Prevent Cesarean Surgery

Information about the risks of c-sections to both mother and baby.

Including quotes from women who have had both cesarean and vaginal birth.

Favorite Recent Pregnancy/Birth Links

I post a lot of web links on my Mamas and Babies facebook fan page, but I often forget to pass the information on here. I think it's important to share as much information as possible, so I'm bringing you some of my recent favorite web links related to pregnancy and birth.

These are in no particular order:

• The Unnecesarean: U.S. Cesaren Rate Reaches Record High, Rises for 13th Consecutive Year - The Cesarean rate for 2009 was 32.9%, up from 32.3% in 2008. The rate continues to climb despite cesarean birth carrying greater risks to mothers and babies in comparison to vaginal birth.
• As early elective births increase so do health risks for mother, child - Babies are being born earlier than they were 10 years ago, thanks to elective inductions and scheduled c-sections. This carries multiple serious risks to mothers and babies. Do you know what the risks of delivering even a week early could be?
• Motherhood: Induced and Seduced: The Dangers of Cytotec - A drug commonly used for labor induction which hasn't even been approved for such use by the FDA, and it carries great risks with it. Why is it used so often? It's cheap.
• C-sections up, overall births down in 2008 - As the cesarean rate increases, the overall birth rate drops? Why do you think this is?
• Pre-Holiday Induction of Labor Without Medical Indication - Some striking statistics about labor patterns through the major holidays of the year. Some food for thought when your doctor or midwife suggests scheduling your child's birth.
• Early skin-to-skin contact after birth: the more the better - A post from Stand and Deliver covering a recent study proving the increased effectiveness of early skin-to-skin contact within the first 3 hours of birth. The more contact, the better the results. 
• A proactive approach to breastfeeding - Another post from Stand and Deliver, about approaching breastfeeding prepared. Taking a proactive stance rather than reactive. Especially good information for first-time mothers or those planning to breastfeed for the first time.
• Everything you ever wondered about breastfeeding during pregnancy, but didn't want to ask... - A straight-forward FAQ style blog post about breastfeeding while pregnant and tandem nursing, from a mom who's been doing it for years.

Happy surfing!

Cesarean and VBAC Resources and Links

I've got a few links to share on the topic of c-sections and vaginal birth after cesarean (VBAC).  I'm not going to comment much, because I'd like you to read them and decide what you think.  Please feel free to post your opinions or questions in the comments below.  Here goes:

• Prepare Mothers and Fathers for Cesarean Birth: Should cesarean education be a part of all prenatal education?
• Unnecessary C-sections on the Rise
• Rate of C-sections in the US is 'Undeniably High,' Doctor Says
• Cesarean Rates in Women of Size:  Are heavier women more likely to have a c-section?
• Special Scars - Special Women:  For women who have had a cesarean.  The creator also has a facebook page and Yahoo group for the same purpose.
• Labor Deemed Good for Women
• VBAC or Repeat C-section:  I found this through Jill on The Unnecesarean.  She said it's her favorite resource on the topic.
• A Woman's Guide to VBAC: Putting Uterine Rupture Into Perspective:  Comparing the risk of uterine rupture alongside other potential birth risks.
• A Woman's Guide to VBAC: Navigating the NIH Consensus Recommendations
• VBAC After 2 Cesareans: Distorted Risk Perception: Are doctors making this out to be more dangerous than it actually is?
• Bill Gates and Robot Cesareans: Are c-sections routine enough to be performed by robots?
• Every Bit as Magical:  The "natural c-section".  Can cesarean birth rival vaginal birth and be just as beautiful?  Should we try to make it that way?

Obesity and Cesarean Section

A recent blog post on The Unnecesarean sheds some light on the connection between obesity and cesarean section:

Obesity Causes a Rise in... Articles about the Cesarean Rate

The post is partly in response to a New York Times article:

Growing Obesity Increases Perils of Childbearing

The Unnecesarean post also cites a really good blog post on The Well-Rounded Mama:

Exaggerating the Risks Again

For a nice overview of the topic, read the post on The Unncesarean, and if you want more info, read the other two as well.

In a nutshell, this is what I learned:

• Obese women are more likely to have a cesarean because of the increased risk of pregnancy complications like Gestational Diabetes and Pregnancy Induced Hypertension (AKA Preeclampsia).  How much?
• According to The Well-Rounded Mama, 90% of obese women will NOT experience GD or PIH.  The risk for GD in morbidly obese women (BMI over 35) is 9.5%, compared to 2.3% in women with a BMI less than 30.  The risk for PIH in morbidly obese women is 6.3% compared to 2.1%.

Jill from The Unncesarean also points out that these aren't the only reasons obese women are more likely to have a c-section compared to other women, and that journalists should write about the reasons and heart of the matter rather than simply sensationalizing the trends.


I personally have a hard time seeing how these complication risks can warrant the current US overall cesarean rate of 33%.  Something to think about.

The Real Risks of Pitocin

This article has been going around the internet like wildfire! I've read a lot about pitocin, but I never realized everything that was involved with its routine use, or the real risks. All expectant parents need this information.

