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Hello, my name is Brenda Minica. I am a San Antonio doula certified with Childbirth International.
Having had seven children of my own I have "been there" and I know how helpful a little encouragement and the right information can be.
Even if you don't need a doula in San Antonio, TX right now I would love to help you in whatever way I can!
So please e-Mail me,
or connect with me on Twitter
or my Facebook group if I can be of service.
With love, Brenda
Jul
24
2009
24
2009
Jul
20
2009
20
2009
Apr
15
2009
15
2009
Some Rules for Birth Partners
Click here to read more from this author – a mom of 3 boys and birth doula in California.
As an educator, I am pretty easy-going. My main goal is to offer accurate, evidence-based information and trust the expectant family to make the decisions they feel are right for their situation. I don’t give a lot of “you should do this” kind of advice — it’s just not my style, and I don’t think it lends well to a woman learning to trust her inner wisdom.
One place where I throw this out the window, though, is when it comes to “rules” a partner absolutely must follow. These rules are not covered in a particular class, rather they come up according to what topics we happen to be discussing. In class last week we happened to touch upon quite a few of these rules, and I told my families, “I should write these down.” Enter, the blog!
These are for partners, so the “you” in the sentence is not the woman who is pregnant, but her direct support person…I think you know who you are.
1. You are not allowed to have bad breath. Her breath will probably be less-than-optimal — she is working hard, breathing through her mouth, it could have been hours since she last brushed her teeth, or she may have thrown up her last snack. None of this matters. She needs support, often in a very close, in-your-personal-space kind of way. If her breath causes you to recoil, you can muster up your strength and remind yourself of the awesome events unfolding within her body. If your breath causes her to recoil, she may, very bluntly, tell you so, or maybe she will just involuntarily vomit in your lap. You have been warned. No chili cheese fries with extra garlic for you, partner. Breath mints, gum, and mouthwash are your friends.
2. You are not allowed to comment about anything else that might come out of her that is NOT a baby. It is very common for a woman to have a bowel movement during the second stage of birth — it is actually a good thing — not only does it provide extra space for a baby, it also shows she knows how to push. If a woman asks later, “Did I poop?” be careful, this question can be as loaded as, “Do I look fat?” My best answers to this question: “Hmm, I don’t remember,” or a solid, “No.” One situation, kids, where honesty doesn’t pay.
3. You are not allowed to try and have a conversation with her during a contraction. Commonly, partners pick this one up pretty quickly, so it is kind of a freebie. But, there is a second part: While this seems like a simple idea to you, others coming and going may not remember to “respect the contraction.” Your job is to run interference so the laboring woman can focus — remember her contractions are her body’s little bursts of working energy, and her concentration is needed. If a nurse or friend tries to talk to her at this point, not only can it be a source of irritation to her, it can actually impede her body’s ability to unroll the red carpet that is the birth process. “Let’s wait and ask her when the contraction is over.”
4. You are not allowed to suffer in silence if there are people in the room that your partner is obviously not comfortable with. This includes friends and family as well as hospital staff. If the person(s) happen to be friends or family, and they just won’t listen to your kind requests of removal, enlist help from your doula or nurse or practitioner. Get one of these fine folks alone in the hall and let her know your company has gotten out of control, and to save yourself the potential grudge at the 4th of July party and forever, could she please help you out? These professionals have mouths like magic wands and they can easily clear a room with smiles on their faces and official-ness in their voices. Your guests will never know what was at the root of their departure, and you have helped protect your partner and the space she needs to un-focus for birth.
If the unwanted guest happens to be working at the hospital, it is perfectly acceptable to ask for a replacement or a removal. If you feel there is a bad connection with your nurse, you can talk to her about it, talk to the nurse manager about it, or talk to your practitioner about it, and see if the situation can be changed for the better, either with improved communication, or with a new nurse who better fits your philosophy and birthing plans. If a nurse walks in with a group of students and your birthing partner does not want to be on the observation deck, this is a situation where you can ask for removal, in a nice way, of course. “My-partner-the-laboring-woman and I discussed this beforehand, and she is not comfortable having students present.”
