What are the REAL risks of a cesarean?

[AN EXCERPT FROM INA MAY’S GUIDE TO CHILDBIRTH .  Ina May is America’s leading Midwife, well educated and published author with an impeccable birthing record.]

“Most Americans are unaware that women ever die from cesarean operations, particularly when those surgeries are scheduled, rather than emergencies.  Only rarely is a tragedy like this covered by news media.  Most maternal deaths in the United States are kept secret from the general public.  Few people have any way of knowing that maternal deaths take place in hospitals or that unnecessary surgery can actually cause a death.  The twenty-first century began with the revelation from the Institute of Medicine of the National Academies of Science that roughly 100,000 people die from medical mistakes in the U.S. every year. Some of them -too many- are pregnant women.

Women can hardly make truly informed decisions when some of the most relevant information is not available to them.  How many know, for example, that cesarean section (including the scheduled kind) involves the following risks to women?

  • increase in hemorrhage requiring transfusion
  • hysterectomy for uncontrollable hemorrhage 
  • accidental cutting of the bowel, leading to peritonitis, possible colostomy, or death.
  • accidental cutting of the uterine artery
  • surgical trauma to bladder and ureters
  • increased postpartum infection, scar breakdown
  • scar pain, numbness
  • long-term severe back pain following epidural block
  • increased pulmonary embolism 
  • anesthesia mishaps, including paralysis and death
For future pregnancies the very real and underreported risks include:
  • decreased fertility
  • abdominal adhesions leading to bowel obstruction. This risk can happen irrespective of future pregnancy and can be fatal.  
  • increased tubal pregnancy
  • increased placenta previa (the placenta lies over the cervical opening)
  • increased placenta accrete (the placenta attaches too deeply into the uterine wall to separate normally, profuse and often fatal hemorrhage is the result)
  • increased placenta abrupt (the placenta is prematurely separated from the uterus, cutting off the baby’s only source of oxygen)
  • increased uterine rupture
When cesarean is elective with no emergency present, the woman’s chance of dying from the procedure itself is nearly THREE times that of nonsurgical birth….Dangers to the baby in these cases include:
  • accidental fetal laceration, which occurs in nearly 2% of all cesareans; in breech presentations the incidence rises to 6%
  • respiratory distress, a major cause of neonatal mortality; it is greatly reduced if the woman is allowed to go into labor prior to the C-section.  Most women who choose cesarean however do not labor at all, since scheduling the surgery is often a high priority for them and their obstetricians
  • accidental prematurity because the cesarean was performed too early.  Even repeated ultrasound scans do not rule out this possibility. 

“In no way can we improve a normal pregnancy and labor in a healthy woman; we can only change it, but not for the better” ~G.J. Kloosterman, Dutch OB and Professor in 1984

I am in no way suggesting that mothers who have a cesarean are of course going to suffer one of these consequences, or that it was even unnecessary. Remember to ask all the questions you can and do your research so you can really make an informed decision.  There are of course, true emergencies that require surgery, and thank God we have surgeons to perform them! But unfortunately the way our maternal health system is set up  in the US, we have a cesarean rate approaching 40% when the World Health Organization has called for a rate no more than 15%, and midwives like Ina May are delivery babies with a cesarean rate of 2% .  Something isn’t lining up with those numbers.  My heart breaks for the mothers and families that have become a statistic because of too many interventions, impatient and/or overworked physicians or midwives, misinformation, and fear of lawsuits.

(photo credit: http://crunchydomesticgoddess.com/2010/02/02/live-c-section-on-the-today-show/)

To eat or not to eat?

Check out this article in the American Journal of Nursing about the hospital practice of fasting for women in labor.  Read this if you plan to have your baby in a hospital- great information!

http://journals.lww.com/ajnonline/Fulltext/2011/10000/Preoperative_Fasting__Will_the_Evidence_Ever_Be.20.aspx?WT.mc_id=EMxj08x20111114xL4

(photo credit: http://www.nickyspur.com/lessons-from-a-36-hour-fast/)

Pop The Pills For Post-Partum Depression

I know, I know, consuming your placenta seems incredibly hippie and way too crunchy for you.  I get it.  I do.  BUT take a moment and think about it. Though I will admit there is not much (if any) in the way of randomized placebo research on placenta encapsulation or placenta indigestion postpartum, here are the list of benefits I have accumulated from various sources (books, websites, and personal stories):

  • Fights off Postpartum Depression
  • Can stop hemorrhage postpartum.
  • May increase breast milk supply.
  • May increase energy and fight fatigue postpartum.
  • Decrease likelihood of iron deficiency.
  • Decrease likelihood of sleep disorders or insomnia.

