C-Section Not Best For Breech Birth

The Society of Obstetricians and Gynecologists of Canada will launch program to teach physicians breech vaginal delivery

from Globe Life Health and Fitness

by Carla Wintersgill

"Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.

"Released yesterday, the guidelines are a response to new evidence that shows many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first. Normally, the infant descends head first.

“Our primary purpose is to offer choice to women,” said André Lalonde, executive vice-president of the SOGC.

“More women are feeling disappointed when there is no one who is trained to assist in breech vaginal delivery,” he adds.

"Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

"As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

"The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

"With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

"The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

"News of the change is a boon for the Ottawa-based Coalition for Breech Birth.

“We're really, really pleased,” said Robin Guy, co-founder of the coalition.

"Ms. Guy started the group after the birth of her second child in the fall of 2006. Although she had given birth to her first child at home with a midwife, Ms. Guy delivered her daughter in the hospital because of the baby's breech position.

“I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her,” said Ms. Guy.

"The aim of the coalition is to ensure that women know what their options are when it comes to breech birth. Ms. Guy believes that many women don't realize that vaginal breech births are even possible.

“Educating women is our primary goal because it takes more than just a guideline change,” she said.

"The SOGC stresses that because of complications that may arise, many breech deliveries will still require a cesarean section.

"Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.

"The new decision to offer vaginal breech birth aligns with the SOGC promotion of normal childbirth – spontaneous labour, followed by a delivery that is not assisted by forceps, vacuum or cesarean section. In December of 2008, the society release a policy statement that included its recommendation for a development of national practice guidelines on normal childbirth.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

"Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

"The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

"The national average for babies delivered via cesarean section in Canada is 25 per cent."

Cesarean Birth and SIDS

If you or someone you know is considering scheduling an elective c-section, you should know that:

"Studies have shown that infants born through elective cesarean section may be at greater risk for SIDS."

RT for Decision Makers in Respiratory Care: Cesarean Birth and SIDS

The above article cites several studies that have been done about cesarean section and SIDS, and there are some alarming findings. I'll list in a nutshell what I consider key information from the article:

What is an Elective Cesarean Section?

"A mother may undergo cesarean section electively or as the result of an emergency. In an elective cesarean section, no labor takes place. This option may be chosen for several reasons, such as to avoid the risk of labor-induced uterine rupture if a mother has undergone previous cesarean sections; as a personal lifestyle choice; or if mother has tocophobia (severe fear of labor). An emergency cesarean section, on the other hand, takes place after labor has begun. It is performed in cases of fetal distress; prolonged, unprogressive labor; breech birth; or if the mother’s life is in danger."

Why is there a higher risk of SIDS for babies born via elective c-section?

"Because of the suspected role of sleep apnea in SIDS, infants are considered at greater risk for SIDS if they have symptoms of (sleep) apnea. These respiratory alterations are more pronounced if the infant is delivered by an elective cesarean section" because of two main factors:

• Gestational age at the time of birth. Elective cesarean sections are more likely to be done at 38 to 39 weeks gestation, whereas emergency cesareans are more often done at 40+ weeks gestation. The gestational age has an impact on the infant's respiratory health. Babies that are born before 40 weeks are more likely to have respiratory problems, which can cause sleep apnea, increasing the risk of SIDS.
  
• Compression. In an elective cesarean there is no trial of labor, so the baby doesn't experience any contractions. In labor the contractions have been found to compress on the baby's body in such a way that it prepares the infant's lungs for breathing outside of the womb. Babies delivered by c-section with no labor contractions don't have this vital preparation. The article details a study done on baby rats in which they tested the impact of compression on respiratory health, and the findings are clear that compression is very important.
  

I'll share some of the facts from the rat study involving compression:

• The group of rats that were given compression initially had 5 breaths/min and it increased to about 20 breaths/min during the hour in which this group of rats were observed.
• One group of rats that were not given any compression (but had cooling) had a significantly reduced respiration rate immediately after birth (about 1–2 breaths/min) and had a smaller increase in the rate of respiration to about 3–4 breaths/min by 1 hour. The other group that had no compression (but had cord clamping) all died within an hour of observation.
• In one group of rats that had no compression only 23% of the rats were breathing by 1 hour.
• In the groups of rats that involved compression, 100% of the rats were breathing by 1 hour.
  

What can you do to lower these risks?

• Avoid an elective cesarean section. Plan to birth your baby vaginally, if possible. If you do plan to have a c-section, you may want to consider doing a trial of labor by allowing your body to labor and experience contractions and give the baby important compression before the surgery is performed. According to the article, "even a short duration of labor seems to stabilize a neonate’s respiration after birth."
• Schedule your cesarean section at 40 to 42 weeks gestation. This will give your baby more time for the lungs to develop properly before birth.
• Send your infant to the NICU if your baby was delivered by elective cesarean. This would likely be a decision made by your care giver, but it could improve the baby's chances of survival because respiration patterns could be closely monitored and periods of apnea avoided through the efforts of NICU workers.
  
