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2010 VBAC Summit 02/19/2010
 
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Nancy Wainer, CPM and Author of
Silent Knife:
Cesarean Prevention and VBAC

Below you will find one of the Power Point presentations used by one of the speakers, which talk about the effects of cesarean birth on the newborn. It is one of the topics that concerns our organization as we try to help mothers and fathers to make educated decisions about methods of birth and how they impact the well-being of our babies.

2010 VBAC Summit Topic: Conversations about the reality of maternity care in the United States:  Skyrocketing cesarean rates and the decline in vaginal births after cesareans.

Make sure to click with your mouse on each slide to go to the next.

http://www.vbacsummit.org
Speakers:
Nancy Wainer, CPM
Dr. Magloire, OB-GYN
R. Zachary Pearson-Martinez, MD FAAP
Tamara Taitt, MS
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The Coalition for Improving Maternity Services (CIMS) is concerned about the dramatic increase and ongoing overuse of cesarean section. Since 1983, one in five women or more has given birth by this major abdominal surgery. Today, one in four or 25% of women have a cesarean for the birth of their baby. The rate for first-time mothers may approach one in three. Studies show that the cesarean rate could safely be halved. The World Health Organization recommends no more than a 15% cesarean rate. With a million women having cesarean sections every year, this means that 400,000 to 500,000 of them were unnecessary.

No evidence supports the idea that cesareans are as safe as vaginal birth for mother or baby. In fact, the increase in cesarean births risks the health and well being of childbearing women and their babies.

For elective repeat cesarean, the consensus of dozens of studies totaling tens of thousands of women is that elective repeat cesarean section is riskier for the mother and not any safer for the baby. Recent studies used to conclude otherwise are both seriously flawed and have been misrepresented in the media.

In addition to the hazards of cesarean section per se, the risks of certain complications increase with accumulating surgeries. Studies also show that seven out of ten women or more who are allowed to labor without undue restrictions will give birth vaginally, thus ending their exposure to the dangers of cesarean section.

Hazards of Cesarean Section to the Mother
  • Women run 5 to 7 times the risk of death with cesarean section. ·Complications during and after the surgery include surgical injury to the bladder, uterus and blood vessels (2 per 100), hemorrhage (1 to 6 women per 100 require a blood transfusion), anesthesia accidents, blood clots in the legs (6 to 20 per 1000), pulmonary embolism (1 to 2 per 1000), paralyzed bowel (10 to 20 per 100 mild cases, 1 in 100 severe), and infection (up to 50 times more common).
  • One in ten women report difficulties with normal activities two months after the birth, and one in four report pain at the incision site as a major problem. One in fourteen still report incisional pain six months or more after delivery.
  • Twice as many women require rehospitalization as women having normal vaginal birth. 
  • Especially with unplanned cesarean section, women are more likely to experience negative emotions, including lower self-esteem, a sense of failure, loss of control, and disappointment. They may develop postpartum depression or post-traumatic stress syndrome. Some mothers express dominant feelings of fear and anxiety about their cesarean as long as five years later.
  • Women having cesarean sections are less likely to decide to become pregnant again. 
  • Long-term risks of cesarean section include pelvic pain, pain during sexual intercourse, and bowel problems. 
  • Reproductive consequences compared with vaginal birth include increased infertility, miscarriage,placenta previa (placenta overlays the cervix), placental abruption (the placenta detaches partially or completely before the birth),and premature birth. Even in women planning repeat cesarean, uterine rupture occurs at a rate of 1 in 500 versus 1 in 10,000 in women with no uterine scar.
Hazards of Cesarean Section to the Baby
  • Studies comparing elective cesarean section with vaginal birth or cesarean section for reasons unrelated to the baby find that babies are 50% more likely to have low Apgar scores, 5 times more likely to require assistance with breathing, and 4 times more likely to be admitted to intensive care for breathing difficulties.
  • One to two babies per 100 will be cut during the surgery. 
  • Some babies will inadvertently be delivered prematurely. Babies born even slightly before they are ready may experience breathing and breastfeeding problems. 
  • Babies born after elective cesarean section are more than four times as likely to develop persistent pulmonary hypertension compared with babies born vaginally. Persistent pulmonary hypertension is life threatening.
  • Mothers who have cesareans are more likely to have difficulties forming an attachment with the infant. This may be because women are less likely to hold and breastfeed their infants after birth and have rooming-in, and because of the difficulties of caring for an infant while recovering from major surgery.
  • Cesarean born babies are less likely to be breastfed. The adverse health consequences of formula feeding are numerous and can be severe.
 Hazards of Elective Repeat Cesarean Section
  • Elective cesarean section carries twice the risk of maternal death compared with vaginal birth. 
  • Old scar tissue increases the likelihood of surgical injury. 
  • One more woman in every 100 with a history of more than one cesarean will have an ectopic pregnancy (embryo implants outside the womb); hemorrhage associated with ectopic pregnancy is one of the leading causes of maternal death in the US.
  • Compared with women with no uterine scar, women have more than 4 times the risk of placenta previa with one prior cesarean, 7 times the risk with two to three prior cesareans, and 45 times the risk with four or more prior cesareans.
  • Compared with women with prior births and no previous cesareans, women with one prior cesarean or more have greater than 4 times the risk of placental abruption. About half of maternal deaths due to hemorrhage involve placenta previa or placental abruption.
  • The odds of placenta accreta (placenta grows into or even through the uterus) jump from 1 in 1,000 with one prior cesarean to 1 in 100 with more than one prior cesarean. Nearly all women with this complication will require a hysterectomy, nearly half will have a massive hemorrhage, and 1 in 11 babies and 1 in 14 mothers will die. The incidence of placenta accreta has increased 10-fold in the last 50 years and now occurs in 1 in 2,500 births.
  • Women having elective repeat cesareans are more likely to experience hemorrhage requiring transfusion, blood clots, and infection compared with women planning vaginal birth.
  • Postpartum recovery after repeat cesarean section is even more difficult when there is another child or children to care for.
For a Print out please click here:

