Maternal Mortality Rates Rising

"New Study Shows More Women are Dying After Childbirth, but Most Deaths are Preventable"

Full Text Here

According to the World Health Organization, the U.S. ranks behind more than 40 other countries when it comes to maternal death rates, with 11 deaths per 100,000 pregnancies when measured in 2005. More women die in the U.S. after giving birth than die in countries including Poland, Croatia, Italy and Canada, to name a few.

My first instinct is to loudly shout, "I told you so!!!", but I am going to refrain. At least for the moment.

The popularity of scheduled C-sections has also been cited by public health experts as a possible cause for rising maternal mortality rates. The latest data from the CDC shows that 31 percent of the mothers now choose to have C-sections, up 50 percent since 1996. Studies have repeatedly shown a higher rate of mortality in mothers who have a C-section delivery, especially those who have multiple C-sections. "If the risks of a Cesarean birth are small, they're magnified greatly when you add many more Cesarean births each year," said Main, adding that "not that many women actually choose to have an elective C-section at the beginning, but it's easy to fall into a pattern of care that ends up resulting in a C-section."

I'm really biting my tongue now. I mean, HELLO!!!!!! Where have the doctors been when the natural birth advocates are shouting - "NO, it's not JUST about OUR experience... it's about safety!"

And, it drives me crazy - because they aren't looking at ways to REDUCE the underlying cause - the cesarean - they are looking for better ways to warn and treat mothers AFTER they have the cesarean. While this is important, this DOES NOT solve the problem... or even ATTEMPT to solve the problem.

Essentially we're saying - "Hey, I know that your risk of dying is higher if you have this completely unnecessary elective cesarean, and even more so if you decide you want more children... but we'll just put some compression boots on your legs and let you know that if you feel funny, you should tell someone... and that will make it all better."

BULL!

Cesarean surgery is associated with 33 serious complications – a number 8 times greater that the risks of vaginal birth.

In comparison with vaginal birth, a cesarean increased harm due to:

- Death, related to surgery or anesthesia (rare)
- Emergency hysterectomy
- Blood clots and stroke
- Injuries from surgery
- Longer hospitalization
- Rehospitalization
- Infection
- Severe and long-lasting pain
- Ongoing pelvic pain
- Bowel obstruction (due to scar tissue and adhesions)

In comparison with cesarean, vaginal birth (both spontaneous and assisted with vacuum or forceps) increased harms due to:

- Perineal pain
- Any urinary incontinence
- Any bowel incontinence

The risk of maternal death 3 to 5 times greater during or after operative delivery.

We should be focusing on the cesarean rate, the induction rate, the rate of routine and unnecessary interventions to the normal labor and birth process...

But, now I'm moving on to a completely NEW post, and I will save that for later.

Induction Increases Cesarean Rate

REALLY? No... You must be joking.

Ok, so enough of my sarcasm and on with the facts...

To start with, here is the full text of the article.

NEW YORK (Reuters Health) May 15 - Elective induction of labor significantly shortens the active phase - by an hour, on average - but nearly doubles the risk of cesarean section, researchers report in the May issue of Obstetrics and Gynecology.

Did you get that, one hour. You are shortening your active labor time by one hour, and in return, you're doubling your chances of getting major abdominal surgery. What is the draw here?

Forgive me, I'm feeling annoyed about our skyrocketing induction and c-section rates. No, make that ANGRY.

With all this hot-air about health care reform and lowering health care costs... what on earth are we letting happen in Maternity Care? No matter how many studies are done, no matter the results.. nothing is changing. Studies have shown over and over that modern obstetrical protocols are causing more c-sections, more deaths and more bad outcomes than the traditional methods that midwives use.

This is NOT rocket-science people. Why is it so hard for us to understand that a c-section is not a minor, no-big-deal procedure? When are we going to start telling women openly , honestly that c-sections are major surgeries, with major risks, both for the current and in the future when that same woman gets pregnant again, and maybe again after that?

The induction rate MUST be addressed. It's insane for this many women to be consenting to inductions that are completely unnecessary.

