Too Many C-Sections: Docs Rethink Induced Labor

The rise in cesarean-section deliveries in recent years has been characterized by some as a key indication of the overmedicalization of childbirth. While the procedure undoubtedly saves lives and leads to better health outcomes for mothers and infants who face problems during pregnancy and labor, many experts say the procedure is being performed too often, and in many cases for nonmedical reasons, putting healthy women and babies at undue risk of complications of major surgery.

The rate of C-sections has reached more than 31% in the U.S., a historical high, according to 2007 data from the American College of Obstetricians and Gynecologists (ACOG). The reasons for the increase are many and have been widely discussed: the rising rate of multiple births, more obesity in pregnant women, the older age of women giving birth. In fact, C-sections have become so common that many women may have an inflated sense of safety about them. "For the most part, moms and babies go through the process healthy and come out healthy, so maybe there's this sense that we're invincible," says Dr. Caroline Signore of the Eunice Kennedy Shriver National Institute for Child Health and Human Development. (See pictures of pregnant-belly art.)

But C-section carries all the attendant risks of major surgery; and data show that compared with vaginal birth, cesarean delivery increases the odds that a mother will end up back in the hospital after birth with complications such as bleeding or blood clots.

Now obstetrics experts are actively seeking ways to drive down the number of C-sections. On July 21, the ACOG issued new guidelines recommending that hospitals allow most mothers who desire vaginal birth after cesarean, or VBAC, to attempt a trial of labor, including some mothers who are carrying twins or have had two prior C-sections. Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits. (Read how postpartum depression can strike fathers.)

To read the rest of this article click here.

Birthing Options Grow Scarce after C-Sections

By Hana Askren
WeNews commentator
Tuesday, November 15, 2011

In her doula work Hana Askren finds that women who want a vaginal birth after a Caesarean often cannot find a doctor or hospital to provide this kind of care.

We are constantly making choices about how to lead our lives. We wage political and economic battles over what kinds of choices citizens should be allowed to make--from school vouchers to having an abortion--with the recognition that each choice entails conflict.

But one choice you don't hear so much about is that of certain maternity patients to choose their birthing method. That's because, in this case, little choice is left.

Mainly I work as a journalist. But in my sideline work as a doula, or nonmedical birth assistant, I come across many women desiring the security of hospital facilities "just in case" who can still attempt a natural birth with a hospital-based midwife or doctor.

Bookmark and Share

No similar choice exists for many who have had a Caesarean section and would like to try a vaginal delivery referred to as a VBAC, vaginal birth after C-section.

If such women are not comfortable with giving birth at home, they are often unable to find a doctor to agree to attempt a vaginal birth in a hospital. One woman I spoke to worked with seven care providers in her part of Maryland, never finding a doctor to support her, while another, in Brooklyn, transferred three times before she found a VBAC-friendly practice. At that point she was 32 weeks along.

During the last 10 to 15 years, many hospitals have banned VBAC and obstetricians have stopped offering it in favor of elective repeat Caesarean sections, mainly due to liability concerns.
VBAC Safety Studied

At the same time, recent studies from health authorities such as the National Institutes of Health and the Agency for Health Quality and Research have shown that VBAC can be safe, often safer for the mother than a repeat Caesarean. There is a fraction of a percent chance that labor contractions will cause the old scar to separate. Meanwhile, repeat Caesarean sections carry a comparable risk of hemorrhage, infection and other complications, increasing with each subsequent surgery.

To read the rest of this article click here.