A Few Great Articles

These articles are on different topics, but all caught my eye for one reason or another.... As I don't have time for separate blog entries, here they are!

On the subject of the dangers of multiple cesarean deliveries:

Dangerous Delivery Shows Peril of Multiple C-sections

The ease with which cesarean deliveries are handed out nowadays fills me with both anger and grief. Mothers are pounded repeatedly with the "horrible perils" of VBAC, but never told the risks to both them and their babies of cesarean delivery, especially repeat cesarean delivery. This article deals with the dangers to the mother of repeat cesareans - primarily adhesions and placental attachment abnormalities - such as placenta percreta, when the placenta burrows too deeply into the uterus at the site of a cesarean scar, causing hemorrhage and usually necessitating an emergency hysterectomy.

Regarding a case of placenta percreta in a woman having a repeat cesarean, the author (an OB) says:

"But with my patient's placenta stuck and bleeding, only one option remained: removing the entire uterus with the placenta still attached. Because the pregnant uterus is large, swollen, and filled with blood, a hysterectomy after a delivery is very dangerous and performed only as a last resort.

"By the time we finished the surgery, blood covered the floor. Blood filled suction buckets, and saturated our sterile gowns and drapes. Blood-soaked sponges piled up in the corner.

"My patient lost three times the entire blood volume of a normal person, sixteen liters in all. Only a massive transfusion kept her alive. Anesthesiologists pumped in 51 units of red blood cells and seven six-packs of platelets.

"Vessels deep in her pelvis refused to stop bleeding, and instead of closing her, we packed her abdomen with surgical towels, hoping the pressure would stanch the slow, steady flow. She left the operating room and headed to the intensive-care unit with her abdomen still open."

How many OBs are quoting risks like these when handing out cesarean deliveries like hot cakes?

***

Regarding the other set of risks to cesarean sections - the risks to the infant - I absolutely loved this article:

"Natural Births Better for Babies"

The bulk of this article deals with the issue of bacterial transfer. During a vaginal birth, the infant - who comes from the womb sterile - is coated from head to toe in the mother's beneficial vaginal bacteria, and thus the bacterial population of his body is started off in a healthy and balanced way. During a cesarean section, not only does a baby miss out on beneficial labor hormones that he would get during a vaginal birth, but also misses out on the beneficial bacterial colonization. Instead, he is at the mercy of the bacteria of his surrounding environment. The same holds true for mothers whose bodies are artificially sterilized by GBS-protocol antibiotics. It really makes sense to me that cesarean babies have higher levels of all sorts of diseases, from dental cavities to diabetes to allergies to asthma (and why babies born to mothers on antibiotics have higher rates of E. coli infection). The author states:

"BABIES born by caesarean section are more vulnerable to asthma, allergies and infection as they miss out on receiving their mothers' good bacteria during birth, a scientist says.

"Professor Patricia Conway, of the School of Biotechnology and Biomolecular Sciences at the University of NSW, said babies delivered vaginally received protective bacteria as they passed through the birth canal. Left on the baby's skin, this bacteria could then colonise the intestine and help inoculate newborns against hospital bugs. Gut flora was also crucial for developing a balanced immune system, Professor Conway said. "With a C-section, the newborn baby misses an opportunity to pick up a lot of mum's good bacteria," she said.

"'This can have long-term health implications, as the development of a good intestinal ecosystem is necessary for health and immunity to allergies, from childhood right through to adulthood.'

'Professor Conway said emergency caesareans, performed after labour had begun, meant babies did receive some of the beneficial bacteria, particularly if the waters had broken. But elective caesareans were ''sterile'' and gave babies no chance to pick up any of the mother's good bacteria....

"In 2008, European researchers examined 20 previous studies on the link between type 1 diabetes and caesareans and found babies born surgically had a 20 per cent increased risk of developing diabetes.

"They hypothesised the increase could be attributed to surgically born babies having gut microbes picked up from hospital environments rather than their mothers' vaginas, having reduced or delayed exposure to infection in early life or being exposed to non-specific perinatal stress."

The author also dealt with the issue of labor hormones. Cesarean babies, especially those born by scheduled cesarean, miss out on the labor hormone cocktail which they experience during vaginal birth:

"Australian College of Midwives vice-president Hannah Dahlen said babies born vaginally had the advantage of hormonal surges during labour, which made them more wide-eyed and able to connect with their mothers.

"Both mother and baby experienced a surge in catecholamines - the fight-or-flight hormone - during labour, making babies more alert at birth.

