Pregnancy, Parenthood & Playtime

This time they featured “12 Surgeries You may be better off without” and not only do they include cesarean sections, but they also include episiotomies, which have been common practice for a long time in our Obstetric model of maternity care. Some women even getting them without consent or even being told by their doctor that he/she was cutting an episiotomy. Long term studies have shown little to no benefit to having an episiotomy, so it is a wonder why they are still being done in relatively large numbers.
Here in Connecticut alone, we have numbers well over the “recommended” 5%, some hospitals even exceeding 25%!!

As women, and consumers, we need to be educated on the procedures we undergo, the providers we choose for our care, and the risks and benefits that are associated with these choices, which I fully believe are not being truly detailed for many women, and the repeat cesarean section numbers in Connecticut alone show that. The vast majority of hospitals have a 90%-100% repeat cesarean section rate. Don’t believe me? I obtained these statistics yesterday from an e-mail directly from the Connecticut Department of Health.These statistics are for low risk pregnancies. Another alarming number is the amount of women in 2007 who were considered low risk, as well as the number of primary (first) cesarean sections that are taking place in our state hospitals.

Now, back to what consumer reports has to say.

“Two of the most frequently performed major operations in the U.S. are exclusively for women: hysterectomy, or surgical removal of the uterus and often the ovaries, and cesarean section. In both cases research suggests that most physicians fail to follow treatment guidelines from the American College of Obstetricians and Gynecologists (ACOG). More than 700,000 women a year are also subjected to episiotomy, a less invasive but even more dubious procedure in which physicians make a short incision to widen the vaginal opening during childbirth.”

“Cesarean section. Most C-sections are done because labor is progressing too slowly. But several less-invasive approaches—medication, deliberate rupture of the membranes around the fetus, even a shoulder or foot massage or a warm shower—may be enough to stimulate labor. Physicians also perform cesareans in the vast majority of women who’ve already had one. But ACOG says that most of those women could safely try for a vaginal delivery, which would succeed about 70 percent of the time; if it doesn’t, the doctor could simply switch to cesarean delivery.”

Unfortunately for women, and their health, especially here in the state of Connecticut, finding a provider who will attend a VBAC (Vaginal Birth After Cesarean) is almost like looking for a needle in a haystack, especially if you want to have your VBAC in a hospital. If you have had more than one cesarean section, for whatever reason, you have no options if you want a hospital birth, it is repeat cesarean, or do not have any more children in most cases.  But what concerns me the most is what many major health organizations have to say about the growing cesarean sections rates in the United States, which as a whole is at 31.8% nationwide, but here in Connecticut we are higher at 34.6% as of 2007. If we turn the tables back 20 years, the vast majority of women who had a cesarean section at one point in their life went on to have a successful VBAC without having to fight tooth and nail.
The other day I blogged about a woman who was dropped by her providers because she would not consent to a repeat cesarean section, which in turn was completely unnecessary. She went on to have a perfectly fine, uncomplicated, vaginal birth, and her and her 6th daughter were perfectly happy and healthy. She would have been subjected to an unnecessary surgery had she not stood up to the providers she chose, who were supportive of her VBAC her entire pregnancy.  The problem is the ramifications of these cesarean sections that people are not taking into consideration today.

There are so many risks when you start getting into the second, third, or fourth cesarean section.
Here are a couple examples of the risk factors with increasing cesarean section surgeries.

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion’s : 21.6% (1 in 5)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion’s : 32.2% (1 in 3)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in
Risk of Dense Adhesion’s : 42.2% (2 in 5)

Note : “Major complications” include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.

But back to what consumer reports went on to discuss.

“Recommendation. Ask what percentage of normal deliveries as well as births following a prior cesarean the physician delivers by C-section. Ideally, look for rates below 15 percent in women who haven’t had the procedure and about 60 percent in those who have. (Those rates can be higher if the physician treats many high-risk patients.) Ask about the doctor’s willingness to try nonsurgical steps first. Alternatively, consider delivery in a hospital by a certified nurse-midwife, if available. Deliveries by those practitioners tend to require C-sections less often than those done by obstetricians, with equally good results overall. And nurse-midwives have access to an obstetrician, who can perform a cesarean if needed.”

