Jerusalem doctor describes c-section risks

Dr. Glazerman, a doctor located in Jerusalem, describes the risks involved in elective c-sections and repeat elective c-sections:

• Damaging other organs during the operations,
• Greater risk of hemorrhaging and infection,
• Maternal death rate is 2.5 to 3.5 time higher than natural birth,
• Dangers with anesthesia,
• Chance that internal organs eventually adhere to one another due to membrane damage,
• 20% increase in extra-uterine pregnancies after a c-section,
• Increase chance of miscarriage after a c-section,
• Increase problems with placenta in future pregnancies after a c-section,
• Risk of uterine rupture in future pregnancies,
• Babies born by c-section are more likely to have respiratory problems,
• Problems bonding with baby after a c-section.

read the full article: http://www.haaretz.com/hasen/spages/1118906.html

Hospital Bans Don’t Add Up

VBAC Community would like to extend the very best wishes for Joy Szabo, mother of 3 with a fourth on the way. All of Joy’s children, so far were delivered at Page Hospital in Arizona, but hospital policy has recently changed to prohibited VBACs. Joy had her first child naturally, her second was an emergency c-section because of a placental eruption and her third was a VBAC. Now Page Hospital is forcing her to have an elective C-section. The hospital claims it does not have the staff to handle an emergency C-section, but any labor has the possibility of necessitating an emergency cesarean.

As Joy states,  “They (hospital administrators) don’t want to allow VBACs because she (hospital administrator) said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency.”

In the article, Joy is pictured next to a message she wrote on the windshield of her van:

Page Hospital
Enter my body without permission
Sounds like rape to me.

This situation happens all over the United States. As VBAC Community continues to inform more and more women about their rights, their health and their options, we hope fewer women are forced into dangerous situations against their will. Joy, we are all rooting for you.

Read the orginal article: Hospital policy pains expectant mom

VBAC Community Fall 2009

Back to school means back to work for everyone contributing to VBACcommunity! During the end of summer we’ve been busy integrating some fantastic new features and content!

RSS feedswith the latest VBAC news and VBAC developments: check out the “Call for Pregnant Women Facing VBAC Bans” in North Western States.

Extensive addition of VBAC birth stories. We’ve been scouring the web for inspiring and informational birth stories and compiling them into one easy to access page!

State listing improvement. We’ve added more offices and practices to the state-by-state list of vbac supportive doctors. See if your state is listed, submit and recommend your OB/GYN or Midwife for others to use.

VBAC Community merchandise on CafePress. Support the VBACCommunity by purchasing a cute infant onesie, maternity t-shirt or durable tote-bag from our online store at CafePress. All proceeds support the future of the VBACCommunity website.

Re-designing the site. We implemented subtle design changes to improve the site navigation.

Rachel’s birth story

All through my pregnancy I wasn’t especially concerned whether I had a natural delivery or a c section – I could see the pluses and minuses of each. I had assumed I would probably have a natural delivery, but it was nice to know a c section was there as an option in case it was needed. I planned to use a TENS machine (very common in the UK where I’m from) and cleared this with my OB. I had to buy my own, whereas in the UK you can just rent one. I also planned to wait as long as possible before having an epidural, and then only if I felt I really needed it. I also booked a doula so my husband could relax more during the birth, and I would have more support.  

I chatted with my doula a number of times in the lead up to the birth. She warned me that if the baby was big (over 9lbs) they would push for a c section, but this didn’t really sink in at first. At my OB check up at about 39 weeks I had a scan to see the size of the baby. It was estimated at 9lbs6oz. Straight away my OB was talking about how I should have a c section and if I didn’t the baby could suffer shoulder dystocia, and how this could be very serious and might result in the baby not surviving. I was told to choose which day the following week I would have the c section and they’d book it that day. I felt very pressured to do this and that my OB didn’t want to discuss the matter with me or answer my questions – he just wanted me out of the office. I was surprised at this as he had been very nice and good at answering questions before, as had the others in the practice (it was policy to see all of them which I was fine with).

So the c section was booked for the following Wednesday and I was almost in tears on the way home. Fortunately I’m a pretty logical person and I come from a medical family so by the time we were home I had a plan. I would research big babies and shoulder dystocia on the web to see what the general consensus was on the matter. Also, we looked at all the measurements and weight estimates from my previous scans (I’d had quite a few as the baby had a minor issue they were tracking). The weight estimate had certainly taken a jump from the previous one and one of the measurements used to calculate it was off the scale (i.e. outside 95 percentile). My parents had flown in the night before and seeing as my Dad is a Consultant Radiologist he was able to say that this measurement was very easy to over-estimate as it was the abdominal circumference. If the sonographer doesn’t place the points in  just the right place then the measurement will be oblique (oval around the body) instead of circular. This made us doubt the accuracy of the latest weight estimate, and besides they are always + or – 1 to 1.5 lbs at that stage as it is a calculation, not a set of scales.

