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Doula, Birth Advocate, Aspiring Midwife, Mother, and Wife

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WHO says Elective Cesareans are too Risky

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I have been sitting on this article for about a month now trying to think how I would go ahead and review it, and pass along the information that it contains in a way that doesn’t come off too radical since most know I am not the biggest fan of c-sections, especially after having not one, but two myself. While I like to include my own personal opinions in my writing, I also like to include factual information which has helped me to form my opinion. I am not just some radical that spouts off random nonsense.

So, without any further wait… I will share an article that was published on January 11th, 2010 regarding elective cesarean sections, and their safety. When we look at the word elective, when it comes to medical terms it often means for no medical reason. Most do not know this, but the majority of scheduled repeat cesarean births do fall into this category, unless there is a real underlying medical condition that may have caused the need for cesarean birth, or some type of complication from the primary cesarean section that made subsequent surgical births necessary. Medically necessary c-sections are not what is being discussed today, or written about in this article.

The Scientific American Article includes a statement from WHO, also known as The World Health Organization and discusses that surgical births, while they may be growing in popularity around the world are simply not the safest option for mothers and babies.

“A new report from the survey, which was published online today in the medical journal The Lancet, found that in Asia—in both developed and developing nations—cesarean section births only reduced risks of major complications for mother and child if they were medically recommended. Elected surgical deliveries, on the other hand, put both at greater risk.”

“Cesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby,” the authors of the report concluded. Common reasons for a recommendation for cesarean delivery included a previous cesarean section, cephalopelvic disproportion (when the baby’s head cannot fit through the mother’s pelvic opening) and fetal distress.”

Which is something we are seeing in growing numbers in The United States. In Connecticut alone, the number of repeat cesarean sections is over 93% leaving the number of women who go on to have a VBAC (Vaginal Birth After Cesarean) at a small 6%.  But why are so many women making the choice for these elective surgeries? I mean, having major surgery is no walk in the park by any means.
One of the reasons is the lack of information and education about repeat cesareans, complications, and the REAL risk factors of VBAC.
Other reasons are liability for Doctors or even hospitals banning VBAC all together, leaving women with little or no options but birthing at home if they wish to have a natural birth after having a surgical birth previously.

The article then goes on to say the number of cesarean sections have reached “epidemic levels”… Makes you stop and think.

“But these risks have not necessarily been absorbed into popular, or even medical culture. The rates of cesarean section procedures are on the rise in many countries across the globe, the authors report, and in some countries they “have reached epidemic proportions.” Among the nations studied, China had the highest rate of cesarean sections that were performed without medical indication—11.7 percent; the overall rate for the facilities studied had a rate of 1.9 percent.”

Also included :

“Surgical childbirth also requires more resources than a natural vaginal delivery, the authors note. Especially in countries where money, medical practitioners or proper equipment is more limited, unnecessary cesarean sections can drain resources away from those cases in which it can improve the chances of a healthy mother and baby.”

Meaning more money, medical resources, time and effort.

While I know my measly blog post about it is not going to change the world, I hope that the increasing number of articles in medical journals will help to make a change in the birth climate of The United States, we are in such a desperate need for huge change to help lower our maternal mortality rates, and by lowering our cesarean section rate, that would be a great start!

Danielle Elwood

8 Responses

  1. Angel says:

    I have heard so many women say that they were having a c-section because they “just couldn’t handle the pain of childbirth.” I wonder if they truly realized that the “pain” of childbirth is over after the baby is born, whereas most c-section issues do not heal up for WEEKS (or, if there are complications, MONTHS) after childbirth.

    Some women just do not do their research. They take everything their doctor says as gospel. Like one woman who said her doctor told her it was a good thing she had a repeat c-section because her uterus was “paper thin” and would not have made it through labor and delivery…but it did make it, in tact, the fully 9 months of uterine expansion with no problem.

    I do not believe that Medical Malpractice is the culprit. I do believe it is greed and impatience that is the culprit.

  2. elwood says:

    And it would turn around if women started suing over the unnecessary cesareans and the long term effects from them. But sadly that will never happen because the malpractice lawyers will not take on a case unless there is a baby that has been harmed or a serious mistake.

  3. angie says:

    Do a quick google search for “medical malpractice childbirth” and you’ll have your answer. Cesareans have lower SHORT-TERM risks, but of course have far worse outcomes, overall, for mother and baby (that, of course, they don’t have to deal with and are harder to place the burden of proof on/base a case on, after the fact).

    If you are able to find a family practice physician out there who still delivers babies, my experience is that they’re more likely to encourage/practice normal birth. But most just aren’t willing to pay the malpractice for it anymore.

    Attorneys are scum.

  4. elwood says:

    Jasmine, you are very right, and another huge problem with the current standard of maternity care in the United States is the lack of hands off births. If more OB/GYN’s were to start practicing the “midwifery model of care” then the birth risks and climate would be MUCH different than it is today.

  5. Jasmine says:

    There are plenty of doctors out there that fully abide by the WHO guidelines. There is a lack of education on all levels on the risks and benefits of C-births, there is a money factor, hospitals and doctors benefit and relying too much on the latest technology as doctors have lost their ability to be more hands on. I am just glad when I hear OB/GYNs who will get on their backs on the floor to deliver a baby and not just in the comfy quarter-back position waiting for the baby.

  6. elwood says:

    What about the number of other studies that show vaginal delivery as a much safer option? I mean, it is not rocket science. Even medical professionals will tell you the path with the least risk for the vast majority of women is a vaginal delivery.

    Major surgery for no medical reason should not be promoted.

  7. The conclusions drawn by the authors of the 2010 WHO survey are seriously flawed given the actual data contained within the survey’s findings. You can read the following reports for more information:

    30 Jan 10 Nigel Hawkes: A bad case of bias against Caesareans, Independent
    http://www.independent.co.uk/life-style/health-and-families/health-news/nigel-hawkes-a-bad-case-of-bias-against-caesareans-1883667.html

    26 Jan 10 Funny Figures from WHO on Caesareans, Straight Statistics
    http://www.straightstatistics.org/article/funny-figures-who-caesareans

    12 Jan 10 Study advises against non-medial cesareans but how accurate is the advice?
    http://cesareandebate.blogspot.com/2010/01/study-advises-against-non-medial.html

  8. Lindsey says:

    “But why are so many women making the choice for these elective surgeries?”

    Because they 1) honestly don’t know they have a choice, 2) know they have a choice, but believe a cesarean is the safer option, or 3) know vbac is the safer option, but are too scared of birth/lack support to try.

    It’s a multifaceted problem, that will require a multifaceted solution. But the first and biggest step is: Awareness. You can’t solve a problem until you’ve admitted you have one. And this article is a step in the right direction!