Cesarean Rate Hits a New High - 31.1%

Below is the current ICAN press release (http://www.ican-online.org/) in response to the CDC report released today regarding 2006 childbirth data (http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf ). The latest Colorado numbers (2006) are showing a 25.3% cesarean rate an increase of 2.8% since 2005. Though this is clearly lower than the national average, Colorado is still nearly double the reasonable cesarean rate of 10-15%. By no means should we feel comforted by this, falsely secure or safe knowing that other states have more extreme numbers.

I hope we are outraged that the current standard and attitude in maternity care is causing needless major surgery, allowing women to be lied to about true risk and benefit, injury to women and babies (even death), future fertility/pregnancy issues, emotional trauma, and financial strain personally and governmentally (I could go on and on).

It is time for women to take charge of their own care by insisting their provider use protocols and practices that are proven safe (almost always that would be normal unfettered vaginal birth) or vote with their wallets, insurance cards, and feet!

No peace today. Desirre

Cesarean Rate Hits a New High

Recent Studies Show Cesareans Can Pose Dangers to Mothers and Babies

Release Highlights:

• Cesarean rate at record high in the U.S.

• Cesarean rise coincides with CDC report that maternal death rate rising for the first time in decades.

• World Health Organization data shows that mothers die at a higher rate in the U.S. than 40 other countries.

• Consumer Reports includes cesarean on “10 overused tests and treatments”

Colorado Springs, CO, December 5, 2007 – The National Center for Health Statistics has reported that the cesarean rate has hit an all-time high of 31.1 percent.

“Cesarean section is major surgery and doctors are overusing it on women and their babies,” said Desirre Andrews. “People tend to think because cesareans are common that they are risk-free, but unfortunately, many women and babies are paying the high price of complications from this surgery.”

For the second year in a row, ICAN has compiled a list of research from the past year that shows cesarean surgery should be used more judiciously and that VBAC should be used more routinely. (See attached) Currently, more than 300 hospitals across the U.S. ban women from having a VBAC, essentially coercing them into unnecessary surgery and feeding the growing rate of cesarean. In Colorado, all of the western slope hospitals have joined this trend.

The risks of cesarean were tragically highlighted this year by a rash of deaths related to the surgery, including two schoolteachers and friends from New Jersey, Valerie Scythes and Melissa Farah, who died within two weeks of each other in the spring. Both left behind healthy baby girls.

In August, the Centers for Disease Control released a report showing that, for the first time in decades, the number of women dying in childbirth has increased. http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf Experts note that the increase may be due to better reporting of deaths but that it coincides with dramatically increased use of cesarean. The latest national data on infant mortality rates in the United States also show an increase in 2005 and no improvement since 2000. http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm

“At a time when maternal and infant mortality rates are decreasing throughout the industrialized world, the United States is in the unique position of having both a rapidly increasing cesarean rate and no improvement in these basic measures of maternal and infant health.” says Eugene Declercq, Ph.D., Professor of Maternal and Child Health at Boston University School of Public Health.

Another report released in October by the World Health Organization, the United Nations Population Fund, the U.N. Children's Fund, the U.N. Population Division and The World Bank, and published in the Lancet shows that the U.S. has a higher maternal death rate than 40 other countries. http://www.thelancet.com/journals/lancet/article/PIIS0140673607615724/fulltext “Women in the U.S. think they’re getting top notch care, but our death rate for mothers shows otherwise,” says Udy. The U.S.’s maternal death rate tied with that of Belarus, and narrowly beat out Bosnia and Herzogovena.

ICAN’s collection of research highlights from 2007 demonstrates the inherent risks of cesarean including a higher risk of dying in childbirth, a higher chance of suffering from potentially fatal placental problems in subsequent pregnancies, and babies having a higher chance of dying in the first year. Research from 2007 also shows that VBAC continues to be a reasonably safe birthing choice for mothers.

“The research continues to reinforce that cesareans should only be used when there is a true threat to the mother or baby,” said Udy, President of The International Cesarean Awareness Network. “Casual use of surgery on otherwise healthy women and babies can mean short-term and long-term problems.”

For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients. The resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure. The guide can be found at http://www.ican-online.org/resources/white_papers/wp_vbacbanqa.pdf.

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican-online.org for more information. In addition to more than 90 local chapters nationwide, the group hosts an active on-line discussion group that serves as a resource for mothers.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. http://www.ican-online.org/resources/white_papers/index.html

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

For women who have experienced a cesarean, who are working towards a VBAC, or simply want to know how to prevent a first cesarean, ICAN of Greater Colorado Springs is available to provide resources and support. For more information on how to get involved, contact:f Greater Colorado Springs

Desirre Andrews Chapter Leader

719-331-1292 or ICANCOS-owner@yahoogroups.com

http://health.groups.yahoo.com/group/ICANCOS/

www.ican-online.org

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Rising Cesarean Rate Bad for Mothers

Top 12 Studies from 2007

1. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study (Villar, et al., British Medical Journal, 2007;335:1025, 17 November)

Study Design: Researchers assessed the risks and benefits of cesarean delivery vs. vaginal delivery.

Bottom line: Cesarean carries twice the risk of injury and death for both mother and baby. Women with cesarean experience double the rate of hysterectomy, blood transfusion, admission to intensive care, prolonged hospital stay and death, compared to mother who delivered vaginally. Babies born by cesarean were 45 percent more likely to be in the neonatal intensive care unit for 7 days and 41-82 percent more likely to die than babies born vaginally.

2. Risk of Uterine Rupture and Adverse Perinatal Outcome at Term After Cesarean Delivery (Spong, et al., Obstetrics and Gynecology 2007; 110: 801-7)

Study Design: Researchers examined the risk of uterine rupture after cesarean and what harms it may have for mothers and babies.