Also remember, your provider, or a provider you may be interviewing as a possible care provider does have these numbers, and does keep track of these numbers annually, not only for their practice, reporting to the department of heath, but also for insurance purposes including medical malpractice insurance. If a provider tells you they do not know their numbers, or do not keep track of it, that is a clear red flag.

Remember, you are a consumer and your health care is important to you.
So many people spend months researching cars, big screen TV’s, or other big purchases, but spend no time, or very little time researching their care provider and often go with the first person a friend recommends, or their insurance will cover. Demand better care, in the end it is your choice, and you have the final say.

Connecticut Hospital Cesarean Statistics for 2007

Connecticut Hospital Repeat Cesareans Vs. VBAC Statistics 2007

93.94%

4,999 Deliveries

10 years ago, to think about an international organization, or a website designed to help women get through having a cesarean birth would have been completely unheard of. But with the rising cesarean section numbers, for a number of reasons across the board, the number of women unsatisfied, hurt, and damaged by their birth experience is also climbing.

After the birth of my first child by cesarean, which I still feel to this day was not a necessary or lifesaving procedure, I felt hurt, confused, and overly emotional. I did not know that there were other women out there that felt as I did. I had no one to relate to, no one to share my feelings with. Then I discovered ICAN. The International Cesarean Awareness Network, a international support group that helped me to deal with my negative feelings from the birth of my son, and strive to make a difference in my community helping women like myself who had these same feelings and experiences. I have been doing this for going on two years now, and it is rewarding, and has helped in my own personal recovery immensely.

As time goes on and I get more involved in the birth community, support systems, and other blogs which run along the same lines of what I write about, I learned about a website called BirthCut. A site focused on women who have had negative experiences with cesarean sections, and giving them a safe and comfortable environment to share their story, and use artwork to express their feelings. After viewing the website on several occasions, I met the creator Michele Demont of Danbury, through ICAN. What an inspiration to anyone who has been through the experience of a traumatic cesarean or birth in general.

Before I leave you, there is another organization I would like to praise for their work with cesarean mothers who have been hurt by their experience. Solace For Mothers is a great resource for any woman that has had a traumatic birth experience, whether it be a cesarean or not.

Not all mothers who have c-sections will feel this way, and many may even enjoy their experiences, but this should not discount the hurt that others may feel, and the same should go for any birth including a vaginal birth. Cesarean sections are amazing and lifesaving procedures when used appropriately and correctly, but at the increased numbers we are seeing today, some may be very unnecessary. A woman’s feelings regarding her birth should be respected, not put down.

To close, I would like to share a video of my two experiences.
I hope people can be mature enough to understand these are my experiences, and my experiences only.

My Birth Journeys

My Birth Journeys from Danielle Elwood on Vimeo.

Above picture is an actual picture of a sign in a OB/GYN office in Utah.

“Because the Physicians at Aspen Woman’s Center care about the quality of their patient deliveries and we are very concerned about the welfare and health of your unborn child, we will not participate in a “Birth Contract” (which is a fancy name for a Birth Plan), a Doulah assisted (doula) or bradley method delivery (type of childbirth class). For those patients who are interested in such methods please notify the nurse so we may arrange transfer of your care.”

Things like this are popping up all over the country and becoming more and more common. But one of the main problems is the lack of support these providers are giving their patients, and the blatent disrespect to their wishes. As someone who is familiar with all of the “banned” things on the sign pictured, I could not imagine why on earth a provider would want to ban them, when most great providers encourage the pictured things.

First I will discuss why it is silly on the part of a provider to “ban” doula’s. Long term studies on doula supported delivered have shown a number of positive things. Decreased cesarean rates, lower induction numbers, deliveries are less likely to be forcep or vaccum assisted, shortened labor time, reduction of pain medication use, less NICU admission in the babies… the list goes on.

