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The Cesarean
Debate
Family Doctors Speak Out on the
Right to Choose Vaginal Birth (September 2006)
Discussion of a woman's right to choose a planned cesarean has been of
interest recently. Conversely, we hear very little about a woman's right
to choose a VBAC or a vaginal birth for breech presentation. A recent essay
in the Annals of Family Medicine concludes that,
“The growing pressure for cesarean delivery in the absence of a medical
indication may ultimately result in a decrease of women’s childbirth
options. Advocacy of patient-choice requires preserving vaginal birth
options as well as cesarean delivery.”
Babies Delivered by Cesarean More Likely to Die (September 2006)
Researchers at the Centers for Disease Control and Prevention analyzed
over 5.7 million live births and nearly 12,000 infant deaths over a
four-year period. The research,
published in the journal Birth: Issues in Perinatal Care, found
that neonatal mortality rates (death in the first 28 days after birth) among infants delivered by cesarean section were more than twice
those for vaginal deliveries, even after adjusting for socio-demographic
and medical risk factors. "These findings should be of concern for
clinicians and policy makers who are observing the rapid growth in the
number of primary cesareans to mothers without a medical indication,"
says lead researcher Marian MacDorman.
Full text of the article
Results of NIH
Conference on "Elective" Cesareans (March 2006)
The report from the conference concluded that "There is insufficient evidence to
fully evaluate the benefits and risks of Cesarean Delivery
by Maternal Request as compared to Planned Vaginal Delivery,
and more research is needed." This disappointing and
baffling conclusion has provoked plenty of reaction in the
birth community. Here are a few links for more information:
Full text of the report
Analysis by Childbirth Connection
Press release from the
ACNM
Op ed piece from the Boston Globe
New Research Debunks Elective Cesarean Myth (March 2006)
Childbirth Connection (previously known as the Maternity Center Association)
has released preliminary results from their second Listening to Mothers
survey, conducted with Lamaze International. They found that only one woman
(0.08%) of more than 1,300 surveyed might have chosen an initial or
"primary" cesarean without medical reason. These first national results from
women themselves clarify that demand from mothers for “elective” primary
cesareans is virtually non-existent. In addition, nearly 10% of survey
respondents reported feeling pressure from a health professional to have a
cesarean delivery, vastly outweighing the pressure from mothers to have
one. Visit
Childbirth Connection
for the full press release and information on the survey.
Term Breech Trial Flawed (February 2006)
The infamous Term Breech Trial,
published in 2000, claimed that planned cesarean was safer for breech babies
than vaginal delivery. It soon became difficult to find an OB in the US who
would allow a vaginal delivery for a breech baby. Now, the
American Journal of Obstetrics and
Gynecology has published a stinging critique that concludes the
original study was deeply flawed and its conclusions unsupportable (Glezerman
M, Five years to the term breech trial: The rise and fall of a randomized
controlled trial. Amer J Ob & Gyn
(2006) 194, 20-5). The article thoroughly itemizes the methodological flaws
and clinical problems with the Term Breech Trial. To read the full opinion,
visit tinyurl.com/8nn6b.
Thanks to Citizens for Midwifery for bringing this to our attention!
Cesarean Rate Continues Its
Alarming Climb (November 2005)
The cesarean delivery rate has risen for the eighth straight year according
to preliminary birth data for 2004 released by CDCs National Center for
Health Statistics in November 2005 (tinyurl.com/dgwxs).
Among the CDC’s troubling findings:
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29.1% of all births in 2004 were cesarean deliveries, up from 27.6% in
2003.
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Since 1996, the cesarean rate has climbed 40% and the VBAC rate has
plunged 67%. The 2004 VBAC rate was only 9.2%.
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Nineteen states had
Cesarean rates higher than 30% in 2004 (as compared to seven states for
2003).
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The percent of babies born preterm or low birthweight also continued to
increase, even among singleton deliveries.
What Every Pregnant Woman Needs to Know About
Cesarean Section (July 2004)
Childbirth Connection
(previously known as the
Maternity Center
Association) unveiled their new information booklet. Initiated after the ACOG Ethics Committee Opinion publicized in
October 2003 (see below), the booklet has been endorsed by many
organizations, including
Citizens for Midwifery.
The booklet is easy to read, accessible, and looks thoroughly at the
evidence. It provides women with information on the short and long term
risks and benefits of cesarean sections for mother and for baby. It also
includes information about what women can do to lower their chances
of having a cesarean.
Download the booklet
(free registration is required)
Previous Cesarean Doubles Rate of Unexplained
Stillbirth in Following Pregnancy (November 2003)
A research study published in the November 2003 edition of the British
journal The Lancet finds that Cesarean section significantly increases the
rate of unexplained stillbirth before labor in the following pregnancy.
Abstract
ACOG Opinion on Elective Cesarean (October
2003)
October 31, 2003 press release
"New ACOG Opinion Addresses Elective Cesarean Controversy" about a new
ACOG Committee Opinion "Surgery and Patient Choice: The Ethics of Decision
Making."
Response by Lamaze, CIMS and DONA to a Washington Post story
on the press release.
Cesarean Section Increases Maternal Mortality Rate 4-Fold (August 2003)
A research study published in the August 2003 edition of the journal
Obstetrics and Gynecology finds that Cesarean section significantly
increases the maternal mortality rate.
Additional Resources
Find factual resources from
Citizens
for Midwifery
and
ICAN
(International Cesarean Awareness Network).
CIMS Fact Sheet
"The Risks of Cesarean Delivery to Mother and Baby"
Contacting the Media
Click
here for tips on
contacting the media about this and other issues.
Tips
for Contacting the Print Media and Radio Talk Shows
Nice piece from MANA on how to interact effectively with the media
(particularly about the Pang study, but the guidelines are universal).
Tips
for Writing a Letter to the Editor
by Susan Hodges of Citizens for Midwifery
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