raving_liberal
31 August 2009 @ 03:43 pm
(Another) study confirms homebirth's safety  
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD,
Robert M. Liston MD, Shoo K. Lee MBBS PhD

Abstract

Background: Studies of planned home births attended by
registered midwives have been limited by incomplete
data, nonrepresentative sampling, inadequate statistical
power and the inability to exclude unplanned home
births. We compared the outcomes of planned home
births attended by midwives with those of planned hospital
births attended by midwives or physicians.

Methods: We included all planned home births attended
by registered midwives from Jan. 1, 2000, to Dec. 31, 2004,
in British Columbia, Canada (n = 2889), and all planned
hospital births meeting the eligibility requirements for
home birth that were attended by the same cohort of midwives
(n = 4752). We also included a matched sample of
physician-attended planned hospital births (n = 5331). The
primary outcome measure was perinatal mortality; secondary
outcomes were obstetric interventions and adverse
maternal and neonatal outcomes.

Results: The rate of perinatal death per 1000 births was
0.35 (95% confidence interval [CI] 0.00–1.03) in the group
of planned home births; the rate in the group of planned
hospital births was 0.57 (95% CI 0.00–1.43) among women
attended by a midwife and 0.64 (95% CI 0.00–1.56) among
those attended by a physician. Women in the planned
home-birth group were significantly less likely than those
who planned a midwife-attended hospital birth to have
obstetric interventions (e.g., electronic fetal monitoring,
relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal
delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes
(e.g., third- or fourth-degree perineal tear, RR 0.41,
95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95%
CI 0.49–0.77). The findings were similar in the comparison
with physician-assisted hospital births. Newborns in the
home-birth group were less likely than those in the midwife-
attended hospital-birth group to require resuscitation
at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy
beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings
were similar in the comparison with newborns in the
physician-assisted hospital births; in addition, newborns in
the home-birth group were less likely to have meconium
aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to
be admitted to hospital or readmitted if born in hospital
(RR 1.39, 95% CI 1.09–1.85).

Interpretation: Planned home birth attended by a registered
midwife was associated with very low and comparable
rates of perinatal death and reduced rates of obstetric
interventions and other adverse perinatal outcomes compared
with planned hospital birth attended by a midwife
or physician.
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raving_liberal
13 August 2009 @ 01:02 pm
Atlanta Medical Center's mother-baby separation policy  
Atlanta Medical Center is currently beginning the process of trying to becoming the first Baby-Friendly hospital in Georgia – to this end, they would have to stop their current practice of mother-baby separation being encouraged by the neonatologist and the nurses. If you would like to see the mother-baby separation ended, please write to the Atlanta Medical Center and tell them how pleased you are that they are trying to become Baby-Friendly certified and how you hope they will implement policies and practices (such as keeping mothers and babies together) that help them reach this goal.

Here is the letter that I am sending using the contact form found here. Please feel free to use it or to modify it to your own needs:

I am writing to urge the Atlanta Medical Center to meet the goals necessary to become Georgia’s first certified Baby-Friendly hospital. By ending practices such as routine mother-infant separation, your facility could put itself at the forefront of encouraging breastfeeding success and providing an environment that serves to strengthen the important bond between new mother and baby. Keeping mothers and infants together during the first days after birth is vital to the establishment of the breastfeeding relationship. The Atlanta-area’s extensive birth and breastfeeding advocacy communities strongly encourage you to continue your efforts towards achieving Baby-Friendly certification and providing Georgia mothers with a positive, supportive option for maternity care.
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raving_liberal
08 July 2009 @ 03:29 pm
This is one (of many) reason(s) to stay home  
This article on the Unnecesarean blog has to be one of the most disturbing things I have ever read about current trends in obstetrical practice in the United States.

"Pit to distress" - administering the highest possible dosage of Pitocin in order to deliberately cause fetal distress, with the intended outcome of cesarean section. This isn't something made up by one or two conspiracy-seeking natural birthers. She includes links to references in other articles, quotes from individuals with firsthand experience, and even a photocopy from Labor and Delivery Nursing text book addressing the issue (it says that "'pit to distress' is not an acceptable order. If a provider writes 'pit to distress,' notify your charge nurse or supervisor [...] At all times, you must practice to prevent harm.). This is a real phenomenon.