You can wait another 2 weeks for your baby to be born. They will be healthier for it, and so will you... and so will the rest of the babies you have.

Tell me, which looks like more fun?

THIS ONE



OR

THIS ONE



Ok, rant done. Go ahead - call me the EVIL, ANTI-INDUCTION DOULA.

Just for FUN...

Jill at the Unnecesarean is having a contest! So, just for fun, I thought I'd throw in an entry.

When VBAC, meets CBAC...

VBAC = Vaginal Birth after Cesarean
HBAC = Home Birth after Cesarean
WBAC = Water Birth after Cesarean
CBAC = Cesarean Birth after Cesarean

For every woman there is an end to pregnancy. Yes, even for those women who's OB's told them they really would stay pregnant forever if they didn't do X, Y or Z. It's an exciting time, anxiously awaiting the impending birth of their new baby.

But, for a VBAC mom, the end of a pregnancy can be bittersweet. There is endless preparation, reading, praying, hoping and dreaming of the long awaited birth. Will they be able to accomplish this? Are they really broken?

If it ends in another cesarean, what is left of that mom? Peace? Emptiness? Gratitude? Pain? Just another scar?

The nationwide VBAC success rate is around 20 percent. But, if you look more closely, you will find better odds. A VBAC mom who is under the care of a practitioner who regards VBAC as no riskier than any other delivery and chooses to deliver in a setting that does not consider VBAC women "high risk,", her success rate is more like 75-90 percent.

So, what does a VBAC turned CBAC mom do?
- Recognize, honor and accept the feelings of loss or sadness if they are present.
- Share your story and feelings with other CBAC mom's.
- Above all, love yourself and your baby.
- Get help if you need it.

Cesarean

Ladies - don't underestimate the cost of a cesarean; on your body, your mind and your baby.



Do your research NOW - http://ican-online.org/

Pregnant Woman = Doormat?

So, I've been reading a lot of articles and stories lately about women who have been treated badly during labor and birth.

Here are just a few:

Skol v. Pierce Update: Doctor Fined and Placed on Probation

New Jersey Cesarean Refusal Case: The "System" is Schizophrenic

Since when did pregnant women become doormats? No one, especially a woman in labor, deserves to be treated like this.

This all has me thinking.

A pregnant woman, like any other competent adult, has certain basic rights. She has the right (for any or no reason) to decline medical treatment. This has long been recognized by the common law in the United States, Canada, England and Australia. (from Childbirth and the law; By John A. Seymour)

It amazes me that in this country you can actually choose to have an abortion, yet you (obviously) can't choose to refuse a cesarean. And while I don't want to open a can of worms in regards to abortion, we need to sort out some facts.

An abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus/embryo, resulting in or caused by its death. (from Wikipedia)

So, an abortion ends in the death of the fetus (or embryo as the case may be), and it is a deliberate act. And if we take into consideration that there are a few doctors in this country that still do LATE term abortions, we can factually say that some abortions are performed on viable fetuses. So, we are legally allowed to cause death deliberately to a potentially viable baby, but we are not allowed to refuse a cesarean (even when fetal distress is the reason given for it).

Abortion = Deliberate Death = OK
Cesarean Refusal = Possible Death = Not OK

Now, I am not advocating for women to refuse cesareans if their baby is in true distress. And I think that most women are smart enough and brave enough to admit that cesareans are a wonderful live-saving tool and a benefit when used judiciously. But to tell a woman that she must sacrifice her bodily integrity to potentially save the fetus's life seems out of line.

Lets talk a bit about fetal monitoring for a moment.

Results were the same in all four studies: more electronically monitored women ended up...with Cesarean deliveries. Cesarean section rates ranged between 63% and 314% higher for electronically monitored women than manually monitored women. There was no improvement in perinatal outcome for the babies delivered by Cesarean section. The principal "reasons" alleged for these surgical deliveries--fetal distress and cephalopelvic disproportion (disproportion of head to pelvis)--cannot be proved or disproved. The real reasons, according to these studies, are attending physicians' impatience and nervousness. (Brackbill et al. 1984:10)

Ok, so according to 4 studies, the diagnosis of fetal distress via electronic fetal monitors which led to an implied life-saving cesarean, showed NO better outcome.