I did many searches on the web and found lots of useful articles on when a baby is considered big (some say over 9lbs, some say over 10lbs), whether or not this increases the chance of shoulder dystocia (it doesn’t, as it’s based on the relationship of the baby to the mother’s pelvis, not just the size of the baby) and whether or not a predicted big baby should be used as a reason for an elective c section (it shouldn’t). In fact, many places said that the use of ultrasound to size up babies in the later stages of pregnancy should not be done at all as it is no better than a guess.

Obviously, going with a natural delivery still presented a small risk of shoulder dystocia, just as there would be for anyone, so I also read more about the potential risks of c sections (to decide if I felt they were more acceptable or not), as well as the risks of various negative outcomes from shoulder dystocia and the methods that can be used to facilitate delivery when it does occur. I found that there are many procedures that can be used if the baby does ‘get stuck’ and that in almost all cases delivery can still be made, though sometimes with temporary and / or minor injury to the baby. I also found that a c section is no walk in the park and that there can be serious implications for future fertility / pregnancies.

Based on this information I decided that I was going to cancel the c section, and ask about waiting to see if labor started naturally, or whether I could consider an induction instead. My Dad supported this decision as he had read the information I’d found as well, and eventually my husband also felt comfortable that I wasn’t taking any unnecessary risks. At my OB appointment on the following Monday I was prepared with questions, some prints of the information and a strong mind to not be pushed into something I didn’t want.

I was seeing a different member of the practice, in fact the one deemed the most laid back about letting women decide what to do, so that was helpful. I think she was prepared that I was going to need some extra time to talk about things. I said I was canceling the c section, and asked about induction. I was told that was not an option as they would lose their malpractice insurance if they were seen to induce someone known to be carrying a big baby. I then asked how overdue I could go before they would want me to have the c section anyway and she said I could go the full 2 weeks. We also discussed the fact the baby’s measurement seemed to have jumped and how this could have been influenced by a different sonographer on a different machine. We agreed to schedule another scan with the same sonographer I’d used most of the way through, on the same machine she always uses. This was booked for Friday morning and then I’d see her again straight afterwards. I left feeling much happier and back in control of the situation.

On Wednesday I felt that baby was much lower than before and thought something might happen in the next day or so. I was right because at 5:30am on Thursday my waters broke. I went to the bathroom and found the trickle had stopped. I put in a maxi pad and went back to bed. I lay there wondering if I could have been wrong and that nothing had happened. In the end I decided that if my waters hadn’t broken then I should just go back to sleep, and if they had then I would be having a busy day so really should get some sleep. Either way, sleep was the best option! At 8am I woke either just before or just after the baby moved. I felt a big pop and then I knew my waters really had broken. Off I went for breakfast and to tell everyone today was the day. My contractions started straight away, and were about 5 mins apart from the beginning, but weren’t too painful. By 9am they were getting worse and I headed up for a shower. I didn’t make it in straight away as I found I needed to lean forward on the bed or all fours during the contractions to deal with the pain. My husband found me like this a little while later and said that if I wanted that shower I should really get in there now.

After the shower I had my husband fit the TENS machine electrodes and I started using the machine. He said I should call the OB and I said, no he should! He did and was told we should head straight to the hospital. He called my doula with the news and said we’d meet her there. Getting to the car was more of a challenge than we’d expected. It took a few threats of calling 911 to get me to start moving, and each contraction I had to get back down on the floor. Eventually we made it and off we went. I was using the TENS machine all this time, and gradually increasing the strength and using the boost button during contractions. It makes you feel all tingly in your back where the electrodes are, though as you increase the strength it goes from tingly to down right uncomfortable, though at least takes your mind off the contractions. The idea is that it stimulates the body to release endorphins (natural painkillers). To get the most from it you need to build it up over time, hence putting it on near the start of labor.

During our drive to the hospital my husband made the most of a police car that pulled out ahead of us, deciding that if he was behind it then it couldn’t stop him for speeding. My parents were telling him to slow down, but that had no effect. Nor did my shouting not to accelerate during contractions, but only between them. He said afterwards that he was worried I might have the baby in the car. By the time we got to the hospital and up to the birthing center it was about 11am. It was pretty obvious I was in labor so I bypassed triage and went straight into a delivery suite. I was asked to change into a gown, and remember heading to the bathroom alone and then calling out that I could do with some help. Once changed I was checked and was already 5cm dilated. I’d been expecting a long first stage of labor so had prepared plenty of videos to watch, but there’d be no need for those.