But why on earth would Doctors or midwives not want this?  Some providers say that doula’s “get in the way” or “encourage mom’s to not follow medical advice” but if a mother actually takes the time to question a provider shouldn’t that be ok? I mean, moms do have the right to full informed consent. That is federal law.
Many hospitals are now taking an active step in banning birth doula’s in their facility. Which all in all is a violation of a patients right to have whoever she wants supporting her during birth. With the aboe benefits wouldn’t a provider want that kind of help?  Or having the common hospital interventions questioned stepping on their toes?  Not all moms want the cascade of interventions that many laboring women cannot fight while laboring themselves.

An advocate in the delivery room is very important for all women.

As for birth plans, or “birth contracts” which this picture refers to, are also positive because they help the mother to put her wishes down on paper, making them know to the provider as well as the hospital staff. If a mother does not wish to have pain medication or an episiotomy, it is very hard for her to express that while she is in active labor. Again, why is this a bad thing? Bad because a provider who may knowingly violate the wishes of the mother has proof that they did so in a birth plan? Or they simply do not care what the mother wants for her birth?

As for the Bradley Method, which is a husband coached birth class, which teaches their couples about common hospital birth procedures, epidurals, inductions, cascades that lead to cesarean sections, and actually helps to educate unlike the majority of hospital birth classes I have sat in on, which in my opinion teaches their patients to be exactly that… good patients.

Heaven forbid a couple becomes educated on the process of birth and what they want to take place. Granted, there are things that come up that some cannot plan for, or do not plan for, but that is what makes being educated even more important. Knowing how to handle the issue, whatever it may be without being blind sided by hospital staff suggestions, is a great positive.

I always recommend birth classes in a out of hospital setting. It is so important to become educated before you step foot into the hospital to give birth!

As for the above picture, it is sad that giving birth is coming to that with their providers. When did such great benefits start to become taboo and unwanted?

I was shocked, and a bit floored yesterday when I stumbled upon a new report released by the CDC regarding the infant mortality in The United States.
I first came across the article on Birth Activist another publication I have been writing for in recent weeks, and then after they had already broke then news, the AP (Associated Press) released the same story.

While I am not good at analyzing statistics, a friend of mine, Jill from the website Unnecesarean is, and she made a brilliant post about the release, and I would like to share a couple points that she made in hope to help educate parents, and future parents of our nations youth.

“Authors of Behind International Rankings of Infant Mortality: How the United States Compares with Europe explored what they refer to as the recent stagnation in the U.S. infant mortality rate that has generated widespread concern among researchers, policy makers, health care providers and activists.

Using data from the United States’ Linked Birth/Infant Death Data Set and the European Perinatal Health Report, authors Marian F. MacDorman, Ph.D., and T.J. Mathews, M.S. of the CDC National Center for Health Statistics found that the main cause of the United States high infant mortality rate when compared with Europe is the “very high percentage of preterm births in the United States.”

According to the study, while infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.”

I hope I am not the only one that finds this a bit disturbing. We have the best care, and one of the highest survival rates in our babies that are born before 37 weeks gestation, which many consider to be “term”, but the highest infant mortality rate for babies born after 37 weeks gestation, when these babies are supposed to have smooth sailing. Could it be that many of these babies thought to be at “term” have incorrect due dates making them fall into the under 37 weeks gestation category?
It is the number of unnecessary cesarean sections, as well as unnecessary labor inductions that are causing complications in these infants?
We all know that cesarean sections, and labor induction are not risk free procedures, and often have greatly increased risks in some cases. Even the CDC the same agency that released this article have come out in the past month against the high cesarean, and labor induction rates.
Maybe because these numbers are starting to go hand in hand?

The United States remains near the bottom of the rankings.

These graphs help to really depict and put a picture, and numbers to how badly the United States is falling behind.

“The report states, “Reporting differences have little effect on the percentage of preterm births because most preterm births occur well after 22 weeks of gestation. For example, the percentage of preterm births for the United States in 2004 was 12.5% when all births were included and 12.4% when births of less than 22 weeks of gestation were excluded.”