Forgive me, I am failing to see why a pregnant woman's autonomy should be violated...

VBAC

What is a VBAC? Simply put, it is a vaginal birth after cesarean. I talk to a lot of pregnant women. Most of the mother's I speak with who have had previous c-sections will express some interest in a VBAC, but won't follow through. This is unfortunate, because the risks associated with VBAC's are less than those of elective repeat c-sections.

And yes, I did say elective repeat c-sections. This is what they are... elective. You don't have to have one.

Risks to the baby from elective cesarean section:

* Babies delivered by elective cesarean have an increased risk of neonatal respiratory distress syndrome (RDS), a life-threatening condition,3-7 and other respiratory problems that may require NICU care.
* Babies delivered by elective cesarean have a five-fold increase in persistent pulmonary hypertension (PPH) over those born vaginally.6
* Babies delivered by elective cesarean are at increased risk of iatrogenic (physician-caused) prematurity, usually related to failure to conform to protocols for determining gestational age prior to delivery, or errors in estimating weeks of gestation even with the use of clinical data.7,8 Prematurity can have life-long effects on health and well-being, and even mild to moderate preterm births have serious health consequences.9
* Babies delivered by elective cesarean are cut by the surgeon’s scalpel from two to six percent of the time.10 Researchers believe these risks to be under reported.

Risks to the mother from elective cesarean section:

* Up to 30% of women who have a cesarean acquire a postpartum infection. Infections are the most common maternal complication after cesarean section and account for substantial postnatal morbidity and prolonged hospital stay.11
* Other serious complications for women undergoing cesarean include massive hemorrhage,12 transfusions,13 ureter injury,14 injury to bowels,15 and incisional endometriosis.16,17
* Women who undergo cesarean report much lower levels of health and well-being at seven weeks postpartum than women who have vaginal births.18
* Women who undergo cesarean section have twice the risk of rehospitalization for reasons such as infection, gallbladder disease, surgical wound complications, cardiopulmonary conditions, thromboembolic conditions, and appendicitis. Rehospitalization has a negative social and financial effect on the family.19
* Women who undergo cesarean section report less satisfaction than women having vaginal births.20,21
* Women undergoing cesarean are at increased risk of hysterectomy in both the current and future pregnancies.22,23
* The maternal death rate is twice as high for elective cesarean as for vaginal birth.24
* In subsequent pregnancies, women with a prior cesarean have higher rates of serious placental abnormalities which endanger the life and health of the baby and the mother.25-27 Women are rarely told that a cesarean places future babies at higher risk.
* After cesarean section, women face higher rates of secondary infertility as well as higher rates of miscarriage and ectopic pregnancy.28,29

