Wednesday, July 20, 2011

Are 94% of births really complicated?

C-Section Rates are Higher than EVER!

Rates of Cesarean section deliveries in the United States climbed to 34 percent in 2009, hitting an all time high, a new study says.
Florida, New Jersey and Texas had the highest rates, while Utah, Wisconsin and Colorado had the lowest of the 19 states included in the study.
"Obviously, a 34 percent C-section rate is far too high," said Jacqueline Wolf, a researcher at Ohio University who wasn't involved in the study. "Medical reasons alone cannot possibly explain why more than one in three American women need major abdominal surgery in order to safely give birth."

A C‐section (cesarean section) is necessary to remove the baby from the uterus when a vaginal delivery could risk the health of the mother or the baby, or when a prior C‐section makes vaginal delivery difficult or dangerous.
"In many cases of C‐section in recent years, the benefits may be questionable and important healthcare organizations, including the Joint Commission and the Agency for Healthcare Research and Quality, have endorsed safely reducing C‐sections rates in certain types of pregnancies," wrote the study researchers.
The new study was performed by HealthGrades, a company whose website allows patients to search for and rate physicians.
Rising rates
The researchers examined C-section rate from 2002 through 2009 in the 19 states with publicly available health data. The rate increased from 27 percent to 34 percent during that time. Separate studies by the Centers for Disease Control and Prevention found the national rate to be 32 percent in 2007.
Of the 19 states studied, Florida, New Jersey and Texas had the highest percentages of C‐sections (38.6 percent, 38 percent and 35.9 percent, respectively). States with the lowest rates of C‐section deliveries were Utah, Wisconsin and Colorado (22.4 percent, 25.1 percent and 27.3 percent, respectively).
Risky surgery
Groups such as the World Health Organization have suggested that the Caesarean rate should be 15 percent. The Joint Commission, a non-profit that accredits and certifies health care organizations, noted in their standards of care manual on C-sections that "there are no data that higher rates improve any outcomes, yet the C‐section rates continue to rise."
National C -section rates are on the rise for many reasons, according to the new study. Some factors include common practices such as labor induction and epidural use, which can lead to complications that in turn, can lead to C-sections. Factors that lead to risky deliveries in general — including obesity, diabetes, multiple babies and increased age — are also on the rise.
Some mothers and physicians opt for C-sections just so the timing of the birth is convenient for one or both, the study said.

The rising rate isn't without risk. "Although C‐sections are generally considered safe, it is important to understand that a C-section is still a major surgical procedure that includes serious risks to mothers and babies," the study authors wrote.
Pass it on: C-section rates continue to climb, and many may be unnecessary.

A Surprising Downside of Epidurals

Epidural anesthesia remains the most popular form of pain relief in labor. Nurses, physicians, and many midwives like epidurals because the mother is comfortable and quiet, resulting in less work for hospital staff.

Laboring women like epidurals because they can remain awake and alert, while feeling little or no pain during labor.

Many negative aspects of epidurals have been debated among researchers. Downsides to epidurals reportedly include delay in labor, increase in vacuum/forceps deliveries, and increase in c-sections. But aren’t these possible side effects outweighed by the positive effect of a pain-free labor?

In one research study, investigators found that women who had pain eliminated during labor still reported that they suffered! Concluding that no pain did not necessarily mean no suffering, Wuitchik¹ emphasized the need for women with epidural anesthesia to have continual labor support available. In this study, women described distress over itching, numbness, and nausea–all side effects of epidural anesthetic. The women also reported concern over the baby’s well-being. A common effect of epidurals is a prolonged drop in the baby’s heart rate. While hospital staff may take this in stride, it can be very frightening to the laboring woman. Another interesting finding was that women reported feelings of incompetence and fear over being left alone once they were “comfortable”. Wuitchik concluded, “With epidurals, pain levels were reduced or eliminated. Despite having virtually no pain, these women also engaged in increased distress-related thought during active labor. The balance of coping and distress-related thought for women with epidurals was virtually identical to that of women with no analgesia”.

Women who had epidurals expressed just as much need for continued support as women who had unmedicated births, concludes another research study.² In fact, satisfaction with the support received during labor had more influence on the woman’s satisfaction with her birth experience than her level of pain relief did, according to Mother-Friendly Childbirth — Highlights of the Evidence.

If you are planning an epidural, or even if you are not planning an epidural but plan a hospital birth — do yourself a favor and hire a doula for continuous labor support. It can make a huge difference in your satisfaction with your experience. I think the fact that continuous support influenced birth satisfaction more than pain relief explains why many studies conclude that women who had unmedicated births (most often these are women who have doulas and/or midwives during labor) were happier with their experiences than those with medicated births. It’s not the medication or the absence of medication that made the difference, but the presence of someone there to give continual support. A partner may give excellent support, but partners need support, too! Partners get tired, need to eat, go to the bathroom, get discouraged, just like laboring moms do. A doula is there for both of you, and a good doula will give you your space when you need it, time for just the two of you when you need it, yet be there with just the support you need at the right moment when it is needed.

1. Wuitchik M, et al. (1990) Relationships between pain, cognitive activity, and epidural analgesia in labor. Pain 41:136-142.

2. Lally JE, et al. (2008) More in hope than expectation: A systematic review of women’s expectations and experience of pain relief in labour.

Monday, July 18, 2011

Big Days are Coming Soon!

Big days are coming soon! Or births, I should say :) Everyday gets closer to the 3 amazing births that I will be blessed to attend soon. I am looking forward to every moment of helping the mothers as their children are born. What a blessing!

And hopefully, should things work out in my favor, I will be attending a two day doula workshop in October. Several other local doulas in my network have been a part of past workshops and have given amazing reviews so I am very excited to possibly be a part of the upcoming event and add to my skills.