Also, The United States has higher pre-term birth rates. I fully believe this has a lot to do with many factors.
The number of multiple pregnancies the result of fertility treatments. There are no laws regulating fertility treatments at this point in time, while there are “ethics” that some Doctors do go by, such as not implanting more than 2 embryos at a time, there are bad Doctors everywhere who will not follow these ethics, as we saw earlier in the year with the “Octomom”. Which is one reason we need stricter laws on these practices.
Another reason is lifestyle. The number of obese pregnant women is up, smokers, drinkers, women on some form of a prescription medication, and even illegal drug use. These are things that in the past were unheard of for a point in time, but it seems as though in a short period of time it went from taboo to, just sweep it under the rug. And our children are paying for it.

“MacDorman and Mathews attribute much of the high infant mortality rate in the United States to the high percentage of preterm births. Using the direct standardization method to apply the U.S. gestational-age specific infant mortality rates to Sweden’s distribution of births by gestational age, the NCHS found evidence that lowering the percentage of preterm births could have a dramatic impact on infant mortality in the United States.”

Like I previously stated.
If we stopped these elective procedures such as cesarean sections, and labor inductions at late pre term dates, such as 37 or 38 weeks gestation, we could possibly curb this number, as well as the complications and outcomes of these children. Many organizations, including medical organizations have spoke out about cesarean sections before 39 weeks gestation, and it seems as though now the labor induction guidelines are changing to follow suit. In most cases, when babies are healthy, Moms are healthy, babies will come when they are ready, no matter if you try and force them out early or not.  When left alone in a supported environment, most women will give birth on their own perfectly fine. That is not my opinion, that is just another fact.

Lastly, November is National Prematurity Awareness Month.

There are a lot of simple things that you can do to avoid a premature birth.

• Stay Healthy – Eat healthy, exercise regularly, and overall just live a healthy lifestyle.
• Let your labor begin on its own. Unless there is some type of medical reason for a labor induction, or early cesarean section, avoid them. We know that ultrasound estimates of due dates are often incorrect. Do not take the chance with your precious baby!
• Avoid common labor medical interventions such as the premature rupture of membranes (breaking your water), pitocin, and an early epidural. All have been shown to increase the risk of fetal distress, and can cause possible problems in labor, or slow the labor down.
• Choose a Health Care Provider with low intervention rates. If you go to someone with a 50% cesarean rate, your chances are, you have a 50% chance of having a c-section out of the gate. Same goes for labor induction, episiotomy, and other intervention rates.  Providers DO impact your chance of a safe birth.

We have always tried to make household chores fun, make a game out of them, so that our toddler would grow up knowing these should not necessarily be “chores” but just games around the house that need to be done. Over the weekend my husband had to get all the leaves raked up in our yard. Which is always a chore because we have not one tree in our yard at all!

So he got our toddler to help him, and it turned into more fun than anything!

Doesn't this look like fun?

But it reminds me that as parents, we need to teach our children that through out life, they are going to have responsibilities that sometimes we may not like, but it just goes with being a responsible adult. I feel one of the biggest problems we are having with society today, is the serious lack of discipline, as well as responsibilities, our children have. It is becoming more apparent during the teen years.

In my neighborhood, there is a group of teen boys that wanders around, skate board in hand, and doesn’t really do much that is productive. I frequently find them at the end of my driveway taunting my two dogs. The dogs see them through the fence, and proceed to bark out of control at them. Instead of moving along, they stand there and taunt the dogs more. Eventually I got upset because of two napping children inside the house while they played this game.
Out the front door I walked, and asked them to keep moving. We live on a main road, stopping at the end of our drive way is not a smart idea, they could be hit by a car! There is no sidewalk!
When I asked these boys, who looked to be maybe 13 at most to move along, the words that came out of their mouth almost floored me. Then it struck me…. Where are their parents??

Fast forward to the infamous mischief night, which just so happened to fall on a Friday night this year.  My husband, children, and I went out to dinner. As we returned home, we were unpacking the children out of the car and we heard a noise from the leaves across the street from our house, and there they were…. the group of boys, sitting in the dark waiting for our car to get home so they could throw eggs at it or do whatever they had planned. I went inside and phone the police department. 10 minutes later I went outside to get a couple bags out of the car, and the cops had the

Broken Car Window

boys putting their “bags of goodies” in the trunk of his car.