References:
1 Harer WB Jr. Patient choice cesarean. ACOG Clinical Rev 2000; 5(2).
2 Greene MF. Vaginal delivery after cesarean section - Is the risk acceptable? N Engl J Med 2001; 345(1): 54-5.
3 Bowers SK, MacDonald HM, Shapiro ED. Prevention of iatrogenic neonatal respiratory distress syndrome: Elective repeat cesarean section and spontaneous labor. Am J Obstet Gynecol 1982;143(2):186-9.
4 Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: Influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102:101-6.
5 Hales KA, Morgan MA, Thurnau GR. Influence of labor and route of delivery on the frequency of respiratory morbidity in term neonates. Int J Gynaecol Obstet 1993; 43(1):35-40.
6 Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001;97(3):439-42.
7 Parilla BV, Dooley SL, Jansen RD, and Socol ML. Iatrogenic respiratory distress syndrome following elective repeat cesarean delivery. Obstet Gynecol 1993; 81(3):392-5.
8 Hook, B et al. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 1997; 100(3):348-53.
9 Kramer MS, Demissie K, Yang H, Platt RW, Sauve R, Liston R. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. J Amer Med Assoc 2000; 284(7):843-9.
10 Smith JF, Hernandez C, Wax JR. Fetal laceration injury at cesarean delivery. Obstet Gynecol 1997; 90(3): 344-6.
11 Henderson EJ & Love EJ. Incidence of hospital-acquired infections associated with cesarean section. J Hosp Infect 1995; 29: 245-255.
12 van Ham MA, van Dongen PW & Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74: 1-6.
13 Naef RW III, Washburne JF, Martin RW et al. Hemorrhage associated with cesarean delivery: When is transfusion needed? J Perinatol 1995; 15: 32-35.
14 Eisenkop SM, Richman R, Platt LD & Paul RH. Urinary tract injury during cesarean section. Obstet Gynecol 1982; 60: 591-596.
15 Davis JD. Management of injuries to the urinary and gastrointestinal tract during cesarean section. Obstet Gynecol Clin North Am 1999; 26: 469-480.
16 Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O. Endometriosis in abdominal scars: A diagnostic pitfall. Am Surg 1996; 62(12):1042-4.
17 Wolf GC, Singh KB. Cesarean scar endometriosis: A review. Obstet Gynecol Surv 1989; 44(2):89-95.
18 Lydon-Rochelle MT, Holt VL, Martin DP. Delivery method and self-reported postpartum general health status among primiparous women. Paediatr Perinat Epidemiol. 2001 Jul;15(3):241-2.
19 Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. J Amer Med Assoc 2000; 283(18):2411-2416.
20 Fawcett J, Pollio N & Tully A. Women’s perceptions of cesarean and vaginal delivery: Another look. Res Nurs Health 1992; 15: 439-446.
21 Waldenstroem U. Experience of labor and birth in 1111 women. J Psychosom Res 1999;47: 471-482.
22 Stanco LM, Schrimmer DB, Paul RH, Mishell DR Jr. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol 1993; 168(3 Pt 1):879-83.
23 Bakshi S, Meyer BA. Indications for and outcomes of emergency peripartum hysterectomy. A five-year review. J Reprod Med 2000; 45(9):733-7.
24 Bewley S. Maternal mortality and mode of delivery. Lancet 1999; 354: 776.
25 Zaideh, SM et al. Placenta praevia and accreta: Analysis of a two-year experience. Gynecol Obstet Invest 1998; 46(2):96-8.
26 Ananth, CV et al. The association of placenta previa with history of cesarean delivery and abortion: A meta-analysis. Am J Obstet Gynecol 1997; 177(5):1071-78.
27 Miller DA, Chollet JA & Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210-214.
28 Hemminki, E and Merilainen, J. Long-term effects of cesarean sections: Ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996; 174(5):1569-74.
29 Hall MH, Campbell DM, Fraser C & Lemon J. Mode of delivery and future fertility. Brit J Obstet Gynecol 1989; 96: 1297-1303.

© International Cesarean Awareness Network, Inc. All Rights Reserved.

The most serious risk of a VBAC is a uterine rupture. While this often sounds catastrophic, that is not always the case. Most uterine ruptures occur without symptoms and do not cause problems for the mother or baby. This mild type is usually only noticed when surgery is required for other reasons.

Researchers have shown that women attempting a VBAC and who have undergone a trial of labor have a 1.6 per thousand chance of uterine rupture or 0.16%.

A recent study, The Vermont/New Hampshire VBAC Project, reported that the overall risk of infant death from a VBAC attempt is 6 per 10,000 compared to 3 per 10,000 planned cesarean births.

The rate of uterine rupture rises when labor is induced with oxytocin, prostaglandin preparations, or misoprostol (Cytotec).

Women interested in attempting a VBAC should learn as much as possible about labor, childbirth, cesareans, informed consent and VBAC pros and cons. I also recommend looking into support groups like ICAN and getting the support of a doula or other support person with professional childbirth experience.

A VBAC can be a very emotionally charged and challenging event. But it is often an empowering and healing one as well.

