•Almost half of women wanting vaginal births were induced.
•Women who were induced were twice as likely to have a cesarean birth as moms whose labor starts spontaneously.
•Of the c-sections done after induction, half were performed before the cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role.”
•A third of first time mothers had c-sections.
•C-sections upon maternal request (those done for non-medical reasons) account for only 9% of c-sections.
•Attempts at VBAC are less likely to result in vaginal birth than previously thought. Few women are offered the option of VBAC.

… what can you do about all this if you are pregnant and want a vaginal birth? Here are a few ideas:

Researchers have established that when high levels of lactic acid are measured in the amniotic fluid, it is unlikely the mother will deliver vaginally.

Measuring this acid could help decide whether to end a difficult labour and opt for a Caesarean earlier.

The test is being rolled out in a number of European hospitals.

Prolonged labours which end up in a Caesarean section are seen by many as the worst of all worlds.

In the UK, despite the mantra “too posh to push” more than half of Caesareans are emergency rather than elective procedures, in which the mother frequently undergoes a long and painful labour before an urgent operation is deemed necessary to protect the health of both her and her baby.

… the uterus produces lactic acid as other muscles do when they work hard, but that when it reaches a certain level the substance starts to inhibit contractions.

… The hormone oxytocin is usually administered in cases of slow labours to stimulate the uterus into contracting, but not all labouring women respond to it.

… the test should help doctors establish which women may go on to deliver vaginally, as low levels of lactic acid suggest the uterus could still produce the contractions needed to push out the baby.

“But a high level of lactic acid in the amniotic fluid indicates that the uterus is exhausted. To stimulate this kind of labour with an oxytocin infusion would be like asking a marathon runner to run an extra 10,000 metres after he or she has passed the finish line.”

While Jamie’s twin sister, Emily, was delivered safely, doctors worked for about 20 minutes to get premature Jamie to breathe before declaring that he couldn’t be saved.

… “I unwrapped Jamie from his blanket. He was very limp. I took my gown off and arranged him on my chest with his head over my arm and just held him. He wasn’t moving at all and we just started talking to him.”

Ms Oggs said she and her husband, David, had given up saving Jamie, who was born at 27 weeks and weighed less than 1kg.

… after about two hours of being hugged, touched and spoken to, little Jamie miraculously showed signs of life.

“Jamie occasionally gasped for air, which doctors said was a reflex action,” Ms Oggs said.

“But then I felt him move as if he were startled, then he started gasping more and more regularly.

“I gave Jamie some breast milk on my finger, he took it and started regular breathing.”

… “A short time later he opened his eyes. It was a miracle,” Ms Oggs said.

“Then he held out his hand and grabbed my finger.

“He opened his eyes and moved his head from side to side. The doctor kept shaking his head, saying, ‘I don’t believe it’.”

The Sydney mum spoke publicly to highlight the importance of skin-on-skin care for sick babies.

Home, for now, is a bassinet wedged into a room in the high-dependency unit of St George Hospital, where the two-month-old’s mother lies catastrophically injured.

Grace Wang’s spinal canal was injected with a powerful antiseptic instead of anaesthetic, in what should have been a routine epidural to ease the pain of her first child’s birth.

The devastating medical mistake – inconceivable in its magnitude – has poisoned her nervous system, leaving the 32-year-old distressed, confused, in shocking pain and unable to walk or even sit.

She has lost the strength to hold Alex, and rarely asks about her baby, as she did constantly after his birth.

The future may not bring relief, as Ms Wang’s physical and psychological condition has deteriorated since the accident on June 26, and new symptoms continue to emerge.

In the first three relatively hopeful weeks, her husband, Jason Zheng, cooked for Ms Wang and fed and changed Alex, who has apparently not suffered from the drug error.

Now Ms Wang has had surgery to relieve fluid pressure on her brain, and Mr Zheng maintains a vigil beside his increasingly frightened and disoriented wife, leaving little time for his son. The longed-for baby – who followed three miscarriages – is cared for by a nurse the hospital provides. The couple have no family in Sydney, where they migrated from China.

”It’s like we are ignoring that we have a son,” said the distraught father, who will begin legal action.

