announce the baby’s gender after birth
*I strongly wish to see the baby being born either by lowering of the drape or providing a mirror.
*I do not consent to tranquilizers, sedatives or amnesiac drugs being administered.
*I do not consent to a single layer suture to close my uterus. A double layer closer must be used.
*I do not consent to staples to close my skin layer and instead want sutures.
*I do not consent to my partner and sister or doula being separated from me at any time.
*I do not consent to my partner or doula being separated from me even in the case of general anesthesia. It is important that the birth of our child be witnessed by a family member even if I am not in need of support at that time.
*I do not consent to weighing, foot printing, eye ointment or other routine tasks except suctioning for the first two hours after birth. Blood glucose testing is expected.
*Instead, baby to be placed STILL WET immediately on my bare chest and covered with blankets for warmth.
*Bulb suctioning only unless baby shows signs of problems. Any deep suctioning to be performed with a mobile unit while I hold baby or at my immediate side.
*I do not consent to bathing the baby at all.
*I do not consent to any students, interns, etc. watching or participating.
*I do not consent to the administration of vitamin K or any vaccinations.
*I do not consent to tying my arms down unless I am unable to control them.
*Modestly draped at all times.
*Everyone in the OR introduced to my partner and I and that we are explained what their role is.
*Conversation between staff kept to a minimum (no casual chatter unrelated to the surgery) with focus being on making my partner and I feel as at ease as possible and kept informed as to what is taking place.
*I do not consent to a catheter being inserted until after anesthesia is administered.
*I prefer epidural anesthesia
*I do not consent to the use of any artificial nipples for the baby
*If the baby has hypoglycemia, I wish to use breastfeeding to treat it. My second choice is pumped breastmilk administered using a non-nipple feeding method. My last choice is formula (not sugar water).
*Baby to remain on my chest or in my arms throughout suturing, recovery, etc.
*We intend to keep my placenta. Please keep it clean and refrigerated.
*My preference post-op is to utilize a PCA system for pain management. If oral medication is used, orders to be written for me to be woken up for timely doses (not waiting for my request).
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Sometime I sincerely wonder if any doctors subscribe to the obstetrics update newsletter put out weekly by www.orgyn.com. The site is clearly for OBs, not pregnant moms or aspiring midwives. But at least every other week (sometimes weekly) I hear a story about a doctor pushing a cesarean (or an unnecessary induction which leads to a cesarean). The research I am reading weekly in my in-box would encourage me, if I was an OB, to do some serious thinking about how to lower my cesarean rate. Take the title of one of this week's mini articles: "Cesarean section adhesions linked with delayed delivery" (remember registration with www.orgyn.com is free and provides you with a wealthy of information). Apparently the more cesareans you have the greater your chance of pelvic adhesive disease, and we aren't talking small numbers here either. Almost half of the moms, 46%, who had a second cesarean had pelvic adhesive disease, 75% of the moms who had a third cesarean and 83% of the moms who had a fourth cesarean.1 AND (as if that wasn't enough) in this study it was found that pelvic adhesive disease increases the time it took to deliver the child and with each cesarean, the delay increased. So I did a little research on pelvic adhesive disease (I had never heard of it, don't remember reading anything about it in the fine print when I consented to my cesarean...). Apparently pelvic adhesive disease can cause chronic pelvic pain, painful sex, obstructed bowels and even infertility. If pelvic adhesions are new to you, you might want to read this article.
1 Cesarean section adhesions linked with delayed delivery, Source: American Journal of Obstetrics and Gynecology 2007; 196: 461.e1-e6, posted May 30, 2007, accessed June 2, 2007 from http://www.orgyn.com/en/news/2007/Week_22/Day_2/Cesarean_section_adh.asp?C=5561639236113125
Here are the statistics from Inova Alexandria Hospital, where I was initially planning to have a VBAC.1
Percentage of VBACs 4.5%
Percentage of all cesarean births 36.59%
So, HOW DID I THINK I WAS GOING TO HAVE A VBAC?
Please please please check your numbers! We are so turned inward during pregnancy. Moving fluidly through a hormone rich world, the stark numbers of the outside are softened by our pregnant state. But the harsh reality is that if you are birthing in a hospital where your chances of a VBAC are 4.5%, you aren't going to have a VBAC unless you are birthing with a doctor who is extremely supportive of VBAC (and has the stats to prove it) AND is a sole practitioner (because you don't want to chance getting the doctor on call who has a 2% success rate for VBACs).
So please find out your doctor's VBAC, induction, cesarean (etc. etc.) rates. Ask for a number. All that "Oh certainly, VBACs are definitely best for mom and baby", or "but of course baby comes out when he wants to come out, I rarely induce" talk doesn't cut it. You need a number, plain and simple. And if you don't like that number, switch caregivers. The World Health Organization recommends a safe cesarean rate between 10 and 15%. Homebirth midwives usually have very low cesarean rates, but more on that in a future post.
ICAN Names Top 15 Studies That Should Keep Mothers Out of the OR
If you haven't checked out the above paper, you should. The summary from, ICAN's website, is below. ICAN (the International Cesarean Awareness Network) is a fantastic research for women trying to avoid a cesarean. They also offer support groups for VBACing women. Check out their website for a local chapter near you.
"As the number of cesarean sections in the U.S. continues to mount, so does the research showing that mothers and babies may be paying a high price for this surgery. Research published just in the last year has highlighted the short-term and long-term risks of undergoing a cesarean, for both mother and baby. Other research has called into question the assumed safety advantage of cesarean section over vaginal birth in various situations including vaginal birth after multiple cesareans and breech deliveries... .
Major pieces of research released in 2006 showed that women who undergo cesareans versus women experiencing a vaginal birth have a higher risk of dying in childbirth, have a higher chance of suffering from potentially fatal placental problems in subsequent pregnancies, and their babies have a higher chance of being injured during surgery. The list of 15 studies that ICAN collected also shows that vaginal birth after cesarean, including multiple cesareans, continues to be a reasonably safe birthing choice for mothers."
From http://www.ican-online.org/, accessed 05-02-07
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