Now I know we were all kids at one point in time, but a little toilet paper was the extent of the damage in most cases. Last year we had the back window of our car broken, landing glass in my toddlers carseat, and all over our car. Random act? It may have been, but having issues with a certain group of children that think nothing about damaging personal property doesn’t lead me to believe it.

Moral of the story, I know that a lot of parents have to have both parents working in order to make ends meet in society today, but it does not take that long to instill morals, and rules into their lives. Show them at a young age that responsibility can, and is fun. Monitor them and what they are doing, whether you are at work or not. It may make a difference when you have to buy a $260 car window for a neighbor.

I know many will probably string me up for this post, but I have noticed a lot lately in passing conversations, internet chats, message boards, and other social situations that when a woman shows sadness of the birth experience she had, or expresses some kind of dissatisfaction of her treatment, emotional, or medically, many people look at her as though she has 3 heads and then the famous line always comes….

“At least You have a healthy baby”

Which is kind of like adding insult to injury in any woman who has had a bad experience. Just open that wound up and pour the salt right in!
I never really thought much about this subject until I started feeling the effects of my first birth experience, and really learning that I became victim to the factory style maternity care system that most hospitals have in place. I was young, uneducated on hospital birth, and thought my Doctor knew everything!  Which landed me in a cesarean section, which in turn caused emotional distress and trauma, when I finally realized what happened. It did not happen right away. It took me months. For the first couple months after my son was born, I was fine, schedule all my kids, elective cesareans, no big deal. Then one day, as I started to read more, learn more about inductions, pitocin, and the hospital I birthed in, it all clicked. Something went seriously wrong.

I started searching for some kind of support, a mother who went through what I did, but I could not find anyone who had a cesarean, that I knew, who felt like I did. Everyone was fine with their experience, everyone threw the healthy baby line out, looked at me strangely when I spoke of my experience and the hate, betrayal, and mistrust I felt. I was an odd ball.
I found myself on an internet forum speaking with women who had also given birth in December of 2007, we had bonded over our pregnancies, and now were supporting each other in our post partum periods, and as we moved further into parenthood.

I expressed my feelings about my recent birth experience, which by this point, my son was about 3 months old. I got the same reactions, healthy baby, blah blah blah, then one woman chimed in about something called ICAN. I started searching to see what it was, who these women were, and I was welcomed with open arms. Women who understood my hurt, who knew that the healthy baby outcome was not all I should focus on, women who had been where I was, and got through it!

It is hard to take those emotions and put them into words.
Of course I am grateful for a healthy baby, a beautiful, healthy, bright, warm, loving little boy.
But the mothers emotions should always be taken into account. You can love your child, without loving the way that they came into the world. In fact, when I look at the experience myself, I separate his birth from him. It is the way HE made it into the world, but it is not what describes him, it is not who he is, and my negative feelings from what *I* experienced do not have an impact on my love for him, and taking care of him.

I came across an article written by Shelia Stubbs, which described fantastically a great comparison.

There is one other very special event in a young woman’s life to which I have tried to compare the act of giving birth: your wedding. It is similarly an emotional rite of passage involving your close relatives and friends. It’s also expected to be stressful but a happy time, and one that will certainly change your life. Now imagine after all your planning for the big day, on the way to the church you are involved in a car accident and have to spend the day in the ER.

To your surprise, the the ER nurses don’t really seem to care that this happens to be your wedding day; after all lots of people get married, and lots of people get in car accidents. They agree it’s unfortunate, but it’s the marriage that matters, not the wedding. They see this every day and think you are being ungrateful for their services and imply you are being rather selfish a bit of a baby!

It is amazing how point on this is.

Let’s compare another situation.
Can you imagine if someone spoke to the victim of sexual assault and said something along the lines of “At least you are alive and healthy” can you imagine the kind of reaction that would get? The complete hysterics, and put downs the person who made that comment would experience?
Many women who have experienced a birth trauma, have been compared to the survivors of a sexual assault, and most are referred to rape councilors after their experience, because of the similarities in the experience, and therapy.