5. You are not allowed to get upset if you catch the brunt of some unseemly comments. When a woman is having a baby, some odd things happen in her brain and she may not be in the “polite” part of her mind – that filter of sorts – that “nice-izes” the things we say. Imagine this: your eyes are closed and you are listening to something you know is very important, but it is lightly garbled and it runs together. Your job is to pick out the words and phrases and construct some logical instructions out of it. The words are being whispered, and you are concentrating hard, trying to understand them. At the same time, you are aware of a fly buzzing around your face. You don’t know how long the fly has been there, but suddenly it seems like forever, and in a nanosecond, the idea of that fly just consumes you, and you pop open your eyes and start flailing your arms around like crazy, surprised by how you went from zero to medieval in no time flat. That’s kind of what it’s like in your head when you are absorbed in having a baby.
6. You are not allowed to complain about being tired, hungry, sick, or sore. That just kind of goes without saying. If you feel you might need someone to help you help your partner if one of these four physical conditions should arise, consider hiring a doula. Not only does she help the laboring mother, she also ensures the birth partner is doing well, gets to eat, gets to rest, gets a shoulder rub, etc.
To sum up: Labor and birth are intense times. There is so much going on that it can be hard to know how to help. A woman must go through this process herself – no one can do it for her. But that doesn’t mean she has to be alone while she is doing it. The most important rule a partner should remember is to be with her and remind her of the wonderful job she and her baby are doing together, and that she has your support, your heart, and your presence during the process.
Author: Stacie Bingham. Printed with permission.
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Apr
13
2009
13
2009
Cesarean Section – What Happens During Surgery
If the mother is to be conscious, an anesthesiologist will inject spinal or epidural anesthesia (usually fentanyl, a derivative from the opium family; and bupivicane, a derivative from the cocaine family) into the mother’s back or epidural space (between the vertebra) via a thin catheter. Vomiting and/or dry heaves may occur as a reaction from the narcotics, as may uncontrollable shivering. A catheter is inserted into her urethra to allow urine to be eliminated.
In a sterile operating room, with a surgical team in “scrubs”, masks, hair net, and gloves, preparation continues with strapping the mother’s arms, crucifix-style, to an operating table. A nurse starts an IV with fluid and/or narcotics (usually demerol or stadol, a derivative of the morphine family), and an anesthesiologist applies oxygen and/or general anesthesia. A curtain is hung between the mother and her lower body to prevent her from seeing the surgery. Her belly is laid bare and she is completely naked, save for a hospital gown that is now pulled up to her neck or just below her breasts. Her belly and pubic area are rubbed with a 10% Povidone-Iodine solution (a.k.a. “Betadine”) and her pubic hair is shaved. A sticky plastic drape is laid over her belly to stabilize her skin.
A horizontal incision is made with a scalpel, just above the pubic bone where the pubic hair begins, slicing through five layers of skin, tissue, and muscle: 1) the derma, or outer layer of skin and 2) fat; 3) the fascia, the tough, thin layer that supports the muscle; 4) the rectus muscle, which is manually separated with the fingers down to the pubic bone; and 5) the peritoneum, the shiny layer that encases the entire abdominal cavity. Suction is applied to absorb excess blood. A metal “spatula” known as a bladder blade is inserted to pull back and protect the bladder. Another “spatula” known as a retractor is inserted at the top of the incision and/or on the sides, and are pulled back tightly to enlarge the incision, usually by two surgical assistants. Another incision is made into a sixth layer, the uterine lining, taking care not to cut the bladder, causing infection. Suction is again applied. Sponges and gauze are used to blot blood and fluid pooling in the abdominal cavity.
The mother may feel intense pulling and tugging to dislodge the baby’s head from the pelvis. If vertex, the baby is pulled by the neck backwards out of the pelvis and then by the head through the incision in the uterus. The baby’s nose and mouth are then suctioned to remove any amniotic fluid, mucous and/or meconium from the airway. The remainder of the baby’s body is pulled from the mother’s uterus through the abdominal incision, taking care not to tear the uterine or abdominal incision wider.
The umbilicus is clamped and cut immediately and the child may be held up over the curtain for the mother to see before being taken to a warm table to be suctioned further, toweled off, footprinted, weighed, measured, tagged and wrapped in a blanket and hat. Pitocin and/or methergine is immediately injected into the mother’s IV to begin contractions of the uterus to aid in the removal of the placenta. The remaining umbilicus is then pulled and the placenta is scraped off the uterine wall by hand to tear away the placenta from the uterine wall. The placenta is removed and examined to ensure all pieces are intact. The uterus is then removed from the mother’s body and placed on her stomach for the incision repair. One set of stitches is made in the wall of the uterus, then a second layer of stitches in the outer lining. The uterus is then pushed back through the abdominal incision and into the mother’s body. Sponges and gauze are counted to ensure none are left in the surgical cavity. The abdominal cavity is irrigated with water to flush out bacteria (to prevent infection) and check for bleeding.