• Use a home apnea monitor on the infant if your baby was delivered by elective cesarean. "Ideally, an apnea monitor could prevent an infant’s apnea from progressing to SIDS. The monitor sounds an alarm if it detects a prolonged episode of apnea, hypoxia, or bradycardia, at which point parents can arouse their infant or do cardiopulmonary resuscitation if necessary."

The article also states that more studies are needed on this subject, and I agree.

CDC Says Cesarean Triples Neonatal Death Risk

The following article offers some surprising facts about cesarean section increasing the chances of neonatal death, regardless of the risk factors of the mother and baby:

July 29, 2009, by Misha Safranski

"While the increased risks of cesarean section to neonatal and maternal health have long been known, an even more grim issue came to light in a study released in the September, 2006 issue of Birth Journal. The CDC conducted research on cesarean section and neonatal mortality, expecting to find that the neonatal mortality rate (defined as death within the first 28 days of life) following cesarean section correlated directly with medical complications of the mother and baby. What they found, instead, was that regardless of risk factors, babies born by cesarean section face a risk of death nearly three times that of vaginally born babies.

"MacDorman, et al. analyzed national birth and death data for 5,762,037 live infants and 11,897 neonatal deaths, for the years 1998-2001. The purpose of the study was to examine the neonatal outcomes of primary cesarean delivery in women who had no other known complications or medical risk factors. The logical result of this examination would seem to be comparable neonatal mortality rates among cesarean and vaginally born infants. In fact, what the results show is that cesarean independently raises the risk of neonatal death by almost three-fold - .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies.

"Even more astounding than the simple fact that cesarean section raises the risk of infant death - regardless of the reason the cesarean was performed - is that even when the researchers adjusted for sociodemographic, medical and congenital factors, and removed infants with APGARs under 4, the risk of death was only reduced "moderately". A stark difference in the death rates between cesarean born infants and vaginally born infants remained even with no medical explanation.

"We aren't talking about babies dying from the few, rare complications that can arise in childbirth. We're talking about healthy, low-risk mothers electing for a primary cesarean section with no medical indication resulting in a nearly three times higher rate of death than those who have a vaginal birth.

"According to Marian MacDorman, the CDC's study leader, "These findings should be of concern for clinicians and policymakers who are observing the rapid growth in the number of primary Caesareans to mothers without a medical indication."

"While the findings of this research on cesarean and neonatal mortality were reported by major media outlets upon its release, publicity for the issue quickly waned. It is evident that care providers and mothers have continued to discount the disturbing results of the CDC study on neonatal mortality and cesarean, as the rate of surgical delivery has continued to climb to a record-breaking high of 31.8% in 2007, up from 31.1% in 2006.

"The World Health Organization recommends no more than a 10% cesarean rate in developed countries, based upon research indicating more harm than good to both mothers and babies when the cesarean rate tops 15%. Until mothers and obstetricians start taking the risks of elective cesarean section seriously, we will likely continue to see tragic consequences of the interference of surgery in childbirth."

Click here to access this article on Associated Content

BOBB Newsletter, Including News from Brazil with 93% Cesarean Rate for Middle Class Women

I know I post about The Business of Being Born a lot, and it's because they are doing such wonderful things in advocating birth options and education for women. Their film is part of what has motivated me to be so active in this pursuit. They have released their most recent newsletter. To go directly to the newsletter, click HERE. There is a ton of new information, and you should take a moment to see what's going on.

The most interesting part of the newsletter for me is the report from Abby's trip to Brazil. Most industrialized countries have a c-section rate of about 30%, which is astronomical considering that only as much as 15-20% of births have a medical indication for c-section. Brazil, as a whole, is extremely baby and family-oriented, so it's incredibly surprising that in Brazil's middle and upper classes the cesarean rate is about 93%! Abby's report gives some interesting information about why this is, and contrary to popular belief it's not the doctors that are pushing for the surgeries; it's the women. Please take some time to read it, and let me know what you think!

Study: Elective C-section babies born before 39th week face risks

You learn something new every day. At least, I do, and I like it that way.

I just learned today that babies born via Cesarean Section are more likely to have respiratory problems compared to babies born vaginally. A recent study tracked more than 24,000 women who had repeat c-sections performed at 37 weeks or later. Of those women, 13,258 had elective c-sections, meaning it was simply by choice with no medical basis for the surgery. Some of the main points of the study are:

• Over one-third of women are having elective repeat Cesareans. This is a significant number.
  
• Delivery just 3 or 4 days before 39 weeks led to increased complications.
• Respiratory problems are more likely with repeat c-sections, as well as other complications, particularly when the surgery is done before 39 weeks or after 40 weeks gestation.
• Parents and Doctors should wait until the 39th week to deliver via repeat elective c-section, and no later than the 40th week.

If you'd like to read the article yourself, please click on the link in the top paragraph. I found this article through another blog.