Placenta Benefits: Placenta for Healing.

San Diego Birth Network- could placentas actually give you more breast milk?

Two Doulas on a Mission: Placenta Info and Benefits. 

InJoyable Birth: Battling fatigue with placenta.

Colorado Springs PBi news report: Dealing with Post Partum Depression with placenta.

The Nest Chicago: Accupuncture and Chinese Medicine for PPD.

Taking it home from the hospital may be tricky, but not impossible.  If you plan to take home your placenta for encapsulation or to bury it, make sure to discuss this with your care provider and assign this job to someone before labor so they are able to retrieve it for you.
And don’t forget to consider delaying cord clamping to allow all of that precious blood (about 1/3 of the newborn’s blood ) to be pumped out of the placenta and into your newborn, as well as allowing the baby to continue to receive oxygen while learning to use their lungs for the first time!

Is a Fetal Monitor Helpful?

Check out  this article for detailed explanations about the different ways to monitor the baby in utero.

Many hospitals now require continuous fetal monitoring.  There are several ways the baby can be monitored, and you can ask to have intermittent monitoring.

This practice originated out of the belief that more monitoring=more successful births.  The philosophy was that you could detect fetal distress earlier.  However, what we’ve found is the opposite: more fetal monitoring=more cesareans and more complications.

There are several suspected reasons for this:
1) Continuous monitoring causes neocortal stimulation for the mother and therefore increased adrenalin and stress.  Having every move your body or baby makes analyzed and monitored by someone (from a nurses station down the hall) and a beeping machine next to you will increase the feeling of being tested and under surveillance.  This is known to inhibit the birth process and cause complications.

2) Hyper-villigance increases the chances of a false diagnosis of fetal distress, resulting in unnecessary interventions.

3) There may be insufficient reading of monitor output.  However, many hospitals have required increase in education for reading the fetal monitors and this has not significantly increased any potential positive results from continuous fetal monitoring.

“We conclude that not all pregnancies, and particularly not those considered at low risk of perinatal complications, need continuous electronic fetal monitoring during labor.”

N Engl J Med. 1986 Sep 4;315(10):615-9. A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies.


Reasons you MAY want fetal monitoring: 
1) You are a high risk pregnancy with many complications.

Types of Fetal Monitoring: 
1) External Electronic Fetal Monitor:
Straps around your belly- one for the fetal heart rate and one to measure contractions.


2) Internal Fetal Monitor:
A probe is screwed into the infant’s scull in utero.

3) Doppler:
This is the monitor that you will see most midwives use.  It is handheld and external and can be used intermittently and underwater for water births.



Don’t forget you always have choices.  Exercise your right to informed consent ladies!

IF it is required, according the Labor Progress Handbook, Early Interventions to Prevent and Treat Dysotcia, 3rd Edition, Penny Simkin, Ruth Ancheta.  There are  ways to move even with fetal monitoring.  Moving is very important in labor for pain relief and successful birth.

TRY THIS:

1) Slow dancing

2)Washcloth used to press monitor firmly in place while standing.
3)Squatting with scalp monitor in place.

Resources:
 

 

American Journal of Obstetrics and Gynecology [1978, 131(5):526-32]
 

The Labor Progress Handbook, Early Interventions to Prevent and Treat Dystocia, 3rd Edition, Penny Simkin and Ruth Ancheta

 
 
 
(photo credits)
http://online.birthandbabies.com/classes/105-medical-procedures-and-medications-in-labour/pages/3-medical-procedures-during-labour/

 http://www.oursbiz.com/Company/94777/Fetal_Monitor_Btd_2030.aspx
http://www.thepregnancyzone.com/pregnancy-tools/fetal-heart-monitor-a-device-used-to-hear-your-babys-heartbeat/
http://www.childbirthconnection.org/pop.asp?ck=10439
http://www.aafp.org/afp/1999/0501/p2487.html

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