Read and be disturbed.
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raving_liberal
03 July 2009 @ 12:06 pm
C-Section Stress Could Alter Baby's Immune Cells  
http://news.yahoo.com/s/hsn/20090703/hl_hsn/csectionstresscouldalterbabysimmunecells
Thu Jul 2, 11:48 pm ET

THURSDAY, July 2 (HealthDay News) -- Babies delivered by cesarean section experience changes to the DNA of white blood cells, which might explain why they're at increased risk for immunological diseases such as diabetes and asthma later in life, Swedish researchers say.

"Delivery by C-section has been associated with increased allergy, diabetes and leukemia risks," Dr. Mikael Norman, a pediatric specialist at the Karolinska Institute in Stockholm, said in a news release from Wiley-Blackwell publishers. "Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life."

Norman and his colleagues analyzed blood samples from 37 infants taken just after delivery and samples taken three to five days after birth. The blood was analyzed to assess the degree of DNA-methylation in the white blood cells, which are a key part of the immune system. In DNA-methylation, DNA is chemically modified to activate or turn off genes in response to changes in the external environment.

The 16 infants born by C-section had higher DNA-methylation rates immediately after delivery than the 21 infants born by vaginal delivery, according to the report, in the July issue of Acta Paediatrica. Three to five days after birth, both groups of infants had similar levels of DNA-methylation.

Further research is needed to determine why infants born by C-section have higher DNA-methylation rates after delivery, the researchers said.

"Animal studies have shown that negative stress around birth affects methylation of the genes, and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress," the researchers wrote.

"We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery," they explained. "When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after delivery than before. This is different [from] a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb."
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raving_liberal
12 June 2009 @ 02:54 pm
AMA Resolution Would Seek to Label “Ungrateful” Patients  
AMA Resolution Would Seek to Label “Ungrateful” Patients

Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1)

The resolution complains:


“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”

“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).

If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients
• Use of these labels fails to recognize patients as competent partners with physicians in their own care
• Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion
• Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers

The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.



(1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients”

(2) Evidence-Based Maternity Care: What It Is and What It Can Achieve

(3) http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans

Resolution 710 text )
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raving_liberal
02 February 2009 @ 04:16 pm
Birth Safety as a Binary Condition  
"Your baby is healthy and that's all that really matters."

How many times have you heard it or some variation of it? How many times have you said it or something like it? A new mom is struggling to make sense of a traumatic or confusing birth experience, to come to terms with unplanned interventions, perhaps an instrumental vaginal delivery or cesarean section that she'd never imagined she'd have. When she expresses her sorrow over the loss of the birth she had hoped for, the beautiful event she'd imagined, too often the response is, "At least you have a healthy baby." Christy Fiscer's essay, "A Healthy Baby Isn’t All That Matters", addresses this troubling tendency to trivialize a woman's birth experience by implying she isn't grateful enough that her baby is "healthy" (which really equates to "not dead or noticeably damaged") or that she's selfish for wanting, let alone expecting, more from birth than to be treated like an insignificant baby-bearing vessel. Seeking meaning in birth outside of a "healthy" newborn is viewed as frivolous, and women seeking empowering birth experiences are portrayed as solely being out to prove something or expecting to "get a medal for going without drugs." There's no need for me to rehash in great detail something that Christy has already addressed so passionately and eloquently. The "healthy baby is all that matters" attitude is merely one facet of a larger flaw in how our culture views birth outcomes.

The other day, someone left a comment [which was deleted due to the comment's author, not the comment's content] on my essay about "bravery" not really being a factor in choosing a homebirth to the effect that, if maternal and neonatal mortality outcomes of homebirths and hospital are nearly identical, that neither hospital birth nor home birth was more or less dangerous. I found this to be an interesting interpretation of the Johnson & Daviss study. While it's true that outcomes in terms of mortality rates were nearly identical, what made the study relevant to my essay was NOT that it showed a difference in the number of deaths, but that the low rate of mortality in the homebirth group was achieved with significantly fewer interventions than that of the hospital birthing group. If safety is measured by number of deaths alone, I suppose this would indicate that neither hospital nor home is more "dangerous" than the other, but is "not a lot of people died" really all that we're going for?