All in all.
I just ask people to be more compassionate and understanding when a woman expresses her negative feelings regarding a birth experience. Healthy baby or not.
Your words may do more harm than good!

Most people assume, since birth has gone into the hospitals at the turn of the 1900′s that maternal and fetal mortality rates have drastically improved. While they have have decreased the loss of women and children around the time of birth, it has not decreased as much as many of us may think.

During my research on this subject, I have come across many jaw dropping sources, one being a half hour video explanation of maternal mortality rates in industrialized nations called Birth By Numbers. The gentleman who is in the video is Eugene Declercq, PhD. Professor of Maternal Child Health at the Boston University School of Public Health. So all in all, this man is not just any joe shamo off the street who was prompted to read off a card.

In the year 2005, 4,138,349 babies were born in The United States.
Out of all those babies, 18,884 babies died within the first 4 weeks of their life.
1,248,815 were born via cesarean section.
4.6… that is the number of babies that die out of 1000 in the first 4 weeks of their life.
42, is where the United States ranks in neonatal deaths, out of the Countries in the World.

With that being said, those are alarming numbers that many may not know.
When we all think of the medical care that we have in our country, especially out maternity care, we think that like most other things, we have the best. But again we would be wrong. Even though The United States pays the most per capita for birth around the world, we have some of the worst outcomes not only for mothers, but for babies.

Last week, The BBC release an article that tackled the tough subject of Maternal Mortality world wide. In the article it details the amount of money the US spends on mothers in maternity care and birth, and while we spend the most, like I previously said, we are more likely to die, than most women in other countries. Like I stated before, over 4 million women give birth yearly in The United states, out of all of those women, about 500 will die from some sort of pregnancy/birth related complication.
Compared to other countries, this is a high number.

“No American woman should die from childbirth in 2009, we can definitely do a lot better,” says Dr Michael Lu, Associate Professor of Obstetrics at the University of California, Los Angeles (UCLA).

In New Jersey, Jim Scythes is bringing up his two-year-old daughter Isabella on his own. His wife, Valerie, died from blood clots shortly after giving birth to Isabella by Caesarean section. Jim still cannot believe that Valerie died after giving birth, here in America.”

So why do so many more women in America die around the time of birth than in other nations which the United States can actually be statistically compared to? While the article states that the reasons are “complex“, I can answer it in my own opinion. (And when I say OPINION, I simply mean OPINION, I do not have any type of medical degree, I am not giving any kind of medical advice, I am just calling it like I see it and what I have discovered when independently researching on the topic) It is the way we handle birth here in this country. More, is not better, in fact from my personal experiences not only with my own births of my children, but with women I have worked with, mentored, and provided support for after their births, less is better. Less monitoring, less intervention, less inductions, less ultrasounds, less cesarean sections. Less is more. In countries around the world where less is more, home births are what 1/3 of the population have, where a mother once she turns 35 is not considered a high risk patient, they have LOWER maternal and neo natal death rates. This is not some magical country I am making up either. This is The Netherlands.

Another reason that women in America are more likely to die during pregnancy/childbirth is the lack of medical care many do not get because of the lack of medical insurance. It is estimated that 17 million women of childbearing age in The United States are uninsured. Even with programs such as medicaid, many do not receive the proper prenatal care or even proper health care prior to becoming pregnant, that they should be getting.
Other reasons also cited in the same article the above quote came from are obesity, poverty, and the number of cesarean sections taking place in The United States.

Dr Bill McCool, at the University of Pennsylvania’s School of Nursing, points out that America is far above the World Health Organization’s goal of a 15% C-section rate.”Surgery of any kind has risk,” he says, and a C-section is, “still the riskiest way to have a baby.
“In the US, almost one third of women have that procedure for delivery of their baby.”

One thing that really stood out to me in that quote is C-sections are “still the riskiest way to have a baby” but so many women are giving birth via cesarean section. In the year 2007, 31.8% of all women in The United States gave birth by cesarean section. 2007 in the most current cesarean section statistic release by the CDC.