Approximately 1000cc of blood is lost during the procedure. A layer of absorbable stitches are made in the rectus muscle, another layer of sutures are made in the fascia. The plastic drape is pulled away from around the abdominal incision and another set of absorbable sutures or staples may be used for the outer layer, usually removed three to five days later by a nurse. A second dose of demerol may be injected into the mother’s IV to aid in relaxation as she is wheeled into recovery to hold her child when the physician allows it. Again, the mother may experience dry heaves and/or uncontrollable shivering and chills.
Within 24 hours, the urine catheter is removed and she is allowed to stand and perhaps walk to the bathroom or shower. Within three to five days she is discharged and permitted to return home, with a check of her incision in two weeks. If infection or seeping occurs, antibiotics may be prescribed. Incision pain may occur constantly or intermittently for up to a year. Feeling may be regained on the incision site, or nerve damage may result in permanent lack of sensation. Her ability to birth normally in the future may be called into question.
For video of a cesarean section, contact The Learning Channel at (800) 544-1717 and request a copy of the video, “The Operation: Cesarean Section.”
This may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All Rights Reserved.
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Mar
27
2009
27
2009
Dangers of Labor Induction
Induction of Labor
The International Cesarean Awareness Network strongly advises women and health care practitioners to avoid induction of labor unless a true medical indication exists. Induction of labor frequently leads to further intervention in birth including the need for fetal monitoring, epidural anesthesia, instrumental delivery and cesarean section. Each of these interventions increases risks to babies and mothers.
First time mothers are especially vulnerable: Induction itself doubles a first-time mother’s risk of having a cesarean section.1,2
A cesarean puts a woman’s entire reproductive life, including subsequent pregnancies, at higher risk.
For all women, induction of labor increases the use of forceps and vacuum extraction as well as rates of shoulder dystocia.2,3
Women with a prior cesarean who are induced have a 33-75% risk of having another cesarean.4,5
Induction of labor has been shown to increase the risk of uterine rupture for women with a prior cesarean scar.6-9
Babies whose births are induced more often experience resuscitation, admission to the intensive care unit, and phototherapy to treat jaundice, which generally require separation from the mother. 10
References:
1. Maslow AS, Sweeny AL. Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstet Gynecol 2000 Jun;95(6 Pt 1):917-2.
2. Dublin S, Lydon-Rochelle M, Kaplan RC, Watts DH, Critchlow CW. Maternal and neonatal outcomes after induction of labor without an identified indication. Am J Obstet Gynecol 2000 Oct;183(4):986-94
3. Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 1998 Aug;179(2):476-80
4. Learman LA, Evertson LR, Shiboski S. Predictors of repeat cesarean delivery after trial of labor: do any exist? J Am Coll Surg. 1996 Mar;182(3):257-62.
5. Sims EJ, Newman RB, Hulsey TC. Vaginal birth after cesarean: to induce or not to induce. Am J Obstet Gynecol 2001 May;184(6):1122- 4.
6. Blanchette H, Blanchette M, McCabe J, Vincent S. Is vaginal birth after cesarean safe? Experience at a community hospital. Am J Obstet Gynecol 2001 Jun;184(7):1478-84; discussion 1484-7.
7. Baskett TF, Kieser KE. A 10-year population-based study of uterine rupture. Obstet Gynecol 2001 Apr;97(4 Suppl 1):S69.
8. Shimonovitz S, Botosneano A, Hochner-Celnikier D. Successful first vaginal birth after cesarean section: a predictor of reduced risk for uterine rupture in subsequent deliveries. Isr Med Assoc J 2000 Jul;2(7):526-8.
9. Ravasia DJ, Wood SL, Pollard JK. Uterine rupture during induced trial of labor among women with previous cesarean delivery. Am J Obstet Gynecol 2000 Nov;183(5):1176-9.
10. Boulvain M, Marcoux S, Bureau M, Fortier M, Fraser W. Risks of induction of labour in uncomplicated term pregnancies. Paediatr Perinat Epidemiol. 2001 Apr;15(2):131-8.
This material may be copied and distributed with retained copyright.
Click here to visit the ICAN Website.
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Mar
25
2009
25
2009
State of American Childbirth Fact Sheet
State of American Childbirth
Pregnancy and childbirth are normal, healthy processes for the majority of women and babies.