… Alex snuggles close when placed alongside his mother, but breastfeeding has been impossible for fear the many medicines she is taking may affect the milk.

”Every day she’s suffering and she says she wants to give up,” Mr Zheng said. ”She was crying last night when she touched her son. I just want to change my body to hers.”

Another thing Mr Zheng wants, and which motivated his decision to speak publicly, is to make contact with anyone who has suffered similarly, in the hope their doctors may advise on Ms Wang’s treatment.

Epidural administration of chlorhexidine – used to clean skin before injections and strong enough to neutralise resistant hospital bacteria – is so rare that Ms Wang’s doctors have identified only one other case.

Angelique Sutcliffe, from Britain, was paralysed for life after the chemical entered her epidural in 2001. But this was just a droplet – a fraction of the eight millilitres infused into Ms Wang.

Managers at St George Hospital yesterday admitted error and pledged to support the family, but would not explain the possible source of such a fundamental mistake in a commonplace procedure: nearly 40,000 epidurals were conducted in 2006, the most recent New South Wales statistics show, in 43 per cent of all births.

The state’s Minister for Health, Carmel Tebbutt, said: ”This is an extremely distressing case and I offer my sincere apologies.”

Home is the perfect environment for many things, but there’s one thing it’s definitely not right for – and that’s giving birth. For that, there are things called ‘hospitals’ and they are full of lovely people called ‘doctors’.

This week there has been a brouhaha, caused by an article written by Cathy Warwick, the general secretary of the Royal College of Midwives. She … is enraged by a report … [that] indicates that home deliveries can double, or even treble, the risk of a baby dying during childbirth.

Now I don’t know about you, but even the teeniest increase in the risk of death to my unborn child, or to myself, would be more than enough to get me into my car and down the local maternity hospital the second labour started.

We’re talking about the life of two people here – and, by association, the lives of everyone they know – and I value that ever so slightly above the need for comforting personal effects and my favourite CD on the stereo.

And to me, anyone who doesn’t is being not only very foolhardy, but also incredibly selfish. As well as having written three books on parenting, I have given birth three times, and never considered having my baby on the Ikea rug in my living room, even though as a young, healthy, fit woman – I had my first child at 23, and the other two at 25 and 28 – I was in a very low risk category and could easily have opted for a home birth.

But thank goodness I didn’t, because two of my ‘low risk’ labours ended up being more complicated than anyone had predicted. It was lucky I was in a hospital with immediate medical care available, or my babies could have been in real trouble.

‘Where motherhood is concerned, exercising our “right” to have things exactly the way we want is potentially damaging’
The reason for this is very simple: childbirth is not an exact science. It’s not predictable or controllable.

It is a natural, biological process, and like many biological processes, it can outsmart even the best human planner.

Those in favour of home birth speak of it as being a ‘ positive’ choice. Of the journey into hospital being ‘unpleasant’. Of hospitals being ‘uncomfortable’ …

Now, I dislike strip lighting, the clinical smell and not being able to drink a cup of tea out of my favourite mug as much as the next woman trying to get a human out of her body.

But these discomforts seem shamefully insignificant compared with the importance of having a safe, healthy delivery – even if the risk is tiny.

“The new unit is essentially a home birth that happens to be in a hospital,” Dr Jollow said.

Offered as a success story on the AirStrip OB corporate website is an article in the St. Petersburg Times in which a physician at Community Hospital, which has a 37.7% cesarean rate, was able to see 30 patients in the office while “keep[ing] tabs” on a patient whose induction began at 5 a.m. that day. The doctor “saw a slight fluctuation in [the baby]’s heartbeat that told him the baby wouldn’t be able to withstand a long labor.” He performed a cesarean on the woman at about 1 p.m. and ushered a “healthy 8 pound, 14 ounce girl” into the world.

The page of testimonials features cheers from physicians, one of whom says, ‘At least with AirStrip OB, I can minimize unnecessary trips to the hospital.” Another raves, “But the greatest aid of all is that I can check the strip in real time when a nurse calls and reports concerns…I just open up AirStrip OB on my iPhone, review the strip and discuss the situation with the nurse…Medicolegally, I expect that this ability will not only benefit the obstetrician, but the hospital as well.”

