Family Wellness First
The E-newsletter for Parents to make Informed Health Care Choices
Issue 3: C-Sections
Elective C-Sections: the Cutting Edge of Modern Maternity Care
The alarming rise in the c-section rate internationally has been receiving much press. From the obstetric point of view, c-sections are managed easier than a natural vaginal birth, decrease malpractice claims, are easier for scheduling and bring in higher monies. Unfortunately this perspective has now influenced many mothers to choose a c-section over a natural birth even without any medical justification! The imposed benefits are influencing more and more women and the elective c-section rate is rising dramatically.
Although "Most doctors agree on two important points: Vaginal births, as well as VBAC, are safer than a C-section, and 70 percent to 80 percent of women attempting a VBAC do so successfully", Dr. Benson Harer, 2000 president of the American College of Obstetricians states his personal opinion that even though there are problems with c-sections, women should be given the information and allowed the choice for elective c-section. Marsden Wagner, MD, former director of Women's & Children's Health for the World Health Organization strongly argues that if you really study the scientific literature carefully, you can see the truth. Additionally, "there is no scientific evidence that doing over 10 percent of births with a cesarean improves the outcome for the woman or improves the outcome for the baby."
Addressing the real motive, Dr. Wagner has this to say, "Anybody who thinks that those obstetricians that promote cesarean are promoting it because they suddenly discovered women's rights, well, I'm ready to sell some swampland in Florida to those people because that's extremely naive. Because there are compelling reasons why obstetricians prefer more cesarean. First of all, it means that there is convenience. You see, an obstetrician--the average birth is 12 hours, a cesarean is 20 minutes!"
View the entire transcript here:http://www.collegeofmidwives.org/news01/gma%20transcript00a.htm#Diane%20SAWYER
This informative article offers valuable insight into the debate as well.http://www.freep.com/news/health/vbac10e_20040810.htm
Most women are not aware of the problems associated with this surgical procedure and are simply choosing c-sections because they seem to be easier all around.
Women who undergo cesareans are at an increased risk of many complications compared with a natural birth. These include:
• Increased risk of mortality
• Infection to various organs including the uterus, bladder or kidneys
• Increased blood loss
• Increased risk of complications in future pregnancies
• Decreased bowel function
• Respiratory complications
• Longer hospital stay and recovery time
• Adverse reactions to anesthesia
• Risk of additional surgeries such as hysterectomy or bladder repair
One of the complications of a C-section that is hardly ever addressed is the problem that the resulting surgical scar has on the mother. It frequently blocks the proper flow of energy through the autonomic nervous system and seriously impairs her ability to stay healthy. Fortunately, this block is relatively easy to repair with a simple injection of procaine into the scar, however very few physicians are aware of this issue and do not check for it.
Cesareans also have a psychological effect on women. As written in “Having a Baby, Naturally,” which is an excellent resource for all mothers-to-be, “Most women who have cesarean sections reported that the experience was traumatic.” Women are also less able to care for the newborn immediately after childbirth and therefore may miss out on bonding opportunities. http://www.mercola.com/2003/sep/27/cesarean_section.htm
Making "Informed Choices" based on Myths and Fear
Women are led to believe that vaginal birth is more dangerous than a surgical procedure. They are often erroneously informed that their baby is too big or that vaginal birth will cause sexual and or incontinence problems. What they are not told, however is the documented truth that most babies are not too big and that the damage to their perineums in vaginal births are caused by the medical procedure: episiotomy.
From the leading OB/GYN test book we read that the assumption that most women's pelvises are not large enough to deliver their babies is a "tenuous diagnosis because greater than 2/3rds of women diagnosed and given c-sections deliver even larger infants vaginally on subsequent births."
As for the damage to the perineum causing sexual and or incontinence, these are largely due to the obstetric procedure of episiotomy, not tearing in natural birthing. In fact, most natural births attended by skilled midwives have a low incidence of tearing because of perineal exercises advised during pregnancy and perineal support in labor.
So unfortunately, when leaving the decision up to women as advised by some, myths rather than facts become the basis of choice.
Finally, there are those women who are told that once they have a c-section they must always have a c-section. There is a rampant fear of uterine rupture in subsequent deliveries even though the literature says otherwise. A recent editorial in BMJ says: Once considered unthinkable, vaginal delivery after a previous caesarean section remains a safe option for many women. Uterine rupture after c-section remains a rare occurrence.http://bmj.bmjjournals.com/cgi/content/full/329/7462/359?ecoll
Some of perinatal specialists believe that advocates of cesareans may be scaring women into believing that vaginal birth (not to mention natural childbirth) is more dangerous than it really is. "I've seen less and less confidence among women in their ability to give birth vaginally and more worry about what can go wrong," says Nicette Jukelevics, who is a childbirth educator in California and has served on many cesarean awareness committees, including ICEA.
Perinatal specialists who have been practicing for a while know that there is a pendulum that swings back and forth between the medical model and the non-medical model of birth. Ensure your clients get the best, most objective information you can possibly give them. Help them make decisions based on their knowledge of all alternatives. This will give them the confidence to keep normal birth normal and less of a surgical event.http://www.birthsource.com/proarticlefile/proarticle46.html
The ethical debate:
Conscientious OB/ GYNS are aware of these risks and there is controversy and concern within their profession about the right to choose a procedure not medically necessary, especially when the procedure poses greater risk for the mother and baby.
The Society of OB/Gyns in Canada has concerns expressed in this article: http://www.cbc.ca/news/background/csection_births/
The American College of Ob/ Gyns states there opinion as well: http://www.azstarnet.com/dailystar/printDS/30288.php
Get the Facts- Restore the Confidence:
Ask your Doctor of Chiropractic for birth care providers an support groups in your community who support the natural process of birth and offer the facts, not fears about natural birthing.
Visit our web site: http://www.icpa4kids.org/research/wellness.htm for numerous articles on pregnancy and birth to make informed decisions.
Visit our links page for additional associations that support the natural process of birth:http://www.icpa4kids.org/links/birth.htm
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