SCOPE AND SCALE OF MATERNITY CARE — EACH YEAR IN THE UNITED STATES:
- Over 4 million Births
- 99% in Hospitals
- Over 90% Attended by Surgeons
- Second Most Common Reason for Hospitalization
- Most Common Reason for the Hospitalization of Women
- Care for Mothers and Babies combined Rank 4th in Hospital Expenses
- Over 6.8 million Obstetric Procedures Performed – 2nd Most Common Category of Surgical Procedures
- Three of the Four Most Common Surgical Procedures Performed in the United States are Obstetric
Nearly all women giving birth in hospitals are subjected to some level of technological or medical intervention.
THE MOST COMMON INTERVENTIONS ARE:
- Over 31% (1.3 million) Cesarean Surgeries – Has risen over 50% since 1996, HIGHEST EVER
- Vaginal Birth after Cesarean (VBAC) rate has fallen over 50% since 1996, ACCESS DISAPPEARING
- 34% (1.4 million) of Labors Medically Induced
- 41% (1.66 million) Need Vaginal Stitching (episiotomy, tears, vacuum extraction, forceps)
- 47% (1.88 million) of Labors Artificially Stimulated
- 60% (2.4 million) of Women Denied Fluids
- 76% (3.04 million) of Women Restrained In Bed
- 85% (3.4 million) of Women Denied Food
- 86% (3.44 million) Given Drugs For Pain Relief
- Over 90% (3.68 million) of Women Attached To Electronic Fetal Monitors
What do we have to show for all this intervention?
OUTCOMES IN THE UNITED STATES:
- High Infant Mortality Rate – Stayed Flat over the last 6 years, 29th in the world – Twice as High for African American Babies
- Maternal Mortality Rate – Not Improved in 20 years, 25th in the world – Four times as High for African American Mothers
- 12.8% (over 546,000) of Babies Born Preterm – has Risen 21% since 1990
- Over 8.3% (over 354,000) of Babies Born Low Birth Weight – has Risen 19% since 1990
- 44% (1.76 million) of Mothers have Emotional Or Physical Impairment after Birth Interfering with Ability to Care for their Babies
- Over 25% (1 million) of Mothers have New Health Problems after Birth
- 63% (2.52 million) of Mothers have some symptoms of Postpartum Depression
- 18% (720,000) of Mothers show symptoms of Post Traumatic Stress with 9% showing all signs of PTSD.
With all the money we spend, why aren’t our outcomes better? Countries with lower costs and better outcomes for mothers and babies rely on midwives to attend most births – and many support out-of-hospital births.
The Midwives Model of Care & The Mother-Friendly Childbirth Initiative
www.cfmidwifery.org/mmoc www.motherfriendly.org
Promote Wellness, Education, and Individualized, Motherbaby-Centered Care.
Midwives are Key to Effective, Affordable Mother-Friendly Childbirth
Reprinted with Permission from Citizens for Midwifery
Click here for this article along with references.
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Mar
16
2009
16
2009
How Unecessary Medical Procedures are Taxing the System
“Two of the most over-utilized and most commonly performed surgeries in America are cesarean sections and hysterectomies. When a doctor and a hospital get involved in the natural process of childbirth, time is money. “Spontaneous deliveries,” as they are often referred to (where there is no surgical intervention), are time-consuming for doctors.”
To read the rest of this article, click here.
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Mar
08
2009
08
2009
What to Do if Your Hospital Has “Banned” VBAC Delivery
Your Right to Refuse: What to Do if Your Hospital Has “Banned” VBAC Q & A
The International Cesarean Awareness Network has tracked over 300 hospitals across the U.S. that have instituted policies seeking to ban vaginal birth after cesarean (VBAC), misleading women to believe they must undergo cesarean surgery whether there is a medical need for it or not. Clinical research shows the risks of VBAC are small and that repeat cesarean surgery carries its own risks. In spite of this, many hospitals have attempted to ban VBAC in order to limit their exposure to liability. As a result, many women around the U.S. have been told they must choose unnecessary surgery or forgo hospital care altogether. Below is a guide for women in this situation. Women who are seeking to avoid other medical interventions will also find this information useful.
Q: Does my doctor or hospital have the right to force me to undergo surgery?
A: No. You have the legal right to refuse any medical treatment, including cesarean surgery. VBAC “bans” exist only because they have not been challenged by patients. The doctrine of informed refusal is upheld by common law, case law, Constitutional law, federal law, state law, state mandated medical ethics and the ethical guidelines of the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). Any facility or care provider claiming that you must undergo a cesarean you wish to refuse is violating the governing principles of their respective institutions and professions, as well as the rule of law.