"Recent studies had shown white blood cells in babies born by caesarean were different to those born vaginally, potentially altering the way their bodies responded to attacks on their immune systems for the rest of their lives.

"The studies could explain dramatic increases in rates of diabetes, testicular cancer, leukaemia and asthma among babies born surgically, Dr Dahlen said.

"'In labour, the baby has a gradual escalation in its stress response and then a gradual decline. Research has shown that this could prime our bodies to respond to stress in a certain way,'' she said.

"'With a C-section, there is a cold cut and the baby has a dramatic stress response. It could be setting that child up to always over-respond to stress.'"

How about those risks being quoted to cesarean mamas?

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I LOVED this article on vaginal exams:

"The Dangers of Vaginal Exams"

There are two parts to this article - the first part shows those things that can be determined by vaginal exam (dilation, effacement, station, cervical position, fetal position, and cervical consistency). The best part, however, is the second section of the article which describes the reasons why vaginal exams are both unnecessary and often harmful.

Why unnecessary? Because in most cases labor progression can be determined in other ways. Additionally, when a labor is progressing normally with an absence of pathological symptoms, knowing numbers for each step of the way is just not necessary.

Why harmful? For too many reasons to count! Here are those reasons listed by the author:

- Premature cervical stimulation
- Risk of premature rupture of membranes
- Negative effect on mother's emotional state ("What do you mean, I'm only a 3???")
- Risk of infection

Good article. Check it out!

***

Then two articles on one of my pet subjects, premature vs. physiological umbilical cord clamping. Current in-hospital practice is to cut the umbilical cord within 30 seconds of birth, when it is still pulsing and the baby is still receiving blood from the placenta. Most homebirth midwives wait until the cord clamps down naturally, which happens within 10-20 minutes after birth (usually), and then cut the cord. Personally, I cannot believe that anyone could consider premature cord clamping as healthy. If it is necessary to disrupt a natural process that has been going on undisturbed in the animal world for millenia (and in the human world until the last 50 years), then (1) the human race would not have survived, and (2) the world would be filled with dying baby animals, staggering about and collapsing on the streets because no one thought to clamp their umbilical cords while they were still pulsing. Think about it.

Wait to clamp unbilical cord, study says

The author says:

"After reviewing the majority of research in the field, Sanberg and his colleagues concluded that delaying cord clamping could reduce the infant's risk of many illnesses, including respiratory distress, chronic lung disease, brain hemorrhages, anemia, sepsis and eye disease.

"The risk of such problems, and thus the potential benefit of delaying cord clamping, is particularly significant for premature babies and those born malnourished or suffering from other complications.

"Still, the researchers suggest delaying cord clamping may be beneficial for healthy, full-term babies as well — after all, it may be what we have evolved to do.

"'Evolutionarily, there is clearly value for this," Sanberg said, explaining that all mammals, including most humans through history, allow the maternal blood to finish being transferred before severing the cord. The squatting birthing position, only recently out of vogue in the West, may have even facilitated this transfer by harnessing gravity."

And also:

"Do We Clamp the Umbilical Cord Too Soon?"

(Short answer: YES. Long answer: YES.)

From the authors:

"At birth, the placenta and umbilical cord start contracting and pumping blood toward the newborn. After the blood equilibrates, the cord’s pulse ceases and blood flow from mother to newborn stops. In recent Western medical practice, early clamping — from 30 seconds to one minute after birth — remains the most common practice among obstetricians and midwives, perhaps because the benefits of delaying clamping have not been clear. However, waiting for more than a minute, or until the cord stops pulsating, may be beneficial, the authors said....

"“Several randomized, controlled trials, systematic reviews and meta-analyses have compared the effects of late versus early cord clamping,” said Dr. Park. “In pre-term infants, delaying clamping the cord for at least 30 seconds reduced incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and decreased the need for blood transfusions.”

"Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors...

"The researchers concluded that many common disorders in newborns related to the immaturity of organ systems may receive benefits from delayed clamping. These may include: respiratory distress; anemia; sepsis; intraventricular haemorrhage; and periventricular leukomalacia. They also speculate that other health problems, such as chronic lung disease, prematurity apneas and retinopathy of prematurity, may also be affected by a delay in cord blood clamping."

Premature cord clamping is a practice that needs to go the way of all antiquated medical practices, and the sooner the better. However, killing sacred cows in the obstetrical world is a world-moving task. Hopefully sometime!

Okay, I've gotten these articles off of my chest - now I can delete them from our browser and stop driving my poor husband nuts! Goodnight, all!

(As always, thoughtful and polite discussion and comments are always welcome. Rude or offensive comments will be deleted without response.)