By Mike Stobbe, AP
Posted: 2007-08-24 23:20:01
Filed Under: Health News, Nation News
Date: 01/10/2003 From AOL News: United States

Friday, 24 August, 2007, 23:20:01

Some numbers crunchers note that a change in how such deaths are reported also may be a factor. "Those of us who look at this a lot say it's probably a little bit of both," said Dr. Jeffrey King, an obstetrician who led a recent New York state review of maternal deaths.

The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to statistics released this week by the National Center for Health Statistics. The rate was 12 per 100,000 live births in 2003 - the first time the maternal death rate rose above 10 since 1977.

To be sure, death from childbirth remains fairly rare in the United States. The death of infants is much more common - the nation's infant mortality rate was 679 per 100,000 live births in 2004.

Maternal deaths were a much more common tragedy long ago. Nearly one in every 100 live births resulted in a mother's death as recently as 90 years ago.

But the fact that maternal deaths are rising at all these days is shocking, said Tim Davis, a Virginia man whose wife Elizabeth died after childbirth in 2000.

"The hardest thing to understand is how in this day and age, in a modern hospital with doctors and nurses, that somebody can just die like that," he said.

Some health statisticians note the total number of maternal deaths - still fewer than 600 each year - is small. It's so small that 50 to 100 extra deaths could raise the rate, said Donna Hoyert, a health scientist with the National Center for Health Statistics. The rate is the number of deaths per 100,000 live births.

In 2003, there was a change in death certificate questions in the nation's most populous state, California, as well as Montana and Idaho. That may have resulted in more deaths being linked to childbirth - enough push up the 2003 rate, Hoyert said.

Some researchers point to the rising C-section rate, now 29 percent of all births - far higher than what public health experts say is appropriate. Like other surgeries, Cesareans come with risks related to anesthesia, infections and blood clots.

"There's an inherent risk to C-sections," said Dr. Elliott Main, who co-chairs a panel reviewing obstetrics care in California. "As you do thousands and thousands of them, there's going to be a price."

Excessive bleeding is one of the leading causes of pregnancy-related death, and women with several previous C-sections are at especially high risk, according to a review of maternal deaths in New York. Blood vessel blockages and infections are among the other leading causes.

Experts also say obesity may be a factor. Heavier women are more prone to diabetes and other complications, and they may have excess tissue and larger babies that make a vaginal delivery more problematic. That can lead to more C-sections. "It becomes this sort of snowball effect," said King, who is now medical director of maternal-fetal medicine at Riverside Methodist Hospital in Columbus, Ohio.

The age of mothers could be a factor, too. More women are giving birth in their late 30s and 40s, when complications risks are greater.

Other characteristics of the maternal mortality rate include:
  • Race: Studies have found that the maternal death rate in black women is at least three times greater than is it is for whites. Black women are more susceptible to complications like high blood pressure and are more likely to get inadequate prenatal care.

  • Quality of Care: Three different studies indicate at least 40 percent of maternal deaths could have been prevented.

Sometimes, there is no clear explanation for a woman's death.

Valerie Scythes, a 35-year-old elementary schoolteacher, died in March at a hospital in New Jersey - the state with the highest Cesarean section rate. She had had a C-section, as did another teacher at the same school who died after giving birth at the same hospital two weeks later. However, Scythes died of a blocked blood vessel and the other woman died from bleeding, said John Baldante, a Philadelphia attorney investigating the death for Scythes' family. "I'm not sure there was any connection between the two deaths," Baldante said.

Also mysterious was the death of Tim Davis' 37-year-old wife, Elizabeth, who died a day after a vaginal delivery at a Danville, Va., hospital in September 2000. "She had a heart attack after a massive blood loss," Davis said. "It's not clearly known what caused the heavy bleeding. There was no autopsy," he said, a decision he now regrets. "Two previous births had gone well. Nothing led us to believe anything was wrong with this pregnancy. She was like a picture of health," he continued, noting she had been a YMCA fitness instructor. A lawsuit against the hospital ended in a settlement. Davis also sued the obstetrician, but a jury ruled in the doctor's favor. The child born that day, Ethan, starts second grade next week. "He's a happy kid," Davis said. "He's just never had a mom."


By Mike Stobbe, AP
Posted: 2007-08-24 23:20:01
Filed Under: Health News, Nation News
Date: 01/10/2003 From AOL News: United States

Friday, 24 August, 2007, 23:20:01

FRIDAY, July 13 (HealthDay) - Convenience has become a fixture in American society. As life grows more fast-paced, people look for more corners to cut and ways to save time. But should the desire for convenience extend to one of the most fundamental natural functions - the act of childbirth?