My doula was a great help keeping me focused and bringing damp towels, etc. An hour later I was checked again and was told I was 6cm. This was rather disappointing given the fast progress earlier on, and the level of pain I was in. I felt I was getting no break between contractions and that I just couldn’t take this so I started asking for an epidural. The anesthetist was busy so I was told I’d have to wait a while. By nearly 1pm he was available and I was asked if I still wanted the epidural. I said yes, but my doula said that I should try changing positions as I’d not done this at all. I’d been on the bed leaning forwards onto a birthing ball, and rocking back and forth as this position seemed to make the pain the most bearable. I was persuaded to try standing up which I did for only a few seconds before the next contraction came and I headed straight for all fours on the floor. I was also grunting and getting a strong urge to push and my doula realized and told me not to. I was helped back onto the bed and went back to the old position. My Mum tried to suggest that I was so close that I might get through ok without the epidural, but I was having nothing of it. Everyone except my doula was sent away for lunch so the anesthetist could do his job.

At the time I didn’t realize it, but looking back I can now see that I was in transition, i.e. the worst part of labor where you don’t get a break between contractions. I think that if I’d realized it was going to change then I might have been able to get through without the epidural. As it was my doula suggested that I was checked again before the epidural – I think she thought I was pretty close too and that if I’d known how close I might have changed my mind. No one listened and so I wasn’t checked until about 1:30pm, after the epidural was in. I was 9cm so was probably 8 or 9 when they started doing it so was quite lucky to have got it I think. I was a changed person after the epidural - was sitting up in bed, chatting away. I could feel when I had a contraction from the increased pressure, but don’t remember any pain. I was also able to move my legs a lot and could turn from one side to another. I don’t know if this was because I had less meds than sometimes or because they had to place it slightly higher than usual due to a small amount of scoliosis in my spine. Obviously the TENS machine had come off before the epidural and the anesthetist had been quite interested in whether I thought it had helped or not.

By 2:30pm I was 10cm and was told by the OB (who was actually one of the ones covering for my practice, though he was in touch with mine by phone) that I could start pushing if I wanted. This took me by surprise as I didn’t think I’d get the choice to push or not! My doula and nurse said I could wait and let the contractions do more work for a while, but I thought I’d have a go at pushing. They let me start, but I know now that they weren’t getting me to do proper pushes for about an hour. At some point I was offered a mirror which I said yes to. The OB kept coming in to see how I was doing and I think he was reassured that I was making progress. My husband joked with him about not sharpening the scalpel just yet. It looked to me in the mirror that I was miles off getting this baby out, but the OB at one point said he’d be out by 5pm. Around that time they started preparing for the birth and at 5:20pm Jack Hayden Matthews was born. Once the head was out he turned on his own and out came the shoulders too! No way were they getting stuck. The OB had to hold the baby’s head on his stomach while he suctioned the mouth and unwrapped the cord from the neck (even with this his heart rate hadn’t dropped during any contractions) and then when he was done, out he slithered without another push. He weighed in at 8lbs 13oz,  big, but not THAT big.

I’d been given an episiotomy, but had torn pretty badly as well so the OB spent quite a long time stitching me up. I kept the mirror the whole time so I could see what was going on and was asking him which layer he was stitching. He didn’t seem to want to go into too much detail though, but he did give me extra numbing injections when I said I could feel what he was doing. Soon I was reunited with Jack and was in my postpartum room. Jack was perfect and I was glad I’d not had the c section as my room mate had and seemed to be having a hard time. A friend who’d badly torn had suffered with an infected wound so I was extra careful to use the spray bottle every time I used the bathroom for weeks after the delivery. I took painkillers for a few days, and was able to move around and sit comfortably from the start. In fact when I didn’t take painkillers on about day 3 I noticed more pain in my arms and shoulders than anywhere else. Eventually I worked out that was from tensing up holding my legs while pushing. In all the excitement of having the baby we forgot that we’d booked a scan for the next morning. I remembered after my husband had left for the night, but had no way of contacting him. We called later the next day to apologise and they said not to worry, they’d guessed we’d probably had the baby.

