Safety, ease lead to C-section surge
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Rising C-section rates that show no signs of letting up have stirred a vigorous national debate about whether many are being performed too often, too early and without medical necessity.
With nearly one in three babies born by Cesarean … doctors and natural birth proponents are concerned that factors such as a woman’s preference to schedule birth on a particular day and a doctor’s fear of malpractice are, in part, driving the increase.
There’s worry, too, that fetal heart monitors, which often raise false alarms about the condition of a baby, or drugs used to induce labor might be leading to unnecessary C-sections and subsequent problems, such as a rupture of the uterus, which can lead to a hysterectomy.
“The C-section rate is probably higher than it should be,” … “We have to figure out which ones are medically necessary.”
An initiative at 60 Michigan hospitals hopes to make a dent in at least first-time C-sections by encouraging natural delivery techniques. The hospitals also are encouraging women to postpone scheduled C-sections until the 39th week of a pregnancy, when a baby’s lungs are healthier, and use labor-inducing drugs less often.
Safety a big concern
After a lengthy, dangerous labor that eventually ended in an emergency C-section, Kelly Morphew of New Baltimore wanted to play it safe this time. She scheduled a Cesarean delivery for her second baby.
Her daughter, Madison, was among 16 babies born Feb. 8 at the [hospital] … Four others also were C-section deliveries …
While safety was her biggest concern, Morphew was happy to get a Tuesday afternoon appointment that allowed her to get to the hospital of her choice and arrange a baby-sitter for her 2- 1/2 -year-old daughter.
“For me, C-section was the best way to go,” … Everything was planned. Nothing was scary.”
“We agree the C-section rate is too high, but we can’t just look at the rate alone,” … “We have to look at why women are having C-sections.”
Besides a woman’s preference, other leading reasons include:
• Doctors’ fear of lawsuits. Obstetricians … are sued the most and pay some of the biggest insurance premiums, as much as $200,000 a year. Reluctant to have a labor go wrong, many doctors perform C-sections for more defensive reasons, rather than good medical ones …
• Policy changes at small- and medium-size hospitals against natural delivery of a baby after a prior C-section …
• Technology. Fetal heart monitors, which often can be wrong, pushing too many women along a path to C-section.
• Labor-inducing drugs restrict the baby’s movement, often leading to a C-section.
• Lack of good evidence about which women with possible medical issues like older age, gestational diabetes or high blood pressure
would benefit more from a C-section.
• Fewer training opportunities for doctors to learn how to deliver babies in difficult circumstances [such as] breech …
C-sections, like other surgeries, can have major risks, including infection in the mother, profuse bleeding requiring blood transfusion and, in rare cases, death. They also carry a small risk of uterine rupture, a serious complication that occurs when the uterus tears open, sometimes leading to hysterectomy.
With safety a major focus in medicine, a Michigan campaign at 60 hospitals hopes to reduce childbirth complications. The campaign is encouraging safe birthing practices; lowered use of labor-inducing drugs … and postponement of elective C-sections until the 39th week of pregnancy …
“the real point is to prevent the first [caesarean]” …
Melissa Maimann, Essential Birth Consulting 0400 418 448
So what is the standard of care post cesarean per ambulation? How soon are women in Australia supposed to be up and moving post-op? How long would a mother have to languish in bed before it is considered to be dangerous?
Generally women are encouraged to ambulate as soon as possible. I’ve known some women to be up and about in 6 hours, others around 12 hours. In some hospitals the women are not encouraged to get out of bed until closer to 24 hours. I think a lot of it depends on the pain relief that is used – if the women have an epidural infusion, often their legs are weak until aftert the infusion is ceased (at around 12-24 hours). Women who have a spinal seem to be up and about earlier. The research suggests that the sooner a woman is out of bed, even sitting in a chair, the better it is in terms of blood clots, pneumonia and so on.