Q: What can I do to protect myself from being forced into surgery?
A: There are multiple steps you can take to protect yourself:
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Know your rights. Visit BirthPolicy.org to learn more about the illegal and unethical status VBAC “bans.”
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File a grievance with the Chief Compliance Officer at the hospital where you plan to give birth. Hospitals that attempt to ban VBAC are in violation of the Center for Medicare and Medicaid Services (CMS) Conditions of Participation (CoP), which require all federally funded hospitals (approximately 80%) to honor the rights of patients to be informed of the risks, benefits, and alternatives of all procedures, to refuse any proposed treatment, including cesarean surgery, and to participate in all treatment decisions. To hold your hospital accountable under these regulations, you must first file a complaint with the hospital’s Chief Compliance Officer, who is required to issue a ruling within 60 days. If the CCO rules against you, then you have the right, first, to appeal to the your state CMS office and then to Office of the Inspector General’s Office at the Department of Health and Human Services. If HHS rules against you, then your appeal goes to the Department of Justice, which is authorized to bring litigation against the hospital on your behalf. You can read the CoP regulations by going to the Code of Federal Regulation’s main page. Enter “42CFR482.13″ into the search engine, which will bring up all of the CoP regulations on patient rights and filing grievances. To find contact information for your state CMS office, go to MedLaw.
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Replace your birth plan with a customized form documenting your refusal to consent. By law, you are not required to sign the hospital’s consent form. You can either customize the hospital’s form or write down your refusal to consent to treatment on any piece of paper and sign it. Put a line through any listed procedure you want to decline and then add the list of routine procedures, including cesarean surgery, you want to refuse, initial each change or addition and make sure you have all the required signatures. Doing so will legally document your refusal to consent and alert staff that you understand and are prepared to protect your rights. In addition, such a document will require staff to obtain direct, verbal consent from you each time they want to do a procedure you’ve already declined in writing. If possible, pre-register at the hospital no sooner than thirty days before your due date and take the forms home with you to review, add to, and sign. Be sure to keep personal copies of any forms you sign ansk your partner or doula to record any changes that were made during the course of your labor.
Q: What if the hospital refuses to admit me unless I consent to a cesarean?
A: The federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to admit women in active labor and to abide by their treatment decisions until after the baby and placenta are delivered. The act was originally designed to prevent hospitals from “dumping” patients who couldn’t pay but has since been widely used to hold hospitals accountable for violating other patient rights, including the right to refuse treatment. If your hospital threatens to perform a cesarean despite your refusal, notify them that they are in violation of your rights under EMTALA and that you plan to file a complaint. To find out where to report an EMTALA violation, go to MedLaw.
Q: What happens if my care provider ignores my refusal to consent and performs a cesarean anyway?
A: Many women have been threatened by their care providers that they would be put under general anesthesia and sectioned if they sought care in the hospital, even if they were close to delivering the baby naturally. While these threats are intimidating, they are not supported in either legal or ethical guidelines. If your care provider performs surgery in spite of your refusal, you are within your legal right to file criminal assault and battery charges and, if you or your baby suffer an injury, you may also sue for negligence.
Q: What if I challenge my care provider and he or she decides to drop me from care?
A: Professional ethical guidelines state that a physician may only drop you from his care after giving you 30 days notice. This means that if you are within 30 days of your likely delivery date, your care provider cannot terminate your care. In addition, if you are pregnant and are outside of that 30 day time frame, your provider must give you a referral and ensure you are transferred to a specific provider. Physicians who fail to meet these guidelines may be charged with patient abandonment, which is grounds for malpractice and constitutes a violation of ethical conduct that could result in loss of licensure.
Q: What if my care provider or hospital seeks a court order to perform a cesarean?
A: While there is always the possibility that the local court could grant an order forcing you to undergo a cesarean, these cases have become very rare in the aftermath of several court rulings declaring that such orders violate the rights of pregnant women. As a result of these rulsing, both the AMA and ACOG have revised their ethical guidelines to state that court-ordered cesareans are rarely, if ever, justified, and are most definitely not justified in instances where the proposed treatment poses any risks to the mother.
Q: I want to give birth in a hospital, but I am afraid that this is too much stress on my pregnancy and my family.