With hindsight I’m pretty certain the epidural slowed down the delivery as I’m sure I’d have pushed more effectively without it. My doula and nurse did say I was pushing well, but I really think the strong urge I felt when standing, and the addition of being able to push not lying on my back / side would have made a difference. However, even though I was technically pushing for 3 hours, I was only really properly pushing for 2 and apart from getting tired it wasn’t a big hardship. Jack made it out fine and I didn’t have a c section so all ended well in the big scheme of things. I’d definitely consider an epidural again, though given the fast labor this time, I may not have time to get one next time. That is a bit of fear for me and I’d prefer more backup options. In the UK nitrous oxide (laughing gas) is used in 60% of births and is great because it is self administered, leaves the body quickly after you stop breathing it and can be started at any time. I’d love to have this option here as I have a friend who used it for her second baby when it ended up being too late for an epidural. I would also love the option of laboring and possibly delivering in a tub, though I’d have to change OBs and hospital to get that.

Shocked! A response to ABC.com article weighing ‘pros’ & ‘cons’ of elective c-sections.

ABC.com News posted an article about the ‘pros’ and ‘cons’ of an elective c-section in January of 2009. The article is in response to a new study published in the New England Journal of Medicine that finds, “…more than a third of c-sections are performed too early — before 39 weeks — putting newborns at greater risk for a variety of health problems.” http://a.abcnews.com/Health/story?id=3291512&page=1

The ABC article goes on to explain that the study found c-sections performed “before the recommended 39 weeks, (makes) babies more likely to visit the intensive care unit, have infections and develop respiratory distress.”

This first portion of the article, which is recapping a recent study, is very reasonable. The second part of the article contains a list of ‘pros’ and ‘cons’ for both a vaginal birth and an elective c-section birth. This list is taken word for word from http://www.babycenter.com/. The article posted on Babycenter.com is said to be “a physician panel-reviewed list of ‘pros’ and ‘cons’ of both vaginal birth and c-sections.” I found the list here: http://www.babycenter./0_elective-cesarean-is-it-for-you_1498696.bc?page=3.

I am reluctant to believe any respectable physician reviewed the Babycenter list and no professional editor approved its use, out of context, in the ABC article, as the list implies an equal consideration for factors of extremely diverse risk, repeats factors in different wording and includes factors that are not scientifically proven.

Certainly the risk of death is a more serious threat than perceived psychological discomfort, however both articles treat these issues with equal consideration. On the ABC article,  negative possibilities of vaginal births are a “Fear of childbirth may cause maternal distress,” and “Labor, with the need for frequent vaginal examinations, can be traumatic,” while the negative possibility of an elective c-section is “Twice the risk of infant mortality.”

Other items in the lists are repeated. Of the six ‘pros’ listed for an elective c-section, the first and the sixth are the same, worded differently:

#1. “Can be more convenient for a woman, and reduce her stress about anticipation of labor,”

#6. “Women feel a greater sense of control knowing when their baby will be born, and can plan for family help, a baby nurse, furniture delivery, work leave, and so forth” i.e. it’s more convenient.

Apparently convenience is such a ‘pro’, it needed to be listed twice.

Also distressing is that the ABC article fails to acknowledge that two of the elective c-section ‘pros’ are not scientifically proven. The two unverified c-section ‘pros’ are:

#2 “Possible decreased risk of incontinence”,

#3” Possible decreased risk of sexual dysfunction for first three months postpartum”

The excerpt discussed earlier in the Babycenter article is, “For the mother, a common concern is pelvic floor damage that leads to urinary and fecal incontinence and sexual dysfunction. But while urinary incontinence is higher at three months postpartum in women who deliver vaginally, the connection between vaginal birth and long-term or later incontinence is still unclear.”

The Babycenter article goes on to cite two studies which refute the belief that vaginal births cause incontinence or sexual dysfunction:

“Many women who’ve never given birth develop incontinence — for instance, a study conducted at the University of Rochester found that nearly 50 percent of post-menopausal nuns reported incontinence — and some researchers suggest there’s a hereditary link…

…And research results are still mixed on the question of whether vaginal deliveries contribute to long-term sexual dysfunction. In one study, done at three months postpartum, women who delivered vaginally reported less sexual satisfaction than those who had their babies via c-section, but by six months there was no significant difference in pain during intercourse related to mode of delivery.”

It is unclear why the Babycenter ‘pros & cons’ list does not make a note that these factors as unproven. It is inexcusable that the ABC article does not mention this ambiguity at all, and it leads one to the conclusion that the ABC author did not actually read the entire Babycenter article.

The ‘pros’ listed for an elective c-section are really just two; convenience for the parents and less chance of oxygen deprivation to the child. The 7 ‘pros’ of a vaginal birth listed in the article are:

Less risk of maternal hemorrhage, infection, blood clots, damage to internal organs

Less risk of baby having specific respiratory problems

Baby potentially less likely to develop allergies, asthma, or lactose intolerance

Shorter hospital stay and quicker physical recuperation

In later pregnancies, labor may be shorter and offer quicker delivery

Mother may breast-feed more effectively

Mother much less likely to require c-section in subsequent pregnancies.