"Pitocin – a very useful drug that improved obstetrics and gave us options to help women in ways we weren’t able to before!

"Pitocin – a very seductive drug that changed obstetrics, increasing risks to mothers and babies in ways that are often not even taken into consideration.

"Both of these statements are true – how can that be? I will do my best to explain this complex issue in a simple and straight forward way. Be warned…much of what you are about to read will probably be new to you because these are the things that aren’t being talked about!"

"Pitocin is a drug used to induce or augment labors here in the US. It is most often given via IV infusion, although immediately postpartum if an IV isn’t already in place it may be given as an intramuscular injection. It was created for the first time in 1953 and became available just 2 years later. Mothering magazine writes, “A survey by Robbie Davis-Floyd, a cultural anthropologist at the University of Texas, found that 81 percent of women in US hospitals receive Pitocin either to induce or augment their labors.” It has been said that only 3% medically require it." (emphasis mine)

I could copy the entire article into this post, but it would be better for you to read it at the source. Please read this important article about the real risks of pitocin:

Pit of Despair

Dangers of Disposable Diapers

Disposable diapers are filled with chemicals that help keep the diapers drier and enable manufacturers to make them thinner and lighter. Pampers new Dry Max diapers are thinner and lighter than any other Pampers diapers, but they are possibly causing chemical burns on infants. Ouch!

Incidentally, it's because of these chemicals that it takes 500 years for a single disposable diaper to decompose. Ew!

Yet another reason I'm glad I use cloth diapers.

Epidural Procedure Photos

Have you ever wondered what the epidural procedure looks like?

Patti Ramos, Photographer, Birth Educator and Doula, has posted photographs of the epidural procedure on her website

It's really interesting and can be helpful in educating yourself about epidural anesthesia.

I've also posted in the past about epidurals:

Epidural: Procedure, Benefits and Potential Risks

It's important to educate yourself so you can make an informed choice in the birth of your baby.

New Moms at Risk - Maternal Death Rates Increasing

Maternal death rates are on the rise, and it's getting some well-deserved attention. In our world of modern obstetrics with advanced technology, one would think that fewer mothers would be dying during or after childbirth, but the opposite is true.

It's Now More Dangerous to Give Birth in California Than it is in Kuwait or Bosnia

That article caught my attention. It was a bit shocking to see the statistics and realize the real impact this is having on real mothers and their families.

According to the statistics from California, the increase in mothers dying is the result of the overuse of interventions such as c-sections and medical induction.

C-section rates are higher than ever. The US has an overall c-section rate of about 33%, with hospitals in some areas boasting rates close to 50%. That means that in the United States, 1 out of every 3 babies is born by c-section. The World Health Organization recommends a safe c-section rate for developed countries (like the United States) is 10-15%. They also state that when the c-section rate is more than 15% the risks outweigh the benefits and more mothers and babies are at risk for complications. Complications that are completely avoidable.

Amnesty International is concerned and advocating for changes in maternal health care:

"According to Amnesty, which gathered data from many sources, including the Centers for Disease Control and Prevention, approximately half of the pregnancy-related deaths in the U.S. are preventable, the result of systemic failures, including barriers to accessing care; inadequate, neglectful or discriminatory care; and overuse of risky interventions like inducing labor and delivering via cesarean section. 'Women are not dying from complex, mysterious causes that we don't know how to treat,' says Strauss. 'Women are dying because it's a fragmented system, and they are not getting the comprehensive services that they need.'"

"In the U.S., we spend more than any country on health care, yet American women are at greater risk of dying from pregnancy-related causes than in 40 other countries."

(Amnesty International Report on U.S. Maternal Health)

ABC has reported about the statistics in California and brought some much-needed attention to this problem. One thing they recommend in this video: avoid unnecessary interventions during pregnancy and birth. This means avoiding induction, scheduled c-sections and other interventions unless they are medically necessary.

What do you think? What else can women do to protect themselves from the dangers of overaggressive obstetrics?

Preventing Preterm Labor and Birth

Preterm labor and preterm birth are increasing dramatically in the United States, and we don't really know why.

"A preterm baby has a 120 times greater risk of death than a baby born full term, and survivors are at risk of breathing difficulties, bleeding into the brain, and having a significant neurological handicap such as cerebral palsy."

"Preterm birth costs the United States $26 billion per year. It is one of the most serious and significant challenges to medicine and society and one whose importance is not fully recognized,"

This article discusses findings that genes in mothers and babies can predispose them to preterm labor:

Genes in Mother, Baby Raise Risk of Preterm Birth

The risk is not completely genetic. "'We have established that one of every three premature babies is born to a mother who has an intra-amniotic infection,' an infection in the normally sterile amniotic fluid that surrounds the developing fetus."

Even expectant mothers who are genetically predisposed to preterm labor can take precautions to stay healthy and low-risk through a healthy lifestyle and diet, including plenty of fresh whole foods and lots of vegetables that contain vital enzymes to aid in proper digestion. This will help ensure that the mother will stay free of infection and reduce her risk of having preterm labor.