A: Unfortunately, the options for women whose hospitals have attempted to ban VBAC are limited. Your choices are to fight and assert your legal rights, submit to surgery, or opt for homebirth, either unassisted or attended by a midwife. Educate yourself about the benefits and risks of each option, and make the decision that is best for you and your baby. Call your local ICAN chapter for more information on your options and on the resources available to facilitate your decision.
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Mar
05
2009
05
2009
Things You Can Do to Avoid An Unnecessary Cesarean
The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly 1 million cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, half of the cesareans could have been avoided. Clearly, there are times when cesareans are necessary. However, cesareans increase the risk to both mothers and babies. These are suggestions of things you can do to avoid an unnecessary cesarean and can help insure that your birth experience is as healthy and positive as possible.
BEFORE LABOR
- Read and educate yourself, attend classes and workshops inside and outside the hospital.
- Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center.
- Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest?
- Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor.
- Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc.
- Become aware of your rights as a pregnant woman.
- Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of cesarean.
- Help ensure a healthy baby and mother by eating a well-balanced diet.
- If your baby is breech, ask your care provider about exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion.
- If you had a cesarean, seriously consider VBAC. According to the American College of Obstetricians & Gynecologist, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesareans can go on to birth their subsequent babies vaginally.
DURING LABOR
- Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you.
- Continue to eat and drink lightly, especially during early labor, to provide energy.
- Avoid pitocin augmentation for a slow labor. As an alternative, you may want to try nipple stimulation.
- If your bag of water breaks, don’t let anyone do a vaginal examination unless medically indicated for a specific reason. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection.
- Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.
- Avoid using an epidural. Medical research has shown that epidurals can slow down labor and cause complications for the mother and baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing.
- Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest.
- Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on you and your baby, and what are your other options.
- Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.
This may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All Rights Reserved.
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Mar
04
2009
04
2009
Cesarean Fact Sheet
*Note from Brenda: The cesarean rate in Texas for 2006 was 33.2% and is much higher in certain hospitals in our area. This is an issue that every pregnant woman needs to be informed about.
Cesarean Fact Sheet
- These facts are presented by the International Cesarean Awareness Network with the hope that parents, childbirth educators, doulas, nurses, midwives and doctors together can effectively reduce the rate of unnecessary cesarean sections and their effects.
- A cesarean (si-‘zar-E-an) section is major abdominal surgery used for the delivery of an infant through an incision in the mother’s abdomen and uterus. The incision may be made across the bottom of the abdomen above the pubic area (transverse) or in rare instances, in a line from the belly button to the pubic area (vertical). Learn More: Cesarean section – what happens during delivery.
- When a cesarean is necessary, it can be a lifesaving procedure for both mother and baby.1 However, psychological outcomes such as negative feelings, fear, guilt, anger and postpartum depression are common consequences of both emergent and elective cesarean sections.2,3,4 A cesarean section is only indicated in the following situations:
- Complete placenta previa at term
- Transverse lie at complete dilation
- Prolapsed cord
- Abrupted placenta
- Eclampsia or HELLP with failed induction of labor
- Large uterine tumor that blocks the cervix at complete dilation (Most fibroids will move upwards as the cervix opens, moving it out of baby’s path.)
- True fetal distress confirmed with a fetal scalp sampling or biophysical profile
- True absolute cephalopelvic disproportion or CPD (baby too large for pelvis). This is extremely rare and only associated with a pelvic deformity (or an incorrectly healed pelvic break). Fetal positioning during labour and maternal positioning during second stage, most notably when women are in a semi-sitting position, cause most CPD diagnosed in current obstetrics.5
- Initial outbreak of active herpes at the onset of labor
- Uterine rupture
- Many reasons given for cesarean, especially prior to labour, can and should be questioned. This includes macrosomia (large baby),6,7,8 maternal age,9 and parity,10 assisted reproductive technology,11 CPD,12 dystocia, failure to progress, breech,13,14 fetal distress or even prolonged second stage.15 There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth.16
- The cesarean section rate remains at an alarmingly higher rate in many industrialized countries than the 10-15% average recommended by the World Health Organization, causing unnecessary risk to both mother and baby.17 Healthy People 2010 recommends a reduction in cesarean births in the US to 15% by 2010.18
- A cesarean poses documented medical risks to the mother’s health. These risks include infection,19 blood loss and hemorrhage,20 hysterectomy,21,22 transfusions,23 bladder and bowel injury,24,25 incisional endometriosis,26,27 heart and lung complications,28 blood clots in the legs,29 anesthesia complications,30 and rehospitalization due to surgical complications,31 rate of establishment and ongoing breastfeeding is reduced,32 and psychological well-being compromised and increased rate emotional trauma.33 Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse.34 Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs and the risk of chronic problems from adhesions.35 One-half of all women who have undergone a cesarean section suffer complications, and the mortality rate is at least two to four times that of women with vaginal births. Approximately 180 women die annually in the United States from elective repeat cesareans alone.