There are, of course, other ‘pros’ not listed here, like the emotional fulfillment a mother experiences having a vaginal birth, the ability to bond with the baby faster, and decreased risk of postpartum depression. It is interesting that the list on ABC and Babycenter includes negative emotional states, such as fear of childbirth, but doesn’t list its obvious counterpart, the feeling of empowerment and achievement after giving birth vaginally.

Now lets examine the ‘cons’ of an elective c-section. According to both the ABC and Babycenter lists there are eight serious issues:

“Twice the risk of infant mortality”

“Slightly higher mortality rate for mother”

“Higher risk of infection and blood clots for the mother”

“Risk of complications from anesthesia (pneumonia, allergic reactions, low blood pressure)”

“Increased maternal blood loss and risk of needing a transfusion”

“Risk of damage to the mother’s bowels and/or bladder”

“Decreased bowel function after surgery”

And of course, an elective c-section sets one up for future risks. “In later pregnancies, risks to mother increase”

It would appear that the ‘cons’ of an elective c-section are of a much more dangerous nature than those of a vaginal birth.

When we scrutinize the vaginal birth ‘cons’ we can eliminate one, “Risk of unforeseen complications during labor such as hemorrhaging.”

Clearly everything in life has the option of an unforeseen complication, therefore eliminating this as a factor. For example, the unforeseen complication of getting to the hospital is a car accident. Perhaps I’m being a little cynical here, but in all fairness, the unforeseen complication factor ought to be listed on the c-section ‘cons’ list as well.

So that leaves us with two actual risks to consider with a vaginal birth:

“Risk of perineum tearing,” and
“Risk of… trauma to baby when passing through birth canl (this would include oxygen deprivation)l, or from forceps or vacuum extraction.”

After examining the ‘pros & cons’ list it becomes obvious that the vaginal birth ‘pros’ seriously outweigh the c-section ‘pros’ while the c-section risks are much more dangerous than the ‘cons’ listed for a vaginal birth. We can speculate that the original Babycenter list and that pasted onto ABC is what I call an intervention centered or hospital centered mindset. The author writes the article from the perspective that birth is a medical condition that requires intervention and hospitalization. In fact childbirth is a natural event that occasionally requires medical assistance.

From this ABC article I have taken a moment to revise the ‘pros & cons’ list. It needs more consideration, but the following list is much more realistic and comprehensive than the list on ABC:

REVISED PRO/CON list.

Vaginal birth	Elective cesarean
Pros:	Pros:
Less risk of maternal hemorrhage, infection, blood clots, damage to internal organs	Can be more convenient for woman, and reduce her stress about anticipation of labor
Less risk of baby having specific respiratory problems (TTN and persistent pulmonary hypertension)	Reduced risk of birth trauma to baby, (including oxygen deprivation) sometimes sustained from passing through birth canal, or from forceps or vacuum extraction
Baby potentially less likely to develop allergies, asthma, or lactose intolerance
Shorter hospital stay (one to three days) and quicker physical recuperation
Mother may breastfeed more effectively
Mother much less likely to require c-section in subsequent pregnancies
In later pregnancies, labor may be shorter and delivery quicker
Less risk of post partum depression
Mother may bond more quickly with baby
Feeling of empowerment and elation for mother
Cons:	Cons:
Risk of perineum tearing (from first degree slight tear to fourth degree extensive tearing into rectum)	Possible pre-term delivery if due date calculation is inaccurate
Risk  trauma to baby when passing through birth canal, including oxygen deprivation, or from forceps or vacuum extraction	Rare: Possible infant injury when the doctor makes the uterine incision
	Risk of damage to the mother’s bowels and/or bladder
	Increased maternal blood loss and risk of needing a transfusion
	Risk of complications from anesthesia (pneumonia, allergic reactions, low blood pressure)
	Slightly higher mortality rate for mother
	Twice the risk of infant mortality
	Higher risk of infection and blood clots for the mother
	Decreased bowel function after surgery
	Risk of lower Apgar scores for the baby
	Longer hospital stay (three to five days) and longer recovery period
	Possible complications with breastfeeding
	Possible increased likelihood of clinical postpartum depression
	Potentially more expensive — your insurance may not cover an elective cesarean
	Internal scar tissue may cause problems in future c-sections
	In later pregnancies, risks to mother increase, whether she delivers by VBAC or cesarean

As I continue to inform and encourage women to consider a vaginal birth, particularly a vaginal birth after cesarean, I can only hope they review the articles available online with more integrity than the editors of ABC health.