cesareanfactsheet.pdf
File Size: 75 kb
File Type: pdf
Download File

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The Coalition for Improving Maternity Services (CIMS) is concerned about the dramatic increase and ongoing overuse of induction of labor. The U.S. induction rate has more than doubled since 1989, rising from one woman in ten to one woman in five in 2001.  This may, however, grossly undercount the true incidence of labor induction. Nearly half of women in a 2002 survey reported that some effort had been made to start labor artificially.  The World Health Organization recommends no more than a 10 percent induction rate.  Despite modern techniques, induction of labor still introduces considerable risk compared with natural onset of labor, and many, if not most, inductions are done for reasons that are not supported by sound medical research.

HAZARDS OF LABOR INDUCTION
  • First-time mothers have approximately twice the likelihood of cesarean section with induction compared with natural onset of labor. This risk is due to the procedure itself, not any reason that might have led to inducing labor.  Inducing labor at 41 weeks in a hypothetical population of 100,000 first- time mothers will result in somewhere between 3,700 and 8,200 excess cesareans and cost an extra $29 to $39 million. 
  • Women who have had prior vaginal births may increase their chances of cesarean section five-fold if the cervix is not ready for labor, and they are given cervical ripening agents.  Inducing 100,000 hypothetical women with prior births at 41 weeks will result in between 100 and 2,300 excess cesareans and cost an extra $25 to $26 million. 
  • All induction agents can cause uterine hyperstimulation (contractions too long, too strong, and too close together and higher baseline muscle tension).  Uterine hyperstimulation can cause fetal distress This means that, paradoxically, inducing labor because of concern over the baby’s condition may cause the very problem the induction was intended to forestall while the baby might have tolerated natural labor.
  • Induction of labor involves the need for other interventions—IV drip, continuous electronic fetal monitoring, usually confinement to bed—that also can have adverse effects.
  • Rupturing fetal membranes, a routine component of labor induction, can cause fetal distress and increases the likelihood of cesarean section It may also precipitate umbilical cord prolapse (a life-threatening emergency for the baby in which the umbilical cord slips down into the vagina).  Forty percent of all full term births involving cord prolapse were induced labors, rising to nearly 50% of births involving prolapse at 42 weeks or more. 
  • Induced labors are usually more painful, which can increase the need for epidural analgesia. Epidurals introduce a higher probability of a host of adverse effects on the labor, the baby, and the mother.
  • Women with prior cesarean sections have a slightly increased probability of the scar giving way with Pitocin (oxytocin) induction (8 per 1,000 vs 5 per 1,000 with spontaneous labor onset) and greatly increased risk when prostaglandins (24 per 1,000) are used for cervical ripening or induction. Prostaglandins include Cytotec (misoprostol), Prepidil (prostaglandin E2), and Cervidil (prostaglandin E2).
HAZARDS AND PROBLEMS OF INDUCTION AGENTS

Cytotec (Misoprostol)