… One of the misunderstandings that many patients have about giving birth in a hospital is that a doctor will be right there, ready to perform a crash cesarean section or operative delivery at the drop of a hat if their baby is experiencing severe fetal distress. But keeping these resources available around the clock is extremely costly … Even in hospitals that do have 24/7 surgical and anesthesia coverage, if they are performing another cesarean, the surgical suite and necessary staff may not be immediately available when an urgent complication develops.

The following guest post was submitted by Amity Reed in reaction to reading about the distancing “benefits” of the AirStrip OB application in an article:

Have you ever been laboring hard in the hospital — attached to all the various wires and machines; surrounded by equipment, instruments and alarms — and thought: how can we upgrade this birth from merely medicalized to hardcore hi-tech? Well, your prayers have been answered, ladies! The latest in baby removal technology allows your OB to take in a movie across town and simultaneously manage your birth. Soon, doctors may not even have to step foot in hospitals in order to do their jobs. This is the wave of the future: taking people out of the care equation altogether!

Yes, my friends, you too can now have major decisions about your maternal care made by any doctor with the latest smartphone application. Called ‘AirStrip OB’, this app delivers (ha!) real-time information about a woman’s labor so that busy doctors can make judgment calls about women they’ve not witnessed in labor (or even met!) from the comfort of their home. No more worries about wasting a highly-educated obstetrician’s time with your piddling requests for mobility, sustenance or support; the AirStrip OB app reduces the embarrassing tendency of patients to ask questions or expect personable care. ‘Emergency’ cesareans can now be ordered and performed before your OB’s sedan has been sufficiently warmed and gone through the Starbucks drive-thru. Technology is amazing, isn’t it? As those of us in the baby removal business like to say: “If you’re not in the room, cut open that womb!”

With this cutting-edge (ha!) technology, it’s never been easier to imagine c-section rates approaching 50 or even 60%. Soon, the use of vaginas for delivering babies will be obsolete altogether, leaving women with fresh, modern ‘love tunnels’ free from the wear and tear of childbirth. No more expensive vaginal rejuvenation surgery or labia lifts! Our technology, with its resulting seven-fold decrease in normal births, maximizes your chance of avoiding dangerous and unsightly vaginal birth.

But, wait, that’s not all! A recent survey found that 85% of the births portrayed on television and in films left fathers-to-be feeling disgusted, terrified and excluded. Everyone knows childbirth is pretty heinous and yucky, am I right? With the AirStrip OB app, you give your partner the gift of feeling secure in his masculinity, allowing him to renew his claim on your vagina. Why have a ghastly ‘husband stitch’ on your perineum when you can have a simple ‘husband staple’ on your tummy? Nothing says ‘I love you’ like abdominal surgery!

We hope all pregnant women come to know and love the AirStrip OB application, as all good mothers should. You don’t want to be one of those mothers who takes her chances for selfish reasons and ends up with a dead baby, now do you?

But C-section carries all the attendant risks of major surgery; and data show that compared with vaginal birth, cesarean delivery increases the odds that a mother will end up back in the hospital after birth with complications …

Now obstetrics experts are actively seeking ways to drive down the number of C-sections … the ACOG issued new guidelines recommending that hospitals allow most mothers who desire vaginal birth after cesarean … to attempt a trial of labor, including … mothers who are carrying twins or have had two prior C-sections. Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits.

Another factor contributing to high C-section rates is the increase in induced labor, especially between 37 weeks and 38 weeks … The use of labor induction in the U.S. has risen from less than 10% of deliveries to more than 22%, between 1990 and 2006 … research suggests that induced labor results in C-sections more often than natural labor … those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.

… previous studies had come to the same conclusion. In her study of … mothers delivering before 41 weeks’ gestation … 44% of women had their labor induced.

… after 41 weeks’ gestation, at which point it is standard policy to induce labor, it may lower the risk of medical complications for mother and baby — including the risk of stillbirth — and even decrease the likelihood of C-section delivery, but those same effects are not seen in women who induce labor before the 41-week mark.