- Each successive cesarean greatly increases the risk of developing placenta previa, placenta accreta and placental abruption in subsequent pregnancies.36,37,38 Both of these complications pose life-threatening risks to mother and baby. Cesareans also increase the odds of secondary infertility, miscarriage and ectopic pregnancy in subsequent pregnancies.39,40
- A cesarean poses documented medical risks to the baby’s health.41 These risks include respiratory distress syndrome (RDS),42,43,44,45 iatrogenic prematurity (when surgery is performed because of an error in determining the due date), 46,47 persistent pulmonary hypertension (PPH),48 and surgery-related fetal injuries such as lacerations.49,50 Preliminary studies also have found cesarean delivery significantly alters the capability of cord blood mononuclear cells (CBMC) to produce cytokines.51 An elective cesarean section significantly increases the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial cost. Even with mature babies, the absence of labor increases the risk of breathing problems and other complications. Far from doing better, even premature and at risk babies born by cesarean fare worse than those born vaginally.
- Cesareans can delay the opportunity for early mother-newborn interaction, breastfeeding, and the establishment of family bonds.52,53,54
- Cesarean rates are influenced by nonmedical factors. These include: individual philosophy and training, convenience of doctor or patient, the patient’s socioeconomic status, peer pressure, fear of litigation, and financial gain.55,56,57
- In the United States, obstetricians offer defensive medicine as an excuse for the astronomical and sharply rising U.S. cesarean rate. Deliberately performing unnecessary surgery in the belief it avoids lawsuits is indefensible. That many obstetricians seem oblivious to the profound violation of ethical principles is shocking.58,59
- Vaginal Birth After Cesarean (VBAC) is safer for both mother and infant, in most cases, than is routine elective cesarean, which is major surgery.60,61,62,63,64,65,66 Learn More in our VBAC Section.
- The risk to your infant from the very low incidence of uterine rupture (less than 1%) after a prior cesarean is much less than the risk to your infant from respiratory distress as a result of a scheduled cesarean.67,68,69,70
The International Cesarean Awareness Network (ICAN) founded as Cesarean Prevention Movement in 1982, has chapters, individuals, an international newsletter (the Clarion), email line and website ready to give you support and information. For more information, please call 1-800-686-ICAN or visit http://www.ican-online.org/.
References:
1. Wagner M. Choosing Cesarean Section. Lancet 2000; 356: 1677-80.
2. Ryding, Elsa Lena, Wijma, Klaas & Wijma, Barbro. Experiences of Emergency Cesarean Section: A Phenomenological Study of 53 Women. Birth 1998; 25 (4), 246-251.
3. Soet, Johanna E., Brack, Gregory A. & DiIorio, Colleen. Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth. Birth 2003; 30 (1), 36-46.
4. Koo, Vincent, Lynch, Janine & Cooper, Stephen. Risk of postnatal depression after emergency delivery. The Journal of Obstetrics and Gynaecology Research 2003; 29 (4), 246-250.
5. Gupta J, Glanville J, Johnson N, et al. The effect of squatting on pelvic dimensions. Eur J Obstet Gynecol Reprod Biol 1991;42: 19-22.
6. Parry S, Severs CP, Sehdev HM, Macones GA, White LM, Morgan MA. Ultrasonographic Prediction of Fetal Macrosomia: Association with Cesarean Delivery. J Reprod Med 2000;45:17-22.
7. Haram, Kjell, Pirohonen; Jouko, Bergsjo. Suspected big baby: a difficult clinical problem in obstetrics. Acta Obstetricia et Gynecologica Scandinavica 2002; 81 (3), 185-194.
8. Sandmire, Herbert F. & Woolley, Robert J. IN THE LITERATURE Macrosomia: Can We Prevent Big Problems with Big Babies? Birth 25 1998; (4), 263-267.
9. Kozinszky, Zoltán, Orvos, Hajnalka, Zoboki, Tünde, Katona, Márta, Wayda, Kornelia, Pál, Attilla, Kovács, László. Risk factors for cesarean section of primiparous women aged over 35 years. Acta Obstetricia et Gynecologica Scandinavica 2002; 81 (4), 313-316.
