39 weeks isn't that long

How many times have you heard (or said yourself) "I am so ready for this baby to just get here already"? Many women are told by their care provider that 37 weeks is long enough for the baby to develop. But this simpy is not true, nor is it based upon current research. Much has been brought to light about inducing and cesarean birth before 39 weeks. How as much as a day or two can mean the difference.

In this article in the Wall Street Journal, the problems with early and especially convenience deliveries are outlined well. Respiratory and neurological problems in the immediate and long term are common. Insurance companies are taking note as well and partnering with such groups as March of Dimes to ensure that women are encouraged to gestate for as long as possible.

Upcoming Teleseminar on Birth from Karen Brody

November 19, 2010
1:00pm-2:00pm

This tele-seminar will discuss preparing for your pregnancy and birth. It looks like an excellent resource for mothers-to-be and a good way get useful information in a world of misinformation.

To learn more about the tele-seminar or to register go to:

http://birthsecrets.eventbrite.com/

Support H.R.5807: The REAL MOMS Bill

Recently the Maximizing Optimal Maternity Services for the 21st Century bill was introduced in Congress. It needs our support and the support of our legislative bodies to become a reality. In this bill there would be more educational funding for more midwives (CNM and CPM) and family practice doctors to enter the workforce. These care providers offer lower-cost, less intervention heavy care for pregnant women. This adds up to less cesareans and better care for women in general. It also helps to increase the awareness of the public regarding racial disparities and evidence-based medicine. This can help close the gaps in maternity care.

True to form the American Congress of Obstetricians and Gynecologists have introduced their own "MOMS" bill. They have taken some of the key points of the MOMS Bill introduced in July and turned them around to suit OB/GYNs. Is this a surprise that a lobbying organization to protect the interests of OB/GYNs should do this? No, but it is underhanded to name their bill an approximation. And it takes the collaborative aspect out of the equation and reinforces the paternalistic nature of the current medical maternity model.

So please support the MOMS bill introduce by Congresswoman Lucille Roybal-Allard. Let ACOG know you cannot be swayed by clever relabeling and faulty research. Let your Congressperson know you stand for evidence-based, low-cost and effective maternity care from an array of providers.

Rethinking "Too Posh to Push"

A recent study in the United Kingdom has come out that takes a closer look at the "Too Posh to Push" phenomena. For many the idea of a truly elective (no medical indication, just preference) seems like a good way to make the rising cesarean rates appear like they are consumer driven. But it seems like that is not the case. While there do exist truly elective cesareans and repeat elective cesareans, they were not found in the study to be a majority or even a strong contender for majority within the causes for cesareans studied. Many of the cesareans in the study were the result of a medically indicated factor like breech or a repeat cesarean.

While this still does not excuse the rapidly increasing cesarean rates, it does take some of the blame off women. Because in many cases the mothers may have chosen an elective cesarean without medical indication due to lack of informed consent or fear of trauma. It seems unfair to label these women "too posh to push" if they are consenting to a cesarean based on faulty knowledge of recovery and risk to subsequent pregnancies.

And for the women who feel they are truly educated before they consent to an elective cesarean, we can only hope them a safe surgery and speedy recovery. It would be sour grapes to hope for them to have an adverse outcome simply because of birth choice.

Doulas and Cesarean Section

I recently found this in response to a query about finding doulas on a local expectant mother listserv:

Word to the wise...when choosing a doula, make sure that the contract you sign does not state that they can keep your money (or half of it) if you end up going into pre-term labor or have a c-section.

Not taking anything away from the mother who went through this, but is a doula really irrelevant within the confines of a cesarean section? While I understand that many hospitals have in place protocols that allow for only one support person in the operating room, can a doula enhance your experience when you have a cesarean birth?

According to this checklist on Pregnancy Today, a doula can help in many ways though the process of cesarean; be it scheduled or emergency. If the doula is comfortable with the process and knowledgeable, she can in fact enhance the process. For many families they are so wholey unprepared so it can be a blessing to have an objective support person there who is not part of the medical team to help guide you and your partner through the process. Here is one mother's story about how her doula facilitated her cesarean birth. She was thankful for her doula.

So perhaps instead of amending the contract to state that the doula will not get paid in the case of the cesarean birth, you should have an open and honest conversation with the doula you are interviewing about her services if you end up with a cesarean. Many mature and responsible doulas are able to work with clients appropriately and interface with the hospital staff to make the process a little less scary and clinical.

Defining "Unnecessary"

Many women feel that their cesarean section was "unnecessary". They felt that, given a different set of criteria and birth setting, they should have been allowed to have a vaginal birth. Recently a obstetrician wrote this piece titled "The Myth of the Unnecessary Cesarean". In this article he explains how he finds the term tiring and incorrect. But for many women, his arguments fall flat.

He argues that one could not conclusively say the cesarean was necessary or unnecessary since you cannot guarantee birth outcome either way. Sure, "hindsight is 20/20" plays a big role in the term "unnecessary", but that does not mean it cannot be a legitimate term. If the cesarean, that was medically indicated at the time of incision, was precipitated by a series of interventions that were NOT indicated, would this not be deemed unnecessary? No one is saying that definitively the woman would have gone onto a vaginal birth. They are just saying given the terms of their OWN birth, they felt it was not necessary to have been coerced/rushed into the cesarean.

And as to elective cesareans, it could be said that many of them are "unnecessary" as well. It could be possible that a woman who is having an "elective" cesarean was not given true informed consent (realities of risk for this pregnancy, future pregnancies and a realistic expectation of recovery) or was expected/forced to have a repeat procedure due to lack of support for VBAC (vaginal birth after cesarean).

Birthing Beautiful Ideas also has an eloquent post devoted to this topic. I think this blogger also understands the sentiment of women who have had cesarean birth and the emotional/physiological/psychological impact of an "unnecessary" one.

Multiple Cesareans Present Increased Risk to Placenta

This video from NBC 4 in NYC is making the round on the blogs. It tells the story of a NJ woman who discovered she had placenta percreta (placenta growing through the uterine wall) and placenta previa (placenta covers the opening of the cervix) during her pregnancy. She had 3 prior cesarean births and did not realize that they presented an increased risk for placental abnormality.

She luckily found out about the complication before birth as it would have presented an issue for increased risk of hemorrhage and/or hysterectomy. The comments from both the mother and the physician interviewed are important.

The mother comments, "if you haven't given yourself the chance at labor, you should". This is a woman with 3 previous cesareans. While we do know her circumstances exactly, we can guess that her 2nd and 3rd cesareans were scheduled. If she were given the chance to have a trial of labor and successful VBAC, her odds of developing placental abnormalities would not be as high.

And the doctor comments, "if we don't do anything about decreasing cesarean section rates in this country we are going to have a lot of mothers who are going to lose their lives". NJ had a cesarean section rate of 40% in 2009.

Update:

According to Rixa's Stand and Deliver blog, the journalist quoted the 40 deaths wrong. There were 42 maternal deaths total, with 12 of those being attributed to "preventable loss" such as placenta acreta. This is still a disturbing number of deaths.