  • Cytotec, although widely used as an induction agent, is neither formulated nor intended for use in labor. Cytotec’s manufacturer, Searle, has repudiated its off-label use as an induction/cervical ripening agent because of Cytotec’s attendant risks. 
  • The FDA states that Cytotec’s major adverse effects include uterine hyperstimulation, which can become severe and result in profound fetal distress; uterine rupture; amniotic fluid embolism, which has a high maternal and infant mortality rate; severe genital bleeding; shock; fetal death; and maternal death. Other adverse effects include retained placenta, cesarean section, and passage of meconium (the baby’s first stool) into the amniotic fluid, which can cause a type of newborn pneumonia if inhaled.
  • Cytotec is commonly believed to pose a life-threatening risk only in women with a uterine scar or with high doses. However, cases of maternal and infant death and hemorrhage requiring hysterectomy have been reported in women with no uterine scar, some of whom were given a minimal dose.
  • Cytotec dosage cannot be controlled because the drug is a small pill that must be cut in pieces.
  • Once given, the drug cannot be rescinded or the dosage reduced in case of adverse effects.
  • Cytotec does not decrease cesarean rates compared with prostaglandin E2, which is FDA-approved for use in labor.
  • Cytotec’s only advantages compared with prostaglandin E2 are much reduced cost and faster labors.  Both benefit only hospitals and doctors as short labors are usually intense, tumultuous, and difficult.
Prostaglandin E2 (Prepidil, Cervidil)
  • Prostaglandin E2 can cause uterine hyperstimulation and fetal distress.  Fetal distress can require cesarean section.
  • Prostaglandin E2 does not reduce excess cesareans associated with labor induction.
  • Unless the drug is formulated in a tampon (Cervidil), the drug cannot be rescinded or the dosage reduced in case of adverse effects.
Oxytocin (Pitocin)

  • Complications of oxytocin (Pitocin) include uterine hyperstimulation,  which can lead to fetal distress; twice the chance of the baby being born in poor condition;  postpartum hemorrhage;  and greater probability of newborn jaundice.  Rare, severe, maternal complications include uterine rupture and water intoxication leading to coma and death. Oxytocin may also cause brain damage or death in the baby.
MEDICAL RESEARCH FAILS TO SUPPORT COMMON INDUCTION RATIONALES
  • Elective induction of labor, that is, induction for nonmedical reasons such as convenience, exposes babies and mothers to the hazards of induction with no counterbalancing benefit.
  • Inducing labor for suspected big baby produces no benefits but increases the likelihood of cesarean section.
  • No credible evidence supports inducing labor in women with gestational—as opposed to pre- existing —diabetes.
  • Routinely inducing labor for prelabor rupture of membranes does not reduce the incidence of newborn infection with the exception of women testing positive for Group B strep who do not receive IV antibiotics during labor.
  • Inducing labor in women with Group B strep has not been shown to improve outcomes when antibiotics are given regardless of membrane status and is not part of the Centers for Disease Control recommended guidelines.
  • Studies claiming to support routine induction of labor at 41 weeks of pregnancy have serious flaws.  No research supports routine induction at any earlier point in pregnancy; no sound research supports routine induction at any point in pregnancy.
  • Proponents of inducing labor at full-term argue that the stillbirth rate and the rates of other newborn complications increase markedly after that date, but, in fact, these rates show no such increase.  Induction at 41 weeks in a hypothetical population of 100,000 first-time mothers would theoretically prevent 120 fetal deaths that would statistically occur in the ensuing week, but:
  1. We don’t know how many of those deaths would actually be prevented by routine induction in that they were unpredictable events in healthy mothers carrying healthy, normally formed babies.  
  2. That number would be offset by some babies dying as a result of the hazards of induction.
  3. Any decrease in fetal deaths would be outweighed by the infertility, miscarriage, and fetal and newborn losses consequent to the excess cesareans.
  • Forty-one weeks is the median length of pregnancy in healthy first-time mothers.  This means that one- half of such pregnancies will last longer than 41 weeks.
  • If there is no reason to curtail the natural length of pregnancy, then there is no reason for measures such as stripping or sweeping membranes, which themselves introduce the possibility of risk.
For References and Print out please click here: 

cimsinduct-fact-sheet.pdf
File Size: 154 kb
File Type: pdf
Download File

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Watch the trailer and the series of interviews done for this amazing new film coming up about Birth, Fathers and unnecessary procedures done to our mothers and babies by Baby Keeper Productions.

"This is such important work. We are in the midst of a terrible trend of over intervention into birth, resulting in trauma and distress. Your films will show the core of the unexpressed pain for parents and for the baby."

Phyllis Klaus, CSW, MFCC
Co-author, "Your Amazing Newborn"


A series of excerpts from interviews with doctors for birth film for fathers,"The Other Side of the Glass." SHOCKING information that needs to be exposed. The producer presents "Doctor's Voices" as a way to support midwifery AND the doctors who support the midwifery model of care/mother-baby focused birth and reform of our current system. For more information, www.TheOtherSideoftheGlass.com.
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