Dr Michel Odent blames fathers for cesareans now

I've never been a great fan of the opinions of Dr Michel Odent, and his particular preoccupation with the role of (the hormone) oxytocin during birth, and his latest suggestion, that men should 'stay away from childbirth' in order to help women, simply confirms my belief that he is out of touch with what pregnant women actually want.

You can read the full story in The Telegraph today, in which he is quoted as saying:

The 'tensions caused by the presence of men at birth could lead to more adrenalin, slowing the production of the hormone oxytocin, which assists effective contractions, making labour longer and more painful and increasing the chance of a caesarean section.'

Emergency cesareans more likely for older mothers

I've just been searching the internet to no avail, trying to find the actual Irish study being referred to in this Irish Times article published yesterday by Lorna Siggins. It appears in the European Journal of Obstetrics and Gynaecology and Reproductive Biology, but may not yet be available online.

I wanted to find out what age range 'older women' refers to, but in any case, the conclusion drawn in this new study (led by Professor John Morrison in Galway) should be of interest to many first-time pregnant women because they may 'run a much higher risk of emergency Caesarean section, even if pregnancies are not complicated (my italics)'.

The birth outcomes of 45,000 mothers at University College Hospital between 1989 and 2005 were analysed and advanced maternal age was found to have a 'strong bearing' on the likelihood of emergency surgery.

What does this tell us?
Prof Morrison told The Irish Times: "The findings indicate that the uterus does not work so well in older women, when one takes out the standard factors for epidurals, inductions, etc.” He continues: "There has been a lot of controversy over Caesarean sections, here and abroad, and their increasing frequency."
“The confirmation that age is a key factor in surgery is not because obstetricians are taking an ageist approach. The clear message from this is that age has an impact on ability to deliver normally."

Just as I commented in a recent post about pregnant African American women, what readers decide to do with research like this is a personal choice - and one to be discussed with your own midwife or OBGYN - but certainly for some women, in the light of research like this, the decision to avoid the risk of emergency surgery, and schedule a planned surgical birth instead, is a perfectly legitimate one.

Likelihood of a primary cesarean delivery is greatest for African Americans

Reuters reports, October 2nd, on a new Kaiser Permanente study examining the racial and ethnic disparities that occur with cesarean delivery, and notes that the study found 'disproportionately higher rate of primary c-sections among African-American women'.

The Californian study, Racial and Ethnic Disparities in the Trends in Primary Cesarean Delivery based on Indications, found that 'compared to Caucasian women, African-American women had significantly higher rates of primary CS while the increase in rates among
Hispanic women was smaller'.

What the study found
Further, it is reported that the disparity 'cannot be explained by education, smoking
during pregnancy, when prenatal care began or maternal age at delivery', and the lead author, Darios Getahun, MD, MPH, continues: 'This study underscores the importance of educating expectant women about the potential impact of CS on the outcome of future pregnancies.'

The figures published in the study's Abstract look at percentage increases in the primary cesarean rate, rather than percentage actual occurence, and it is unclear at first glance what women should do with this information. Perhaps the Full Text would prove a more useful read for African Americans - for example, it would be useful to know how many of these primary cesareans were emergency and how many were planned.

What the study tells African American women
This is the big question, and the answer is quite complex. Does the research call for better preparation for and best practice support during labor, in order to increase the likelihood of vaginal delivery? Or does it suggest that, if a women is likely to 'very likely to end up having surgery anyway', perhaps she'd be better having planned rather than emergency surgery?

Obviously, part of the answer can be found in the woman's personal birth preference, if she has one, and also, very importantly, how many children she is planning to have over the course of her life. Because however her primary cesarean occurs, through medical necessity or through choice, it is highly likely that she will go on to have further surgery in future pregnancies, and of course the health risks increase with multiple cesareans.

As a final note, the study results also note that 'Indication subtypes-specific rates of primary cesarean section varied markedly across race/ethnicity', and again, access to the study's Full Text would be useful for these women.

Vitamin D deficiency may make cesarean delivery more likely

Although quite a small study, this may be of interest to women who are trying to avoid needing a cesarean delivery. Researchers discovered that women with vitamin D levels less than 37.5 nmol/L were 3.8 times as likely to have a cesarean as women with levels greater than that.

Of 253 women, 43 (17%) had a primary cesarean, and the reasons for their cesareans included failure to progress, non-reassuring fetal tracing, malpresentation such as breech, a cephalopelvic disproportion, and variable fetal heart rate.

In addition, it was reported that caucasian women and those who reported any alcohol use during pregnancy were also more likely to have a cesarean. Other studies however, have found that women of other ethnicity are more likely to have a cesarean.