Sleep-Training NOT for Breastfeeding Mothers

Breastfeeding on demand and co-sleeping are some things that I have found, through trial and error, work very well for me and my children. When I do these thing my babies sleep through the night pretty well even from birth. This is not to say they don't wake up to eat at night, but nighttime feedings are much easier and more peaceful and we're able to get back to sleep quickly without even waking up completely.

I've tried having my baby sleep in a separate bed in another room, and I've tried sleep training. There is a quote that helps describe my feelings about it:

"Use discernment about advice that promises a sleep-through-the-night more convenient baby, as these programs involve the risk of creating a distance between you and your baby and undermining the mutual trust between parent and child. On the surface, baby training sounds so liberating, but it's a short-term gain for a long-term loss."

This is from an article on Ask Dr. Sears about it: SLEEP-TRAINING – NOT FOR BREASTFEEDING MOTHERS

Poem: The Dangers of Pregnancy and Childbirth

This poem pokes fun at doctors and nurses, but there is also some truth in it.

The Dangers of Pregnancy and Childbirth

Author Unknown

You're risky if you're big

You're risky if you're small

You're risky if you have 5 kids

Or if you've none at all

You're risky if you're young

You're risky if you're old

You're risky if the weather's hot

And also if it's cold

It's risky with a midwife

It's risky on your own

But with half a dozen strangers

You'll have no need to moan

You have to be in bed

Cause it's risky in a pool

If you don't get out to push

You really are a fool

In fact, we'd better cut you

It won't come out "down there"

We OBs always know what's best

If you refuse, BEWARE:

Your child will be disabled

That's if she doesn't die

You'd best believe me dearie

Cause OB's never lie

So be a good girl now

And just do as We advise

[whispered aside]

We'll have her done in time for golf

If only she complies

Epidural: Procedure, Benefits, and Potential Risks

The most common form of pain medication used in childbirth in the United States is the epidural block. Despite its widespread use, I strongly feel that the majority of pregnant women in the United States are not properly educated about the use of an epidural block. Here is some information that every woman should consider when deciding whether or not she will choose an epidural in labor.

How an epidural is done:

• The drugs used in an epidural are usually a combination of an anesthetic (like bupivacaine) and a narcotic or opioid (like fentanyl). Dosage depends on the anesthesiologist performing the epidural.
  
• The mother must have an IV line to ensure adequate fluids.
• Constant monitoring of the mother's blood pressure and baby's heart rate is needed.
  
• The mother is placed on her side or sits up and leans forward to receive the epidural.
• The anesthesiologist cleans the lower back area.
• A local anesthetic is given and then a hollow epidural needle is inserted between two vertebrae into the epidural space, just before the membrane that covers the spinal cord.
• The mother usually feels pressure.
• A test dose of the medication is usually given to ensure proper placement and effectiveness of the epidural.
  
• A thin, plastic tube called an epidural catheter is threaded through the hollow needle into the epidural space and the needle is removed.
• The catheter is taped to the mother's back.
• Generally each contraction will get easier, and the mother will begin to feel pain relief in about 10 to 20 minutes. Her legs may feel warm or tingly and may feel heavy.
• The lighter the epidural dose, the more control the woman will have to move her legs and the easier it will be to change positions.

Advantages to using an epidural:

• Allows the mother to stay alert throughout labor and delivery.
• The baby is less medicated compared to if an IV narcotic is used.
• The mother can rest during a long labor.
• Can provide pain relief, particularly when labor is induced with pitocin.

Potential side-effects of an epidural:

• The woman's ability to move around or change positions may be limited. She is generally restricted to the bed.
  
• The medication may cause an erratic fetal heart rate. Local anesthetics cross through the placenta.
• Drugs can cause various degrees of maternal, fetal, and neonatal toxicity.
• May slow down labor (particularly if given before 4-5 cm dilation).
• May increase the possibility for use of pitocin.
• May make it hard for the mother to push the baby down. Some women don't feel the urge to push at all when they have an epidural. This is generally related to how strong the epidural is.
• May increase the likelihood of the use of forceps or vacuum extraction.
• May cause a fever in the mother when used for long hours.
• May make it more likely the newborn will be screened and treated for infection.
• Some mothers experience nausea, vomiting or itching when epidural narcotics are used.
• May cause short-term urinary incontinence, and a bladder catheter may be inserted into the mother. A full bladder will generally slow the progress of labor.
  
• Delayed fetal rotation and descent.
  
• Spinal headache if the epidural needle goes in too far (if it punctures the spinal space). This is usually a severe, debilitating headache that can last for a couple of weeks. A blood patch can be done to help repair the damage and alleviate the headache.
• Postpartum backache.
• Possible long-term paralysis. This is more rare than other side effects, but it can happen. I have a friend who experienced a numb spot in her leg for several months after having the epidural.
  

Click here to see photos of the epidural procedure by Patti Ramos

This information was paraphrased and compiled from An Epidural for Pain Relief: Making an Informed Choice by Nicette Jukelevics, MA, ICCE and Pregnancy, Childbirth and the Newborn by Penny Simkin, PT, CD(DONA). For more in-depth information about the risks and benefits of epidurals, please also see The Thinking Woman's Guide to a Better Birth by Henci Goer.