Monday, March 30, 2009

Cesarean section and VBAC, again

Here are a few recent articles that are worth reading given recent discussions about VBACs, cesarean sections (elective or otherwise), and the ever-climbing cesarean rate.

The first is an excellent, thorough article in The Poughkeepsie Journal covering the trend to perform cesareans more and more often: Birth by Surgery: The Skyrocketing Cesarean Rate. The author did quite well in covering the salient issues in depth. The article begins with the story of a woman who had an "elective" cesarean for a large baby that turned out to be 2 1/2 lbs lighter than the ultrasound estimate:

Two weeks before Kristi Ashley gave birth to a son in 2007, an ultrasound exam estimated the baby at a hefty 12 pounds, 10 ounces — too big, her doctor believed, for a safe vaginal delivery. After the child weighed in at 9 pounds, 4 ounces in the delivery room, Ashley came to believe that the planned cesarean section she had, with its attendant pain, long recovery and what she called "emotional damage," may have been a rush to judgment.

"It's very hard to go up against your physician, especially at the 12th hour," said Ashley, 38, of Hopewell Junction. "I think doctors are very quick these days to get scared. They would rather opt for the surgical solution."

Determined to avoid another surgical birth and aided by a supportive doctor, hospital and birthing coach, Ashley last month did something that has become increasingly rare for post-cesarean women today: She gave birth vaginally, to another son.

In an era of soaring malpractice premiums, technology that sometimes sets off false alarms, physicians pressed for time and mothers-to-be conflicted by fear, cesarean-section birth is soaring to its highest levels ever. Read the rest of the article here.

The next article by the same author, Modern medicine increasingly intervenes in the birth process, discusses many of the same issues, in addition to the increasing medicalization of childbirth.
In the decade through 2002, something momentous happened to babies in the wombs of American women, especially white women. The average time fetuses spent there decreased from 40 weeks to 39.

The decline, reported in a 2006 study in the medical journal Seminars in Perinatology, appears to have little to do with nature.

Instead, earlier births may be the outcome of “increased use of induction (of labor) and other obstetric interventions such as cesarean delivery,” said a January report by the U.S. Centers for Disease Control. Prematurity rose 20 percent since 1990, the report said, and the rate of low birth-weight babies hit a 40-year high.

“We are shortening the gestational age,” said Dr. Carol Sakala, program director for the research and advocacy group Childbirth Connection. “That is a big interference with mammalian evolution, human evolution.”

Researchers, midwives, birth coaches and mothers point to such data as symptoms of a flawed system of birthing in America, one they say over-manages, over-medicates and over-monitors labor and delivery, often leading to unnecessary cesarean-section births. Read the rest of the article here.

The last article is a glimmer of hope amidst the gloom of our contemporary obstetrical culture. In C-section births fall, one hospital has lowered its cesarean rate (18% last year, usually around 16%). Some of the key practices the hospital has adopted are taking a midwifery approach to childbearing with a focus on facilitating spontaneous, natural births, minimizing the routine use of technology and interventions, and offering and encouraging VBACs.

While more and more women choose to undergo Cesarean section births despite a national push by the federal government to decrease the number, the local rate has declined and is well below the state average.

North Adams Regional Hospital performs significantly fewer c-sections than other hospitals around the state — an average of 18 percent of all births at the hospital compared to the state average of 34 percent, according to reports released by the state Department of Public Health.

The hospital also has a better prenatal care record, according to the reports: 94 percent of women giving birth have had nine or more prenatal care visits versus the state average of 87 percent having that many visits.

"I think what is being reflected in our numbers is that we are taking a more 'midwifery' approach with our practice then before," Robin Rivinus, a certified nurse midwife with Northern Berkshire Obstetrics & Gynecology at the hospital, said last week. "It means that we do fewer unnecessary interventions — inductions, Cesarean sections, episiotomies. We treat childbirth as the normal, natural thing that it is. We only step in when it's medically necessary, which is much better for both the mother and the baby." Read the rest of the article here.


  1. Thank you for posting all three of these. It's nice to hear some noise being made about this outside our little blogosphere...and nice to see that at least one hospital knows what to do about this calamity!

  2. Hilarious! These were all of the articles I was going to blog tonight!! Now I can just send a convenient link right to this post.

  3. We still have a long way to go... but it gives us a little bit of hope when you read things like this...

  4. I found that part about "shortening the gestational age" to be a bit disturbing. I wonder what the long-term effects are going to be of all this.

  5. The more I think about this subject, the more I think that this problem has two roots.

    1)C/sections are thought of as normal. We need to see a shift of thought on what normal childbirth is, much like we've been seeing in the breastfeeding/formula problem. My oldest child is 5, and I've really been seeing improvement in this area. I'm 23 weeks, and instead of getting formula samples, I've been getting breastfeeding books and DVDs (same doctor's office).

    2)Something needs to take place in our legal drive by lawsuit world. A lot of docs need to know that if they do everything they are trained to do, they don't have to worry about being sued because something "happened" that was beyond their control.


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