When did "didn't die" become our only barometer for success in childbirth? Baby was born/extracted from womb, both mother and child survived, therefor all is well, regardless of whatever other steps may have been involved in that birth/extraction process, regardless of any long-term harm (or increase in risk) to the mother or child, and regardless of the way anyone feels about the experience. Mom and baby lived; most studies would consider that a positive outcome. From a purely statistical standpoint, the birth was a success. This is certainly how birth is judged in this country from an obstetrical standpoint, but are we really satisfied as individuals with this binary notion of birth wherein "bad" is defined only as "dead" and "good" is defined only as "not dead"?

If a living mother and child are all that is required for birth success (or if, indeed, a healthy baby is the only thing that matters) then yes, hospital birth is "just as safe" (or "equally dangerous" or "no more dangerous," choose whichever language you prefer). If you start measuring safety and success by something more than a binary "live or die" condition, however, then you find disparity in outcomes.

What do many homebirth advocates view hospital birth as dangerous? It's not because more women die in hospitals, or because more babies die in hospitals, but because the interventions performed in ever increasing numbers in hospitals can have a devastating effect on long-term physical and mental health. The increased likelihood of cesarean section for women giving birth in hospitals is a good example of what is perceived by homebirth advocates as a danger of hospital birth. Cesarean section is a major abdominal surgery. While some care providers like to present surgical delivery as "just another way to give birth," the reality is that the procedure introduces a host of new risks to mother, child, and future pregnancies. These risks are worthwhile if the cesarean section is necessary, as the World Health Organization says the procedure is for less than 15% of births, but the procedure is grossly overperformed in the United States. Can a woman who did not need a cesarean, but who was manipulated/pressured, legally forced, misled by care providers about the necessity of the procedure, or who experienced iatrogenic health complications (for herself or her baby) due to mismanagement or over-management of her birth, be said to have had a "safe" or "successful" birth experience, even if the immediate outcome of the surgery is that mother and child live?

Maternal mortality rates do not tell us if the mother who had a unneeded cesarean section went on to have more children (as cesareans can cause fertility problems). Maternal mortality rates do not tell us if she had other cesarean deliveries as a result of her primary c-section (as fewer and fewer doctors/midwives will attend VBACs and many insurance providers will not cover them), or what complications or outcomes came from that birth (as each additional cesarean section has increased risks over the previous cesareans). They do not tell us if she experienced uterine rupture during her VBAC or repeat cesarean as a result of scar tissue from the primary surgery (the risk of rupture for VBAC and repeat cesarean is nearly identical, at slightly less than 1%). They do not tell us if she experienced placental previa or accreta in later pregnancies as a result of her prior c-section (the risk of both is increased in women who had have c-sections). They do not tell us if additional surgeries had to be performed after birth to correct iatrogenic health conditions, such as damage to the bowels or bladder (rare, but possible). They do not tell us if she experienced post-traumatic stress disorder, postpartum depression, or sexual dysfunction (all more common among women who had unplanned c-section than women who had planned vaginal births or planned c-sections) as a result of the unexpected surgery. Maternal mortality rates don't tell us if the mother had difficulty breastfeeding (women who have c-section are less likely to breastfeed). The only thing that maternal mortality rates tell us is whether or not a woman died during or shortly after giving birth as a result of that birth. These rates say nothing about the dangers to a woman's long-term health, either physical or mental, that resulted from the cesarean section. These rates say nothing about the feelings of disappointment, guilt, confusion, anger, or fear experienced during or after the birth.

I could list every intervention more common in hospital births than homebirths and tell you exactly why I, as a homebirth advocate, feel the overuse and misuse of these interventions make hospitals a dangerous place for low risk women to give birth, but why beleaguer that point? The heart of the issue, for me, isn't to examine the individual interventions, or even the cumulative risks of the whole cascade of interventions, but to bring attention to how little a binary notion of birth location safety actually tells us about the safety of giving birth.