A growing number of mothers and physicians apparently think so. The rate of women who deliver their babies via Cesarean section stands at a record high in the United States, accounting for more than 29 percent of all births in 2004. While the procedure is sometimes medically necessary for preserving the lives of mother and child, many health experts believe a desire for convenience has driven the Cesarean section rate to its current heights. And, as the use of Cesarean section has grown, so have concerns that the desire for convenience is creating unnecessary health risks.

"Cesarean section is major abdominal surgery, and, as with all major abdominal surgery, it carries major risks," said Dr. Marsden Wagner, a former director of women's and children's health for the World Health Organization. "As you do more and more Cesareans, the chance you are making things better gets less and less."

U.S. health officials are trying to cut the Cesarean delivery rate in half, bringing it down to 15 percent by 2010. That case runs counter to some fairly strong trends.

The use of Cesarean-section surgery has increased by 38 percent since 1997. About one of every five babies was delivered through C-section then; now, the rate is more than one of every four babies. Patient preference is one reason why the rate of C-sections is growing. Rather than waiting in suspense for labor to begin, women can schedule to the hour when they will deliver their child.

"If the woman has been told it's just as safe as vaginal childbirth, there's that temptation to schedule it when grandma's going to be in town,&quto; Wagner said. "Cesarean section also saves time for harried obstetricians who find themselves stretched too thin," he added. "A Cesarean takes 20 minutes. A birth takes 12 hours," Wagner said. "It's a godsend for an obstetrician to do a Cesarean."

However, a mounting body of evidence is showing that C-sections are less safe than normal vaginal childbirth. As such, "the increased use of Cesarean section runs counter to a basic rule of medicine," said Dr. John Zweifler, chief of the Family and Community Medicine Department at the University of California, San Francisco-Fresno.

That rule? First, do no harm.

"At a fundamental level, it's an intervention," Zweifler said. "We should only be intervening if we're sure we're providing additional service. We don't do operations unless we know there's a good reason for it."

In a C-section, the physician cuts into a woman's abdomen to remove the baby. Infection, increased blood loss and decreased bowel function are among the risks.

There are valid reasons for having a C-section, Zweifler said. They include: The baby is in breech -- or feet first -- position in the womb; twins in the womb aren't lined up head first; or there's evidence of fetal distress or maternal hemorrhaging.

International studies have found that the optimal Cesarean rate for a country is between 10 percent and 15 percent, Wagner said. "If the rate is below 10 percent, maternal mortality goes up," he said. "If it's over 15 percent, maternal mortality goes up." The risk of death is also is dramatically higher for C-sections than natural births, Wagner added, even when one takes into account those times when the procedure is medically necessary. "There's a doubled risk the woman will die even if it's an elective Caesarean she's requested with no medical emergency," Wagner said. Studies also have shown that women are three times as likely to experience severe complications during a planned C-section compared with a planned vaginal birth and are highly likely to experience complications during subsequent births. The risk does not end with the mother. Wagner said babies born through Cesarean section are more likely to suffer respiratory distress, because vaginal childbirth acts to squeeze liquid from the child's lungs. "Without that squeezing, the air tries to go in but is blocked by the fluid that's still in the lungs," Warner said.

Zweifler added that he's concerned that the skyrocketing Cesarean section rate will have consequences down the line that cannot be predicted. "Sometimes, we don't appreciate all the effects of our interventions until years later," Zweifler said. "You're getting into uncharted territories here."

To combat the C-section rate, doctors are urging women to become more aware of the risks associated with the procedure. "I don't believe there's a woman who would agree to it if they felt they were putting themselves or their baby at risk," Wagner said. Women who've already had a C-section birth are being asked to consider a VBAC, or vaginal birth after C-section, for their next pregnancy. Studies show that not only is it possible to have a vaginal birth following a previous C-section, but that the risks are roughly the same, Zweifler said. "There is no difference in outcomes," he said.


By Heather B.
Published: April 28, 2007
Filed Under: Health News, Nation News

Complication rate with C-section is high.
The death rates associated with it are higher.
There is a longer recovery time for the mother.

Did you know?

Babies born after a C-section not only are affected negatively by the epidural but also by not going down the birth canal, which prepares their lungs for breathing outside the womb.

Doctors and TV shows will tell you that C-sections are completely safe these days, but that is untrue. A C-section now is much safer than the old version of the C-section, a classical T-cut, but it still has many risks. Maternal and infant death are more likely with C-sections; higher C-section rates have always been associated with higher death rates. There are a wide variety of risks for the mother and baby that doctors often fail to mention to parents who are being advised to consider a Cesarean delivery. One third of all babies are born vaginally, and if that number were smaller, the death rates associated with birth would be lower.

A C-section requires anesthesia, which in and of itself affects the mother and child. That alone can cause breathing problems for the baby and cause the baby to be inactive or sluggish. It can interfere with the bonding process and cause problems with breastfeeding; lower nursing rates are associated with higher C-section rates. C-section babies are more likely to have breathing problems that can be severe.

