The new recommendations came at a conference held in Bethesda, Md., by the National Institutes of Health to examine why the rate of … VBAC … has plummeted, to less than 10 percent from 28.3 percent in 1996. The repeat operations are feeding the nation’s overall Caesarean rate of 31.8 percent, which has been rising steadily for the last 11 years.

… Implicit in the document was the conclusion by the panel that VBAC is a reasonable option for low-risk women. I think that’s fabulous.

… the United States places 41st on the World Health Organization’s list of safest countries for childbirth. As for 2006, 13 women out of every 100,000 died during or shortly after giving birth, which is higher than rates in Canada, the United Kingdom and Poland …

That’s around 550 deaths out of 4 million annual births across the country.

The federal government had set a goal to reduce maternal deaths by 2010, but the new numbers are four times higher than what they’d hoped to attain.

Pregnancy can exacerbate pre-existing health conditions, leaving obese women — who now make up 20 percent of pregnancies — more susceptible to potentially fatal consequences.

… Cesarean sections might be another important factor. The number of women scheduling cesarean births has increased by 50 percent … since 1996 … the procedure is … major surgery.

… most maternal fatalities aren’t considered “preventable” …

Surging C-section rates … have worried experts … just because a woman has had a C-section in the past, there’s no reason she must have one in subsequent deliveries.

However, current medical practice and fear of lawsuits are major obstacles to encouraging women to have a vaginal delivery after a C-section …

… Another problem has been … the fact that they have not had access to care where a trial of labor can be offered …

… “vaginal delivery after Cesarean is certainly a safe alternative for the majority of women who have one prior Cesarean,” …

… bad outcomes remain rare — … there are about 10 deleterious outcomes for every 100,000 births, vaginal or otherwise.

It’s a system where the government pays, the patient pays and the doctor smiles before he or she slaps you with a monstrous bill.

I took notice last year when AAP’s Los Angeles correspondent Peter Mitchell criticised the fees charged by health care providers in the US.

His wife gave birth to a baby boy and the bill come to over $A50,000, but it was completely covered by their $A418 monthly payments for US health insurance.

I have recently confronted a mirror experience as an American journalist living in Australia.

But I calculate that Peter paid less in out-of-pocket costs during his wife’s pregnancy than my wife and I did in Sydney.

We initially decided on the public health system for the birth of our son until we caught sight of our local hospital’s maternity ward: a demountable structure.

… The deal-breaker came when I asked what would be the medical response to an emergency birth.

Answer: a helicopter to transport my wife to a better-equipped facility.

Both of us had private health insurance, which we’d never used, so we thought we’d give it a go.

The out-of-pocket costs for the private hospital were estimated in advance at $500, which turned out to be accurate in the end.

We shopped around for a recommended obstetrician and settled on someone in the CBD who charged $4000, which we thought would be for the delivery, no matter the outcome.

Of that amount, we had to pay $1800 after Medicare.

We heard of prices for obstetricians as low as $3000 in Sydney’s west and as high as $6400 on the north shore.

Our doctor also charged us $100 for every visit to his office, of which we received about $80 back on each bill from Medicare.

So far, we’re in for about $2800, which we thought was about the maximum we wanted to pay in a country that rates its public health care system among the best in the world.

The first anaesthetist charged $700 to stick a needle in my wife for the epidural – a 10-minute procedure.

The second anaesthetist, who was present during the surgery, charged an additional $1386 and did almost nothing.

During my wife’s procedure, a young nurse present made it clear she was there to take photos and asked if I had a camera with me. I did.

The assisting surgeon charged another $420 and to top things off, our obstetrician sent us a bill for another $1539.

Last but certainly not least, a paediatrician making daily rounds at the hospital checked out our son on three separate occasions for less than five minutes a visit.

The cost for that? $700.

She was delivered at home after her mother, Leah, rejected advice to have a caesarean section … because her first baby … had been born that way …

A surgical birth – about 30,000 are performed in NSW each year – would have cost the public hospital system about $8000.

If she had been admitted to a neonatal special care unit, like 70 per cent of babies born by caesarean, including her big brother, it would have cost another $900 a day.

But her entry to the world, in a Dee Why lounge room, cost taxpayers nothing …

[Midwives] are calling for another urgent meeting with the Health Minister, Nicola Roxon, before the new rules come into effect in July.

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 …

You’ve known for days.
The urpy-ness before breakfast (when you can eat breakfast), the swollen bits, the tender bits, all good indications. Even the home-kit was positive but it wasn’t “official” until the doctor said it: you’re pregnant.

But after leaving your first prenatal exam – and after more tests than you’ve had in your lifetime – your mother (overjoyed) read through some information you received and said she never remembered half that stuff when you were born. Grandma (ecstatic) said she wasn’t even awake when your mom was delivered.

Have we come a long way, baby? Yes and no, as you’ll see when you read “Get Me Out” by Randi Hutter Epstein, M.D.

Let’s start in the year 1530. You’re about to become somebody’s mom. Because a sign on the door of your room says “no boys allowed,” you’re surrounded by girlfriends, female relatives and a midwife (if you could afford her). They would have herbs for you, food and drink. Someone might consult a book of pregnancy advice (available for thousands of years). You’d labor with people you knew.
But as an almost-mom in 1530, don’t expect anything for your pain. In 1591, a laboring mother (of twins!) was burned at the stake because she dared to ask for relief.

Fast forward three hundred years.
You’re at a lying-in hospital, so-called because post-delivery recovery takes weeks of bed rest. You might be allowed visitors, but no midwives; male doctors have convinced the general population that midwives are dangerous. Giving birth away from home and family, you’re told, is best for you and the baby.

Instead of 5 percent to 8 percent of pregnant women being diagnosed with gestational diabetes, the new measurements mean that more than 16 percent would be diagnosed with the condition …

… “Women wanting to conceive, or who are already pregnant or breast-feeding, need a minimum of 250 micrograms of iodine each day for the baby’s brain and nervous system development,” …

“Australians now get more iodine in their diets following the mandatory fortification of bread last October, though it is still appropriate for women to supplement their diet with an additional 150 micrograms of iodine every day,” he said.

… “The body does not store iodine, so amounts taken in excess of the body’s requirements will simply be excreted by the kidneys.”