… Among the women whose labor was induced in Ehrenthal’s study, nearly 40% of cases were categorized as elective. In other words, there was no pressing medical indication for induction. Extrapolating from the study findings, Ehrenthal suggests reducing the use of elective labor induction could lower the national C-section rate by as much as 20%.

Several hospitals have already begun reducing medically unnecessary induction as a way to lower the rate of cesareans …

… under the new policy the overall induction rate dropped 33% and the rate of elective inductions fell by roughly the same amount … the total number of C-sections among first-time mothers who underwent elective induction dropped 60% …

If a relatively simple policy shift based on medical evidence can successfully cut the rate of induced labor and C-sections at a single hospital, experts say similar changes applied broadly may help lower the rate of C-sections on a national level.

Midwives say doctors and nurses at OHSU have filed baseless complaints to the licensing agency meant to thwart competition … The threatened lawsuit spurred a passionate online debate among supporters and critics of home birth.

Conflicts between midwives and doctors run deep. One of the biggest problems: Many physicians deal with midwives only when a laboring mother experiences difficulties during a home birth and requires transport to a hospital, sometime urgently.

“It’s an extremely tension-fraught encounter,” according to Melissa Cheyney, an Oregon State University assistant professor and practicing midwife who studied the interactions of midwives and doctors in Jackson County last year. Nearly every physician interviewed by Cheyney and her graduate student expressed the view that births must take place in a hospital to be “safe.”

Studies including higher-risk pregnancies have found that fetal deaths are more likely in home births. But in low-risk pregnancies, most research shows no significant difference in risk to the baby, while home-birth mothers experience fewer complications. In a study in British Columbia last year, women giving birth at home suffered fewer than half as many serious perineal tears, and about a third less postpartum bleeding.

By choosing a hospital birth, women substantially increase the risk of having a surgical delivery. More than 29 percent of hospital births in Oregon resulted in a cesarean during the years 2006-2008. Less than 4 percent of home births ended with a cesarean in a 2005 study of 5,400 births attended by midwives in the U.S. and Canada.

Women who choose home birth often cite the desire to keep birth free of medical intervention. Heather Hermans … transferred to the care of a midwife because she wanted to try a vaginal delivery rather than schedule a cesarean section, as her obstetrician-gynecologist recommended.

Conflicts aren’t inevitable. Cheyney is working with midwives in Lane County and a Eugene obstetrician, Dr. Paul Qualtere-Burcher, on guidelines for smoother, more collaborative relations. Qualtere-Burcher and his colleagues have agreed to help midwives get access to laboratory testing and ultrasound screening for their clients. Midwives are referring higher-risk home birth clients to the physicians for assessment and another perspective.

“We’d like them to come in and see us before it becomes a big issue during labor,” Qualtere-Burcher said. “I think it’s been very successful.”

Home birth by the numbers

Planned home births in Oregon last year: 877 out of 47,675 total births, or 1.8 percent.

Chances of giving birth without medical intervention: 78 percent with a home-birth midwife versus 54 percent in hospitals, according to the 2009 British study.

A women’s chances of having cesarean section when giving birth in an Oregon hospital, 2006-2008: 29 percent.

Fetal deaths in births attended by licensed midwives in Oregon, 2001-2007: 4 in 2,906 births, about 0.1 percent.

Complaints lodged against licensed midwives, 1999-2007: 40.

Disciplinary actions imposed by the Board of Direct Entry Midwifery, 2000-2004: 12

Midwife guide

…

Direct Entry Midwife – A general term for practitioners who train directly into midwifery without a nursing or medical background, and attend births outside of hospitals. Oregon law allows direct entry midwives to practice with no licensure.

Certified Professional Midwife — Direct entry midwives certified by the North American Registry of Midwives, which requires written and practical examinations and practical experience attending 40 births.

Licensed Direct Entry Midwife — Direct entry midwives who obtain a license in Oregon are authorized to use some prescription drugs and medical devices. They must pass a national examination, demonstrate experience in attending births, and complete continuing education every three years. They are licensed by the Oregon Board Direct Entry Midwifery and subject to disciplinary actions if they violate professional standards.

Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home … The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.

Professional organisations … have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK’s Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.