Other issues cited by the CDC for this rate is the number of women who have unknown illness such as heart disease, blood vessel disease, and obesity. Many would say, how does one not know they are “obese” but some do not realize that in some women, especially those who are short, such as myself, a 30-50 pound weight increase in “optimal weight” can mean obesity. You do not need to be 5 feet tall and 300 pounds to be considered clinically obese.

For many women, it is a struggle to lose weight. I am currently battling it myself after the birth of my second child. After my first, I lost the weight very easily, it melted off of me, but this time around is much different. I now find myself counting calories, looking at the ingredients of certain products, and taking time to exercise (besides chasing around after a toddler) because I know at my current height and weight, I am not obese, but I am overweight.
While it may be difficult, the long term benefits of women losing weight, are worth it.

Taking a look at all the information together, it shows a great need for several things.

• Decreased Induction Rates
• Decreased Cesarean Section Rates
• Women improving their health before pregnancy
• Taking care of their bodies and health during pregnancy
• Keeping up with annual check ups, physicals, and other recommended screenings

Until we as women start to make a change, and demand a different kind of birth climate, this number will not decrease.
Let’s work to improve this, if not for us, for our children!

Earlier this week, MSNBC featured an article about Hospitals Across the Country soon implementing stricter guidelines in labor induction due to the rise in late term premature births, and the complications that can rise from these births. I would like to first start by highlighting the inaccuracy of calculating due dates in women. Many women feel as though their due date is D (delivery) day, and that the baby should be evicted before or on that day. Believe me, I was one of those women with my first child. The second time around I discovered how inaccurate they are, as well as ultrasound dating.

“A study has shown that an ultrasound isn’t any more accurate than a reliable menstrual history combined with a pelvic exam by an experienced obstetrician. Researchers confirmed this by looking at pregnancies with known conception dates and comparing due dates arrived at by ultrasound measurements with dates arrived at by menstrual history and pelvic exam. The fact that the old-fashioned method for dating a pregnancy does just as well as ultrasound is a vital point. While a sonogram may be useful in cases where there is uncertainty about when conception occurred, first-trimester sonograms are currently used as the ultimate standard. Your due date will often be changed if it differs from the one derived from the sonogram no matter how the date was previously determined or how sure you are of when you conceived.
Even first-trimester sonograms have a range of plus or minus five days, or a ten-day window, around the calculated date . The range increases to plus or minus eight days in the second trimester and plus or minus ten days for third-trimester scans. For this reason, experts say the due date should not be altered based on results from an early scan unless the calculated date differs by two weeks or more from the date determined by physical signs and symptoms and menstrual history.”

The above is taken from When Is that Baby Due?

Now, knowing that even with ultrasound dating, which we treat is the final method of determining a estimated due date, which I have noticed, everyone always leaves out estimated, because many feel the need to have that “end date”. There is still a 5-10 day window for that baby to be off. When taking this into consideration, babies that are being induced before 39 weeks gestation, could be mistakenly delivered at 35 weeks gestation, long before they are truly ready to join us. Another connection to elective labor inductions, as well as elective cesarean sections, there is an increased number in babies being admitted to the NICU for special care, most of the time for respiratory distress because their lungs are not ready or developed enough to work properly.

“1 in 4 inductions were before 39 weeks
National guidelines from the American College of Obstetricians and Gynecologists have long discouraged elective deliveries before the 39th week of pregnancy. But some hospitals that took a close look were surprised. At Utah’s Intermountain Healthcare, for example, 28 percent of elective deliveries were breaking ACOG’s rule in 2001, Oshiro told a March of Dimes meeting on preventable prematurity this month.”

