It's hard to believe that mortality rates among mothers are on the rise in 2010, but this piece by ABC News (sent to me by Bonnie Petrie of Pea in the Podcast) claims exactly that. Research suggests the rise in planned c-sections are a factor, given that cesarean birth involves a higher risk of infection. Additionally, new findings by Amnesty International suggest that African-American women are four times more likely to die in childbirth than white women.
Cesarean sections make up nearly one-third of all deliveries in the United States-twice as high as recommended by the World Health Organization. African American women have the highest c-section rate of any group. The risk of death following c-sections is more than three times higher than for vaginal births.
To compound the problem, multiple c-sections put mothers at risk for internal bleeding, yet many hospitals have bans against VBAC, or vaginal birth after cesarean.
Last week, the National Institutes of Health met to discuss that very topic, and came to the conclusion that hospitals should lift any bans on VBAC. Web MD covered the panel discussion and suggests that women, given the option, can have a successful vaginal delivery after a prior c-section.
Last week, the National Institutes of Health met to discuss that very topic, and came to the conclusion that hospitals should lift any bans on VBAC. Web MD covered the panel discussion and suggests that women, given the option, can have a successful vaginal delivery after a prior c-section.
About 75% of women succeed in having a vaginal delivery after previous cesarean delivery, assuming that it's not a multiple birth, that the baby is in the normal position, and that their previous C-section required only a single incision.
According to the ABC report, the lives of mothers who deliver via c-section can be saved out of thin air. At Mount Sinai Medical Center in New York, nurses place an inflatable boot on recovering patients to help prevent blood clots that might otherwise cause them to suffer a stroke.
My daughter Adriana was born, much to my chagrin, via c-section after induction. Though my birth plan centered around the mantra, "Squat down, Squeeze it out, Wrap it up, Take it home," my body had other ideas. A few weeks after Adriana was born, I had the privilege of speaking at the March of Dimes National Communications Advisory Council Health Issues Luncheon, "Cesarean Section: Consumer Preference or Medical Necessity?" moderated by Gretchen Carlson. The other mothers I met that day all seemed to have some sense of regret about not having given birth vaginally, yet the doctors present suggested that scheduled (non-emergency) c-sections seemed to be growing in frequency. Have you had a c-section or a VBAC? Did your doctor address any concerns you had and how safe do you feel each procedure to be? Leave your thoughts and stories in the comments!
My daughter Adriana was born, much to my chagrin, via c-section after induction. Though my birth plan centered around the mantra, "Squat down, Squeeze it out, Wrap it up, Take it home," my body had other ideas. A few weeks after Adriana was born, I had the privilege of speaking at the March of Dimes National Communications Advisory Council Health Issues Luncheon, "Cesarean Section: Consumer Preference or Medical Necessity?" moderated by Gretchen Carlson. The other mothers I met that day all seemed to have some sense of regret about not having given birth vaginally, yet the doctors present suggested that scheduled (non-emergency) c-sections seemed to be growing in frequency. Have you had a c-section or a VBAC? Did your doctor address any concerns you had and how safe do you feel each procedure to be? Leave your thoughts and stories in the comments!Photo courtesy of the author, who is shown prepped for her c-section at Columbia Presbyterian in New York, NY.
8 comments:
Carolyn knows, I, too, had a c-section. I, too, hoped for a natural birth. I, too, suffer vague regret, though my c-section saved my daughter's life.
Yes, the c-section was necessary. However, the induction that led to it -- in my non-md opinion -- was not.
Doctors like inducing labor. They can schedule it for a convenient time. It often gives them a sense of control that nature is loathe to let go. Wanna have your weekend free? Schedule "Ms. Smith's" labor and delivery for Thursday at four. The drug is given, labor and delivery follows, and it's golf on Saturday.
Labor and delivery does follow, but very often, that delivery is via c-section.
The fact is, if your body isn't prepared to labor, it will not labor. There are many things that can give you some idea about whether your body will respond to induction drugs. Is your cervix soft, thinning and dilating? Where is your baby positioned in the pelvis? If your body is ready, than the push provided by pitocin, for example, may just do it for you.
If it's not -- and mine was not -- you may have a long and terrifying labor in which your cervix barely dilates and your baby is in near constant distress.
...and then you have a c-section. It's an emergency. You have to save your baby now. You have no choice.
Lots of moms-to-be jump at the chance for an induction, because by the time you reach the end of your pregnancy, you're sick of being pregnant and you just want to meet that person who has been kicking you. Yesterday. I totally get that.