10. Qublan, Hussein, Alghoweri, Ahmad, Al-Taani, Mohammad, Abu-Khait, Sami, Abu-Salem, Areej & Merhej, Ahmad. Cesarean section rate: The effect of age and parity. J Obstet Gynaecol Res 2002; 28 (1), 22-25.
11. Kozinszky, Zoltán, Zádori, János, Orvos, Hajnalka, Katona, Márta, Pál, Attila & Kovács, László. Obstetric and neonatal risk of pregnancies after assisted reproductive technology: a matched control study. Acta Obstetricia et Gynecologica Scandinavica 2003; 82 (9), 850-856.
12. Brabin, Loretta, Verhoeff, Francine, Brabin, Bernard. Maternal height, birthweight and cephalo pelvic disproportion in urban Nigeria and rural Malawi. Acta Obstetricia et Gynecologica Scandinavica 2002; 81 (6), 502-507.
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14. Keirse, Marc J.N.C. Evidence-Based Childbirth Only For Breech Babies? .Birth 2002; 29 (1), 55-59.
15. Janni, Wolfgang, Schiessl, Barbara, Peshcers, Ursula, Huber, Sandra, Strobl, Barbara, Hantschmann, Peer, Uhlmann, Natalie, Dimpfl, Thomas, Rammel, Gerhard & Kainer, Franz.. The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome. Acta Obstetricia et Gynecologica Scandinavica 2002; 81 (3), 214-221.
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21. Engelsen, Ingeborg Bøe, Albrechtsen, Susanne & Iversen, Ole Erik. Peripartum hysterectomy-incidence and maternal morbidity. Acta Obstetricia et Gynecologica Scandinavica 2001 80 (5), 409-412.
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27. Wolf GC, Singh KB. Cesarean scar endometriosis: A review. Obstet Gynecol Surv 1989; 44(2):89-95.
28. 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.
29. 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.
30. Kawashima, Y., Takahashi, S., Suzuki, M., Morita, K., Irita, K., Iwao, Y., Seo, N., Tsuzaki, K., Dohi, S., Kobayashi, T., Goto, Y., Suzuki, G., Fujii, A., Suzuki, H., Yokoyama, K. & Kugimiya, T. Anesthesia-related mortality and morbidity over a 5-year period in 2,363,038 patients in Japan. Acta Anaesthesiologica Scandinavica 2003; 47 (7), 809-817.
31. 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.
32. 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.
33. Ryding, Elsa Lena, Wijma, Klaas & Wijma, Barbro. Experiences of Emergency Cesarean Section: A Phenomenological Study of 53 Women. Birth 1998; 25 (4), 246-251.
34. Hesham Al-Inany. Intrauterine adhesions; An update. Acta Obstetricia et Gynecologica Scandinavica 1998; Vol. 80, 11: 986-993.
35. Almeida EC, Nogueira AA, Candido dos Reis FJ, Rosa e Silva JC. Cesarean section as a cause of chronic pelvic pain. Int J Gynaecol Obstet. 2002 Nov;79(2):101-4.
36. Zaideh, SM et al. Placenta praevia and accreta: Analysis of a two-year experience. Gynecol Obstet Invest 1998; 46(2):96-8.
37. 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.
38. Miller DA, Chollet JA & Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210-214.
39. 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.
40. Hall MH, Campbell DM, Fraser C & Lemon J. Mode of delivery and future fertility. Brit J Obstet Gynecol 1989; 96: 1297-1303.
41. Wagner M. Choosing Cesarean Section. Lancet 2000;356: 1677-80.
42. 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.
43. 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.
44. 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.
45. 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.
46. 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.
47. 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.
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51. Brown, Mark A., Rad, Parmis Y. & Halonen, Marilyn J. (2003) Method of birth alters interferon-gamma and interleukin-12 production by cord blood mononuclear cells. Pediatric Allergy and Immunology 14 (2), 106-111.
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57. Beilin, Y., Friedman, F., Andres, L. A., Hossain, S. & Bodian, C. A. The effect of the obstetrician group and epidural analgesia on the risk for cesarean delivery in nulliparous women. Acta Anaesthesiologica Scandinavica 2000; 44 (8), 959-964.
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66. Mozurkewich. VBAC Safer than You Think. ObG Management 2002; 14:56.
67. 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.
68. 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.
69. 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.
70. 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.
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