2009/2010 Maternity Care Excellence Awards

HealthGrades recognized 145 hospitals with a 2009/2010 Maternity Care Excellence AwardTM. This places these hospitals among the top 10% of all hospitals nationwide for maternity care.

These best-performing hospitals consistently outperformed all other hospitals for maternal complication indicators as well as the weight-stratified neonatal mortality indicator (the number of newborns who died while in the hospital, examined by birth weight). Because of these vast quality differences, women should take care to research quality prior to choosing the hospital where they will deliver their baby.

Unfortunately, not a single hospital in Alabama received an award. In fact, the closest hospital that received the award is in Gainsville, FL, 240 miles away from Dothan. North Florida Regional Medical Center

AND... I am not incredibly happy with this study for its cesarean rates....

C-section rates average approximately 32% among the 19 states studied.

Obviously, a much lower c-section rate would be beneficial.

For a complete list of the hospitals, click here.

C-Sections reach 1 in 3..... WOW.

Mar 18 2009
For Immediate Release

Cesarean Rate Jumps to Record High; 1 in 3 Pregnant Women Face Surgical Delivery

More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery

Redondo Beach, CA, March 18, 2008 – The National Center for Health Statistics has reported that the cesarean rate hit an all‐time high in 2007, with a rate of 31.8 percent, up two percent from 2006.

“Every pregnant woman in the U.S. should be alarmed by this rate,” said Pam Udy, president of the International Cesarean Awareness Network (ICAN). “Half or more of cesareans are avoidable and over‐using major surgery on otherwise healthy women and babies is taking a toll.”

A major driver of cesarean overuse is underuse of vaginal birth after cesarean (VBAC). The VBAC rate currently hovers around 8 percent, far lower than the Healthy People 2010 goal of 37 percent. Driving this decline is the growing practice of hospitals banning VBAC.

In February, ICAN released the results of a new survey showing a startling increase in the number of hospitals banning VBAC. The survey showed a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with “de facto” bans.1 Full results of the research can be seen at http://www.ican‐online.org/vbac‐ban‐info. Between formal and de facto bans, women are not able to access VBAC in 50% of hospitals in the U.S.

Research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean. According to an analysis of medical research conducted by Childbirth Connection, a well‐respected, independent maternity focused non‐profit, in the absence of a clear medical need, VBAC is safer for mothers in the current pregnancy, and far safer for mothers and babies in future pregnancies.2 While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life‐threatening risks as well.

“The choice between VBAC and elective repeat cesareans isn’t between risk versus no risk. It’s a choice between which set of risks you want to take on,” said Udy.

Studies from the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, one most recently published in the February 2008 issue of the Journal of Obstetrics and Gynecology, demonstrate that repeated cesareans can actually put mothers and babies at greater clinical risk than repeated VBACs.3

In October 2008, Childbirth Connection released a report called “Evidence‐Based Maternity Care: What It Is and What It Can Achieve,” 4 showing 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.

“All pregnant women are faced with important choices in their pregnancies. It is critical for women to understand what their choices are, and learn to spot the red flags that can lead to an unnecessary or avoidable cesarean,” said Udy.

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican‐online.org for more information. In addition to more than 90 local chapters nationwide, the group hosts an active on‐line discussion group that serves as a resource for mothers.

For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients. The resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure. The guide can be found at http://www.ican‐online.org/vbac/your‐right‐refusewhat‐do‐if‐your‐hospital‐has‐banned-vbac‐q.

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. http://www.icanonline.org/resource/white_papers/index.html

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. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.


1. A “de facto” ban means that surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.
2. http://www.childbirthconnection.org/article.asp?ck=10210#bottom Best Evidence: VBAC or Repeat C‐Section, Childbirth Connection
3. Mercer et al, Labor Outcome With Repeated Trials of Labor Am J Obstet Gynecol 2008;VOL. 111, NO. 2, PART 1 Silver et al, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries, Am J Obstet Gynecol 2006; VOL.107, NO. 6
4. http://www.childbirthconnection.org/article.asp?ck=10575 Evidence‐Based Maternity Care: What It Is and What It Can Achieve