•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.

Ms Wang was poisoned during the birth of her first child in June at St George Hospital when an antiseptic skin preparation was accidentally injected into her spinal canal in place of an anaesthetic. The case has rocked NSW Health and shocked the public.

The two substances – both clear liquids – were placed in separate dishes on a sterile table in the delivery room, the Herald has learned, and were mixed up as a consequence of being unlabelled. Other hospitals insist drugs are drawn by the anaesthetist directly from their original vial or ampoule into a syringe.

… the practice of drawing medications from stainless steel dishes was routine a generation ago. ”It was identified as being an undesirable and unsafe practice.”

The antiseptic infused into Ms Wang’s spine, chlorhexidine, has increasingly been used in the past five years in NSW because it mixes readily with alcohol, which accelerates drying and the epidural catheter can be inserted sooner.

The chlorhexidine wrongly injected into Ms Wang, who has suffered severe pain and can no longer walk, is understood to have been mixed with alcohol.

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.”

“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.

With the Health Department and midwives’ groups angrily denying the changes would jeopardie the health of women and their babies, The Manly Daily yesterday spoke to the most important people in the debate – new and expecting mums.

Amee Harland said she would wait for the Mona Vale maternity ward to reopen in full before having a second child there.

“I had a 24-hour labour and then they had to call the doctor because the baby’s heart rate was falling and he was there in five minutes and had to use a surgical vacuum,” she said.

… “You wouldn’t want to drive to Manly (or St Leonards) in the middle of labour …

“I would prefer to go to Mona Vale – it is my home town. Why would I want to go anywhere else? They were so good there.”

Mother-of-three Kellie Finney said low-risk births could also require immediate action.