Many scheduled C-sections take place at 37 weeks, which puts the child at a risk of premature birth and all of the problems associated with that. The mother's due date may be off by as much as a month. Even ultrasound dating can be inaccurate. This means the baby could actually be delivered as early as 33 weeks. Babies aren't universally considered "full-term" until 38 weeks, as most babies are born between 38 to 42 weeks.

Scheduling a C-section prior to 40 weeks puts the child at an even higher risk of many problems. Sometimes this is done for a baby that's anticipated to be big, and the child turns out to be very small - and weak. There is no need to do this for a baby that is anticipated to be big anyway, being that you're scheduling a C-section and not a trip down the birth canal, making size irrelevant.

The risks for the mother are even higher, as she is more likely to have postpartum-depression. She may have injuries to the bladder or bowel, reactions to the medications used, or an infection in the incision, uterus, or nearby organs. She is more likely to hemorrhage and to have blood clots in her legs, pelvic organs, or lungs. Many of these complications can be severe and even result in death. Women usually have a longer recovery time and hospital stay after a C-section delivery.

Once a mother has a C-section she is more likely to need another, as some hospitals don't allow VBACs due to the risks. A mother who has had a C-section is at greater risk of placenta previa and placenta accreta. Her uterus is more likely to rupture. This all increases her chances of needing a repeat C-section, which means these risks must be faced all over again. Maybe that explains why the number of women who electively have a C-section is so low, and the number of women attempting VBACs is so high! C-sections are necessary in a number of situations. Cord prolapse, placenta accreta, placenta previa, certain birth defects, and transverse lie are situations when a C-section is unavoidable. When a mother has had a C-section before with a classical T-cut scar or has ruptured before, she should probably have a C-section. Mothers may have serious medical conditions requiring emergency treatment or viruses that make C-section a better option than vaginal delivery. Expecting triplets or more is a good reason to have a C-section. If a woman is past 42 weeks gestation, her baby is at an increased risk of problems, but a C-section should only be an option if labor induction methods have failed.

Half of all C-sections are performed in cases when they are unnecessary. Our country's C-section rate is 30 percent. Doctors say that our Cesarean rate should be closer to 15 percent. Many C-sections are performed due to ignorance or convenience, and these are not good reasons to take on such risks. A well-trained doctor can handle shoulder dystocia, twin delivery, and breech births without resorting immediately to C-section. Moreover, many doctors will resort to C-section simply because the birth is taking too long. This isn't dangerous; it's just inconvenient. Another issue is that C-sections are more expensive, and hospitals make more money from them than vaginal deliveries.

Many C-sections are performed when a baby is breech, but that is not necessary. Breech babies can be delivered vaginally quite safely. There are increased risks with breech babies, but C-section is not a necessity simply because a baby is breech. When and if a true complication occurs, then a C-section should be performed. The same is true of twins, because twins are more likely to be in the breech position. Doctors are afraid that complications requiring C-section will occur, so instead of trying, they go right to the C-section. They should at least give vaginal delivery a chance, given the risks of C-section.

Sometimes they will do it if labor is too slow or stops, but all labors are different. It is normal for labor to quicken, slow, stop, and start again. Doctors like routine, and they also don't want your labor to keep them in the maternity ward for 3 days. They want you in and out. There is no danger in having a long labor. It's also normal for a baby's heartbeat to slow down and quicken during labor. If the baby is truly in distress, his heart rate will dip QUITE a bit for quite a while; only then should C-section be done for that.

The number one reason for C-section is that the baby is considered to be too big to pass through the birth canal. The doctor determines that the baby weighs too much, has too big of a head, or that the mother's pelvis is too small. Ultrasound weight and size estimates are very inaccurate, and the size of a mother's pelvis is no indication of how far it can expand. Therefore there is no reason to schedule a C-section for a baby that seems big or a mommy that is built small.

C-sections are not completely safe, though they are safer than they once more. They carry many risks for mother and child, especially when scheduled at 37 weeks. Most are done out of ignorance or convenience, not medical necessity. Nearly half of all C-sections are unnecessary. Mothers and children are more likely to developed a host of problems and even die after C-section deliveries. There are times when C-section is indeed safer than vaginal delivery, but only about 15% of the time. If your doctor has recommended a C-section, do your research, and think hard before going along with it. And if you're thinking of having one to avoid the pain of labor, think again. It's not worth it.


International Cesarean Awareness Network
Midwife Archives: VBAC, C-Section, and EFM: How Safe Are They?
BBC: Health Firm Stops Funding Cesareans
BBC: Cesarean Births 'Double'
Cesarean Rates Causing Concern

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