When a child is born, a new mother is made. The process of her making, the experience of her birthing, is a meaningful one. Statements like "a healthy baby is all that matters" marginalize the mother by implying that the she doesn't matter, that she is lacking in worth (either by comparison to her child or in general). Though every mother's primary concern is a healthy baby, the mother's own experiences are not suddenly made worthless or unimportant if that goal of a healthy child is attained. Defining birth outcome by whether or not the mother and her child lived is equally marginalizing of the mother, because this narrow definition doesn't allow for variations in personal experience, physical or mental health, non-mortal birth crises. This definition of birth success says that only life or death, not the process, has meaning, and that even if you were poked, prodded, injected, cut, dehumanized -- if you didn't die, well, you were actually "safe" the whole time. You were in no danger, because the end justified all the means.

I don't know about you, but I want more than that particular binary view of safety.
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raving_liberal
31 January 2009 @ 03:45 pm
"Brave" has nothing to do with it  
When hearing the news that I had my last baby at home and am planning to have this one at home as well, the first response from most people is, "You're so brave."

This has to be one of the most irritating things that people say to homebirthers. The implication is that birth is dangerous and that we are willing to take on a tremendous risk to do it anywhere but a hospital. It negates the research and planning that we've done to come to this decision. It makes the choice about balls, not brains. After all, homebirth is "dangerous." Hospital birth is "safe." Therefor, it must be bravado alone that would lead a woman to choosing such an option. Right?

In 2003, over 20% of women had their labors induced, with a rate closer to 40% in many hospitals, while that rate should not exceed 10% (and has remained at 10% in most industrialized nations). Inductions are approximately 5 times more likely among planned hospital births than planned homebirths. An 1999 American Journal of Obstetrics and Gynecology "Green Journal" review of 7000 inductions found that 3 out of 4 of the inductions were not medically necessary. Inductions are performed unnecessarily for estimated size of the baby (too large or too small), going past the estimated due date, amniotic fluid levels that are low but not critically low (correctable in nearly all cases by rehydration of the mother), rupture of membranes without immediate start of labor, the mother being dilated/effaced but not in active labor, or scheduling reasons on the part of the mother or care provider. Approximately 40-50% of inductions fail (depending on the induction method used and the mother's Bishop score), and most failed inductions end in cesarean section. Inductions increase labor pain and length, and create, among other problems, an increased risk of fetal distress, uterine rupture, and cesarean section.

But homebirth is "dangerous." Hospital birth is "safe."

Over 30% of women in the US have cesarean sections, while overwhelming research has led the World Health Organization to set an ideal standard rate of cesarean sections at 10-12%, with 15% being the rate where more harm is being done instead of good. Cesareans are performed at a similar rate across all risk groups, low to high. The cesarean rate for planned births at home or in an independent birthing center is approximately 4%. Cesarean sections increase the likelihood of maternal death by as much as 4 times, and have other immediate and long-term heath risks for mothers that include, but are not limited to, infection, bowel or bladder perforation, hysterectomy, future infertility, and increased risk of uterine rupture for future pregnancies. Risks for the baby include respiratory distress, fetal injury, prematurity (if result of schedule section or failed induction), and breastfeeding difficulties. Four of the greatest causes for the increase in cesarean section are overuse of interventions during labor, concern for malpractice/liability on the part of care providers, failed labor inductions, and "failure to progress" (labor not progressing fast enough or regularly enough for care providers).

But homebirth is "dangerous" and hospital birth is "safe."