Bottom line: Regardless of how the baby was delivered, the rate of uterine rupture was low and complications from rupture were also low for both mother and baby.

3. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. (Declercq, et al. American Journal of Obstetrics and Gynecology. 2007 Mar; 109(3):669-77.)

Study Design: Researcher divided mothers into two groups: women with a planned cesarean after no labor and women who labored and had either a cesarean or vaginal birth and then compared rehospitalization rates.

Bottom Line: Rehospitalizations in the first 30 days after giving birth were 2.3 times more likely in planned cesarean than with planned vaginal births. The leading causes of rehospitalization after a planned cesarean were wound complications and infection. Hospital costs were 76 percent higher for women with planned cesarean, and hospital stays were 77 percent longer.

4. Previous caesarean or vaginal delivery: Which mode is a greater risk of perinatal death at the second delivery? (Richter, et al., European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 132: 51-7)

Study Design: Researchers compared mothers who had delivered previously by cesarean vs. vaginally, and examined the number of babies who died in the subsequent pregnancy.

Bottom line: A previous cesarean delivery was associated with a 40 percent increase in perinatal death (the first week after birth) and a 52 percent increase risk of stillbirth. A vaginal or cesarean delivery in the current pregnancy did not impact the death rate.

5. Postcesarean delivery adhesions associated with delayed delivery of infant (Morales, et al., American Journal of Obstetrics and Gynecology 2007; 196: 461.e1-e6

Study Design: A common complication of any surgery is overgrowth of scar tissue, called “adhesions.” Researchers examined the frequency of adhesions with successive cesareans and whether adhesions caused by cesareans could slow down the delivery of a baby in the next pregnancy.

Bottom line: Researchers concluded that each successive cesarean significantly increases the incidence of adhesions and can slow down the delivery of a baby. One prior cesarean adds 5.6 minutes to the time it takes to deliver the baby, 2 prior cesareans 8.5 minutes, and 3 prior cesareans 18.1 minutes. This delay can compromise the health of the baby, researchers concluded.

6. Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. (Yang, et al., British Journal of Obstetrics and Gynecology: 2007 May;114(5):609-13.)

Study Design: Researchers examined the incidence of placenta previa (placenta blocking the cervical opening) and placental abruption (placenta separating from the wall of the uterus prematurely) in women who have had a prior cesarean vs. a prior vaginal delivery.

Bottom line: Compared to vaginal birth, cesarean increased the risk of placenta previa by 47 percent and placental abruption by 40 percent. Both complications carry the risk of death for both mother and baby. Researchers indicated that complications may be due to the cesarean scar on the uterus.

7. Risks of adverse outcomes in the next birth after a first cesarean delivery. (Kennare, et al. American Journal of Obstetrics and Gynecology. 2007 Feb; 109(2 Pt 1):270-6.)

Study Design: Researchers examined the complication rate of women who delivered their first baby by cesarean vs. vaginally.

Bottom line: Women who had a prior cesarean delivery were more likely to have complications than women who had a prior vaginal delivery. Women with a prior cesarean were more likely to have a placenta previa (odds ratio [OR] = 1.66), placenta acreta (OR = 18.79), and bleeding during pregnancy (OR = 1.23). During delivery, women with a prior cesarean were also more likely to have a prolonged labor (OR = 5.89), uterine rupture (OR = 84.42), and need an emergency cesarean (OR = 9.37). Babies born to women with a prior cesarean were more likely to be small for their gestational age (OR = 1.12), have a low birth weight (OR = 1.30), and to be still born (OR = 1.56).

8. Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. (Coassolo, et al., Obstet Gynecol. 2006 Jan;107(1):205)

Study Design: Women who attempted VBAC before the estimated due date (EDD) were compared with those at or beyond 40 weeks of gestation. Researchers assessed the relationship between delivery after the EDD and VBAC failure or complication rate.

Bottom Line: The risk of uterine rupture (1.1 percent compared with 1.0 percent) or overall morbidity (2.7 percent compared with 2.1 percent) was not significantly increased in the women attempting VBAC beyond the EDD. Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.

9. Incisional endometriomas after Cesarean section: a case series. (Minaglia, et al., J Reprod Med. 2007 Jul;52(7):630-4.)

Study Design: Patients were identified who were diagnosed with incisional endometriomas (functional endometrial tissue outside the uterine cavity, within the incision) after undergoing cesarean section.

Bottom Line: The overall incidence of incisional endometriomas following cesarean section was 0.08 percent. Optimal treatment is by surgical excision.

10. Predicting Failure of a Vaginal Birth Attempt After Cesarean Delivery. (Srinivas, et al., Journal of Obstetrics and Gynecology. 2007 Apr;109(4):800-5)

Study Design: Researchers analyzed the records of women offered VBAC in 17 community and university hospitals, to identify any factors that could be used to predict failure in attempting VBAC.

Bottom Line: Prelabor and labor factors cannot reliably predict VBAC failure.

11. Caesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population. (Gray, et al., BJOG:2007 March 114(3) 264-270)

Study Design: Researchers compared the incidence of stillbirth following a previous cesarean section with stillbirths following no previous cesarean section.

Bottom Line: Pregnancies in women following a pregnancy delivered by cesarean section are at an increased risk of stillbirth.

12. Predicting placental abruption and previa in women with a previous cesarean delivery. (Odibo, et al., Am J Perinatol. 2007 May;24(5):299-305.)

Study Design: In women with a previous cesarean section, researchers compared those who had a placental abruption and/or previa with those who did not.

Bottom Line: Three or more previous cesarean sections was a significant risk factor for placental abruption and previa.

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