Sunday, March 25, 2012

Again, and again, and again? Or not?

Firstly, a note - Now that our little one has been born, and my personal entries are retreating into the arena of private life rather than pregnancy entries, I am once again moving those back over to my other blog. To see what's going on in our life right now, here is my latest entry.

And now, back to our regular programming:

Let's talk cesareans for a moment. Really, with a third of American labors currently ending in cesareans, there aren't many birth conversations that can avoid the cesarean issue.

Here are two of the main problems that I have with our burgeoning cesarean rate:

The first problem with our ridiculously high cesarean rate is one that is entirely dismissed by most medical professionals - the spiritual and emotional toll of denying women the satisfying and transformational nature of giving birth (vaginally) to their babies. I know that I am a completely different woman from the woman I was before my first birth. Giving birth changed and transformed me in ways that I can't even put into words, and has ever since been a source of empowerment, knowledge, and a deep satisfaction that is beyond description.

When a cesarean is needed, it is a source of blessing. But when the reasons for cesareans are degenerating into the downright silly ("I think your baby might be big, so you need a cesarean at 36 weeks"), it is a tragedy to see so many women robbed of their birthright for no good reason.

(This is not to deny that some women love their cesarean experiences or that some women have rotten or traumatic vaginal births - just to say that for many women, a vaginal birth is a highly satisfying experience that they treasure and find precious.)

The second problem with a super-high cesarean rate is, of course, the health problems for both mothers and babies that stem from it (more below). The problems are myriad and growing. (And I'm guessing that we are acknowledging only the tip of the iceberg - as issues such as depleted gut health and immunity in cesarean-born infants due to lack of the microbial colonization that occurs during the normal birth process [an issue also present for babies born to mothers who are on antibiotics from GBS+ status] are only beginning to be recognized.)

Thus, a few months ago, I was surprised when I read one of my favorite mommy bloggers - a woman I highly respect and hope to imitate in her superb homemaking and mothering skills - writing that there were no real health risks of concern to women who chose to have multiple cesareans (and since this is a Quiver-full blog, we're talking lots of cesareans). A friend of mine challenged me to address this issue in the blog's comment section, and so I took up the challenge and did so. I am going to reprint my comment below.

A couple of notes:

- No, I am not going to link to the blog to which I have referred. As previously stated, I love this blogger and have no wish to start a blog war.

- I would love to hear readers' comments on what I have written. I wrote this entry in a big hurry, so I know that it is very incomplete. If anyone would like to offer corrections to my errors or additions to shore up my inadequacies, I would really appreciate it. Please chip in in the comments sections!

Here goes:

Hi, ------!

I am a regular reader of your blog, a several-time commenter, and a huge fan of both you and your blog. I really appreciate your wisdom, and I benefit from it every time I read one of your entries. Please keep them coming!

I would like to take issue with one subject that you bring up in this entry – your statement that repeat cesarean sections are safe and/or advisable. While it is true that individual women can and do experience complication-free repeat cesareans, on a statistical level multiple cesareans carry increasing risk of serious complications and maternal/fetal/neonatal mortality and morbidity.

Here are some of the risks inherent in multiple cesarean sections:

(1) The risk of spontaneous stillbirth is double or higher in pregnancies following a cesarean section:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)14896-9/fulltext

And also:

http://www.scienceandsensibility.org/?p=4208&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+science-sensibility+%28Science+%26+Sensibility%29

(2) The risk of uterine rupture, while low, still does exist for post-cesarean pregnancies. When that happens, it can be fatal.

(3) One of the biggest risks for repeat cesarean sections is the astronomical rise in placental implantation abnormalities. Specifically, the most common problem is placenta accreta, in which the placenta implants too deeply into the uterine wall, causing hemorrhage and often necessitating an emergency hysterectomy. Here is a quote:

“Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.”

Source:

http://www.ncbi.nlm.nih.gov/pubmed/16738145

Here is another link on that subject:

http://www.azcentral.com/news/articles/2009/03/31/20090331csectionrisks0328.html

Added later, another link:

Placenta problems after multiple repeat cesareans

A quote from that article:

"In other words, your risk of placenta accreta increases from first to sixth cesarean delivery:
1 in 417,
1 in 323,
1 in 175,
1 in 47,
1 in 43,
1 in 15."

This is NOT minor stuff.

(4) Other operative and postoperative complications abound with cesarean surgeries, and the risks go up with each surgery. Here is a quote from the above source:

“The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries.”

(5) Additionally, cesarean sections carry short-term and long-term complications for the baby. In the short-term, cesarean-born neonates are much more likely to be admitted to the NICU for respiratory problems or for other problems stemming from iatrogenic prematurity. On a longterm basis, cesarean babies have statistically signifant higher risks of many different health problems – everything from asthma to tooth decay to obesity. The mechanisms, of course, aren’t fully known, but vaginal birth is how babies are meant to be born – and routinely circumventing that process (which has physical, microbiological, hormonal and other components important to the baby’s future health) has consequences.

Bottom line – Cesarean births can pose grave risks to both mother and baby, and those risks rise with every cesarean birth. It is not possible to avoid those risks simply by removing scar adhesions during future cesareans.

Since your blog deals with many childbearing issues, I would love to see:

(1) Your blog encouraging mothers to avoid the first cesarean whenever possible. For example: wide reading for self-education, good childbirth classes, investigating out-of-hospital birth, hiring a birth doula, etc.

(2) Your blog encouraging women who have had one or more cesareans to, whenever possible, investigate and pursue VBAC birth. A wonderful resource for this is the International Cesarean Awareness Network (ICAN), which can connect women to support groups and VBAC-supportive care providers.

http://www.ican-online.org/

My intention, of course, is NOT to be divisive or argumentative or critical – nor is it to deny the lifesaving nature of cesarean deliveries when they are necessary. If a woman chooses to trust God with her fertility and has no choice but to birth via cesarean, then that is that! But for those who have a choice - I just want to get information out there for women, especially mamas of large families, who are faced with childbearing decisions regarding repeat cesarean sections.

Love the blog always – if you ever need subject material, write to me! I have about two dozen subjects I’d love to see covered!

Love,
Diana

***

Blog readers - please let me know what issues I have failed to address (or have addressed incompletely). I'd love to have a complete entry showing all the risks of repeat cesareans, so please chime in!

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