The ACOG and AMA have both come out against homebirthing, calling it a dangerous trend and referring to it as a "fashionable, trendy, [...] the latest cause célèbre," and they paint a horrible picture of complications arising in low-risk pregnancies with no warning that cannot be handled anywhere but the hospital. Despite that, the most thorough study ever done on homebirth safety, Kenneth C Johnson and Betty-Anne Daviss's Outcomes of planned home births with certified professional midwives: large prospective study in North America, BMJ 2005;330:1416 (18 June), found that the outcomes of planned homebirths for low risk mothers were the same as the outcomes of planned hospital births for low risk mothers, with a significantly lower incident of interventions in the homebirth group. The Lewis Mehl Study of home and hospital births, which matched couples in each group for age, parity, education, race, and pregnancy/birth risk factors, found the hospital group had 9 times the rate of episiotomies and tearing, 3 times the cesarean rate, 6 times the fetal distress, 2 times the use of oxytocin for induction/augmentation, 9 times the use of analgesia/anesthesia, 5 times the rate of maternal blood pressure increase, 3 times the rate of maternal hemorrhage, 4 times the rate of infection, 20 times the rate of forceps use, and 30 times the rate of birth injuries (including skull fractures and nerve damage). Breastfeeding success rates are higher and postpartum depression rates are lower for planned homebirths.

But homebirth is "dangerous" and hospital birth is "safe."

The United States spends more per pregnancy/birth than any other country, the vast majority of women in the US give birth in hospitals, and yet the US's maternal death rate is the worst among 28 industrialized nations and the neonatal mortality rate is the second worst. The Netherlands, where 36% of babies are born at home, has lower maternal and neonatal mortality rates than the US. Denmark, where all women have access to the option for a safe and legal home birth, has one of the lowest maternal and neonatal mortality rates.

But homebirth is "dangerous," hospital birth is "safe," and Brutus is an honorable man.

I didn't choose a homebirth because I am brave. Bravery has little to do with it. If anything, I believe women who choose to give birth in US hospitals are the brave ones, because knowing what I know about our technocratic obstetrical system, I can't imagine voluntarily choosing an obstetrician and a hospital for anything but absolute medical necessity. My decision to homebirth wasn't made in a void, but based upon years of research. I wonder how much research the average woman puts into her hospital birth? Considering how many times I've heard someone say "I'm glad I was in the hospital because..." and then given as her reason a non-emergent situation (such as fetal size or nuchal cords), I'd say not that much.

Call me stubborn, because I wasn't willing to accept out of hand the culturally held belief that hospitals are safer. Call me an idealist, because I believe that birth can be a positive, safe, and empowering experience for child and mother. Call me a nonconformist, because I choose to birth at home in defiance of a powerful technocratic system. Call me outspoken, because I can't keep my mouth shut when I hear about yet another iatrogenic birth calamity. Call me a "birth nazi," because I believe it's the right and responsibility of every woman to educate herself about birth and take ownership of her birth experience.

But brave? Don't call me brave. "Brave" has nothing to do with it.
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raving_liberal
22 January 2009 @ 06:55 pm
Increase in severe obstetric complications may be caused by increase in c-section rate  
Severe Obstetric Complications on the Increase

By Serena Gordon
HealthDay Reporter
Wednesday, January 21, 2009; 12:00 AM

WEDNESDAY, Jan. 21 (HealthDay News) -- Although less than 1 percent of women giving birth experience severe complications, a new report shows the rate of such complications increased significantly between 1998 and 2005.

Problems such as blood clots, serious breathing difficulties, shock, kidney failure and the need for blood transfusions rose from 0.64 percent in 1998/1999 to 0.81 percent in 2004/2005.

"Our overall result was that morbidity rates for severe problems are low, but it's devastating when a mother has severe morbidity, and we did find that the trends were increasing," said study co-author Dr. Susan Meikle, a medical officer at the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Md.
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Results of the study were published in the February issue of Obstetrics & Gynecology.

Using national data, the researchers assessed births between 1998 and 2005, as well as whether or not there were recorded complications. In 1998, the data included almost 35 million births, while in 2005, there were more than 39 million.

The study found the incidence of severe maternal complications increased. The biggest jump occurred in the need for blood transfusions, which went up by 92 percent. The next biggest increase was in pulmonary embolism, which increased 52 percent during the study period.

"Pulmonary embolism is a complication associated with any type of surgery, and it's a high contributor to maternal mortality," Meikle said.

The percentage of women in respiratory distress after delivery jumped by 26 percent, and the rate of women who needed mechanical ventilation went up by 21 percent. The rate of women with kidney failure after delivery increased by 21 percent during the study period.