But, barring medical concerns related to disorders like gestational diabetes or preeclampsia, you should think very carefully before leaping into an induction. It's not uncommon for a pregnancy to go beyond 40 weeks, and it's generally not dangerous.
Obviously, this is something that is as individual as each pregnancy, and these decisions need to be made with the input of each individual caregiver, but inductions are not the "natural" end to a pregnancy, even though it is more common all the time.
Natural labor is the natural end of pregnancy.
Thanks for talking about this, Carolyn. Important stuff...
BTW...if you have had a c-section and you interested in a vaginal birth after a c-section, I have much more information for you at Pea in the Podcast here...
http://peainthepodcast.com/podcast/labor-delivery-life-beyond/vbac-vaginal-birth-after-a-c-section/
I had a C-section after my labor (induced) stalled. It wasn't all that much fun having such a medical birth (from the beginning of labor I was plugged into a billion machines), but I healed quickly, had no trouble breastfeeding, and didn't feel like I'd "failed" or anything. I wanted a baby and I got a baby so I don't want to Monday-morning quarterback it!
Hey Ada - excellent point. I know what you mean. I felt the same way - my doctor said I had to have a c-section, so I had one, and that was that.
But, on to Bonnie's point - I was induced because I was 3 days overdue, my mother was boarding a flight and was expecting a baby when she got to me. In hindsight, I wish I knew that c-section delivery and induction were as related as they are. I would have paid for my mother to reschedule her trip for a shot at natural birth.
My first child was 10+ days overdue, and I agreed to have an induction which -- guess what?! -- didn't work. So after 2 days of that I agreed to a C-section. Second child, I'm 40 years old, I had another C-section. Docs didn't even want to consider a VBAC because of my age. In any case, both births went fine and my kids are very healthy, so I don't regret my C-sections at all. More to the point: Carolyn, you make such an important point about compression boots! After the birth of my son I wasn't given them, but I was after my daughter was born. (Had her at a much larger hospital, several years later.) The boots made such a difference in my ability to take care of her. After my son was born my feet swelled up to humongous proportions and I couldn't walk for days. It was horrible. I had no idea that the boots are such a life-saver -- but I will certainly be sharing that info with the pregnant mamas I know!
What a funny and informative post. I didn't know that the VBAC restrictions were lifted, and I laughed out loud at your mantra of a birth plan.
I was induced -because my water broke 5 weeks early-and had a vaginal delivery at a hospital for my first child. I had no birth plan but the only thing I told my partner was: make sure that the doctor double stitched me if I had a C section. I had read somewhere that a single layer of stitches in the uterus were what made VBAC's dangerous.
I did Monday Morning Quarterback my birth- it was pretty traumatic, but mostly because he was so early that I was completely unprepared and he was in the NICU for a few days. I had wanted it to be more "natural".
But I truly dislike this expectation that the most natural is the best way. I like that women have choices, and this lifting of the ban on VBAC's will give women more choices.
( I say this though I had my daughter at home with a midwife and was happy with that experience as a whole.)
No matter where or how you have a baby, it is painful and wild.
I'll interested to see if the VBAC recommendation changes lead to any changes in the maternal mortality rate.
Thanks for your post, I'll definitely bookmark this blog!
When I said "natural labor", I wasn't necessarily talking about the choice to have an "unmedicated" birth. I was talking about labor triggered by by the as-yet-not-completely-understood process that begins when a baby signals to its mother that it is done baking. There are theories about how this process begins (do the baby's lungs produce a protein when they are 100% mature that kicks things off? That seems likely), and that is what I was referring to.
A woman's choice of labor pain management, whether it's some sort of relaxation technique, water, a birth ball, hugging your partner, a round of skip-to-my-loo, a wagonload of nubain, an epidural, or some comnination of all of the above, is solely her own. Every woman is different. Every labor and delivery is different. Everyone should certainly keep their options open.
When you have your baby safely in your arms you will know that every choice you made was the right choice for you. They might not have been the right choices for another mom. They might not be the right choices for you the next time.
But that time, for you, they were the exact right choices.
Great work, Carolyn! <3
Also, I think my first post was a little unkind to OBs. Most of them are wonderful, and care very much about their patients and their babies (and mine didn't golf lol). I think everyone is getting back to the idea that these are all decisions that should be made together, with all the cards on the table.
For example, I write about pregnancy and parenthood as part of my livelihood, and I was not -- until recently -- aware that these boots even existed. My c-section was only five years ago, in a fine hospital in a major metropolitan area.
This is a fascinating topic!
great piece - lots of thought food upon which to chaw.
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