Above taken from The MSNBC Article previously mentioned.
What I have noticed in the past, maybe year, since really focusing more on birth, labor, and the guidelines that ACOG puts into place, there are a large portion of OB/GYN’s, Midwives, and Hospitals that ONLY use the ACOG guidelines when it works for them. Now I am not throwing around accusations, but if you look at the above example of this Utah hospital, and then take a look at the current VBAC denial case of Joy Szabo in Arizona, her hospital stated that they no longer will offer VBAC birth services because of ACOG guidelines. When ACOG was reached to be questioned about this statement and about their guidelines on VBAC births, and ACOG Representative said that Page Hospital in Arizona had interpenetrated their VBAC guidelines incorrectly, and still have yet to make the chance according to ACOG’s guidelines on VBAC. Why? Because it seems as though it is simply easier for them to ban VBAC and be done with it. Even if it means women have to drive 300 miles to the next hospital that will deliver a VBAC baby.

“Most were being induced in week 37, such a small difference that local obstetricians argued it wasn’t a problem. So Oshiro pulled the medical charts and found those near-term babies had more than double the risk of ending up in neonatal ICU, suffering respiratory distress, even needing a ventilator.
It took several years of policing: Inductions now are allowed only after meeting a checklist of requirements. But today, only about 3 percent of Intermountain’s elective deliveries occur before 39 weeks — and infant hospitalizations have dropped, saving money, too, says Oshiro, now a maternal-fetal medicine specialist at Loma Linda University in California. He’s about to pilot a similar program at hospitals in that area.”

While there are some medical reasons to induce birth before the 39th week of pregnancy where the benefits to the baby outweigh the risks, if you look at the above quote taken from the MSNBC article also, it shows that after guidelines were put in place at this specific hospital, only 3% of babies were induced before 39 weeks, and I will go ahead and assume these were for medical reasons.

What is not being mentioned in this article is that, over 40% of all birth inductions, necessary or non medically necessary end in cesarean section. In more recent years, birth professionals such as Marsden Wagner, and Robbie Davis-Floyd have estimated those numbers to be upwards of 50%.  And in many cases, this large risk is not discussed before labor induction. The reason for the large cesarean section numbers with induction is because the body is simply not ready to give birth no matter what kind of medical interventions, medications, or technology you use. In most cases the reason for these cesarean births are labeled as “failure to progress” which is obvious because the body is simply not ready to birth the baby, because the baby is not ready either. Again, when medically necessary induction and cesarean sections are lifesaving to mom and baby, just not at the large numbers we are currently seeing in our country.

In the year 1990 1 in 10 labors were induced, and today, 1 in 5 are now induced, that is nearly double in the span of 20 years, with no medical reason backing this up. I can say, while I was rather young in 1990, the birth climate has drastically changed in many ways since then, inductions being one of them. It seems as though inductions, and cesarean sections scheduled for convenience factors did not nearly take place as much as they do today, 20 years ago. If you go back another 15 years from 1990, you see actual breech births being done in hospitals.
You can say there has definitely been a huge change, but then we have to ask ourselves, has it been for the better?

Last I will address defensive medicine which is also mentioned in this MSNBC article.

“Patient and doctor preference helped drive the rise in inductions, such as women timing grandma’s arrival to take care of the siblings, or minimizing 3 a.m. deliveries. Then there’s defensive medicine, where doctors worried about litigation induce for minor reasons like a slight uptick of the mother’s blood pressure.
So Pittsburgh also had “a little bit of a hard sell” after discovering nearly 12 percent of elective deliveries broke the 39-week rule in 2004, Fisch says. “It was perceived to be a safe and effective way in delivering a baby — and it is, as long as it meets certain criteria.”
After Magee began strict enforcement — requiring that a mother’s cervix be nearly ready for natural labor, and limiting the beds available for elective inductions — too-early inductions dropped to 4 percent by 2007 and are “effectively zero” today, Fisch says. Overall, elective inductions dropped 30 percent.”

Minimizing 3am deliveries? I guess it was just silly for me to expect someone like a Doctor, or a Midwife, to attend deliveries no matter what time the birth is. If you are concerned about being woken up in the middle of the night because a woman is in labor, maybe you should have gone into a field other than Obstetrics?

Again, I go back to the question…. Has birth really changed for the better?

Lastly I will say…. FINALLY! Good for these hospitals FINALLY cracking down on this!
It is about time!