Meikle said the researchers found that the increase in severe complications wasn't related to rising maternal age, but that some complications, such as the need for a blood transfusion, blood clots and shock, may be associated with an increase in the rate of Caesarean deliveries.

"This is an interesting study, but the database isn't complete," said Dr. Robert Welch, chairman of obstetrics and gynecology at Providence Hospital in Southfield, Mich. For example, he said, the study doesn't separate those who have elective C-sections from those who have to have one after hours of hard labor.

Still, he noted, this study highlights that the risks of C-sections "sometimes get downplayed. It's often taken as just a step above natural childbirth, but it is a major abdominal operation that needs to be respected, and hospitals need to be prepared to deal with severe complications."

Meikle added that there was an association between obesity and pulmonary embolism (a blood clot that travels to the lungs), but that the link didn't reach statistical significance in this study.

A second study in the same issue of Obstetrics & Gynecology, also suggested that additional weight can create more problems during delivery. This study looked at more than 10,000 teen births and found that obese teens had more than a fourfold increased risk of delivering by C-section compared to their normal-weight peers. Obese teens also had four times the risk of developing gestational diabetes, according to the study.


SOURCES: Susan F. Meikle, M.D., M.S.P.H., medical officer, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Robert Welch, M.D., chairman, obstetrics and gynecology, Providence Hospital, Southfield, Mich.; February 2009, Obstetrics & Gynecology
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raving_liberal
19 December 2008 @ 03:16 pm
Birth By The Numbers  
"Unfortunately, history shows that advancements in the practice of medicine and surgery are rarely obtained in a thoroughly rational manner, but that a period of undue enthusiasm, or even of almost reckless abuse, usually precedes the establishment of the actual value of a given procedure."

John Whitridge Williams, pioneer of academic obstetrics
Author of Williams Obstetrics, the leading text in obstetrics for over 100 years


In Birth by the Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.





Learn more about the short film Birth By The Numbers here.
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raving_liberal
16 December 2008 @ 04:33 pm
A great quote from Dr. Marsden Wagner  
"Most of the present care system for birthing women in the Unites States is designed not to assist the mother but rather to control her.

Doctors control women with fear. They have succeeded in convincing the great majority of American women that they cannot safely give birth outside the hospital; that nearly half of them have uteruses that are non-starters and need to have labor induced or augmented with powerful drugs; that up to two-thirds of them cannot tolerate labor pain and must be made numb from the waist down with an epidural block so they cannot feel the birth of their babies; that one-third of them cannot push out their babies but must have it pulled out with forceps or a vacuum or cut out by C-section. When we try to make women believe that they can't give birth without the help of men, machines, and hospitals, we take away their confidence and their belief in their own bodies -- and with their confidence gone, any feelings of power and autonomy also disappear. Women in the United States have become victims of a medical vision of female reproduction, and that needs to change. The most effective way to avoid this medicalization of birth is to stay away from where it goes on -- the hospital."

from Born in the USA
Marsden Wagner, M.D., M.S.
Former Director of Women's and Children's Health, World Health Organization
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raving_liberal
19 March 2008 @ 06:37 pm
From [livejournal.com profile] anamatapia: Atlanta Hospital Statistics  
This is a listing of the birth centers at metro Atlanta hospitals. C-section rates are included.

And you wonder why I have such a low opinion of hospitals )

Northside's c-section rate is simply reprehensible. 36%!?!?! Jesus tapdancing Christ!

Incidentally, Dr. Marsden Wagner, former director of women's and children's health for the World Health Organization, says that a reasonable rate of c-sections for a nation is 5-10%; anything above 15% represents some fundamental flaw within the healthcare system, while anything below that increases the risk for poor fetal/maternal outcome. The current c-section rate for the United States is 32%. Some experts are predicting we will see a cesarean rate of 50% in our lifetime.

More reading on the subject:

Soaring C-Section Rate Troubles Doctors

Caesareans Rising: C-section Rates Have Been Steadily Increasing — and There's No Change In Sight.

Answers prove elusive as C-section rate rises