Monday, November 3, 2008

The impact of planned cesarean delivery on mother and newborn

A research paper from the Department of Obstetrics and Gynecology at Weill Cornell Medical College, New York has advised that "the most concerning risks related to maternal request cesarean delivery are neonatal respiratory morbidity and those that may affect the mother's future reproductive health, including life-threatening conditions, such as placenta accreta", and advises that pregnant women should be counseled on these.

Risks for the mother are lower with PCD than with PVD
Authors YM Lee and ME D'Alton write: "The literature suggests that overall risks of maternal complications with cesarean delivery on maternal request are slightly lower than a trial of vaginal delivery and are primarily driven by the avoidance of unplanned or emergent cesarean deliveries and their associated increased rate of complications."

This is something I have been highlighting (along with many others) for many years. The risks associated with planned vaginal delivery include ALL potential outcomes of a trial of labor and should be recorded as such. Comparisons between PCD and spontaneous VD alone are ineffective and misleading.

Other issues to consider
The authors do acknowledge that cesarean delivery on maternal request is not a simple decision to make. For instance, "there are many areas on which studies are lacking", and in addition, "numerous factors can alter the risks and benefits - such as culture, maternal obesity, and provider background". This echoes the advice given by the NIH in 2006 that maternal request is only ethical following individualized consultation.


Christine Fiscer, Birthkeeper said...

The funny part one is comparing elective cesarean, to truly natural childbirth.

No drugs, no restriction, no episiotomy ( which happens in less than 2% of home or birth center births! ), no instrumental delivery ( where, the risk is dramatically cut when an epidural is not in place ).

Birth is getting worse and worse because of what doctors do to it, and because of what women allow.

NOT because of vaginal birth being riskier or cause more damage.

Wake up woman!

Anonymous said...

So its all about the mothers? What about whats best for the babies?

Instrumental birth happens during c-sections too.. If women would stop allowing doctors to do all sorts of interventions the "risks" of vaginal birth would be much lower.

Basically to prevent getting cut in your vagina its a better idea to have your stomach muscles cut open and have the baby pulled out without giving the baby the benefits of a vaginal birth? Sorry but that makes no sense at all.

cesarean debate said...

birthkeeper - vaginal delivery has never been risk-free, and to suggest that it has is misleading to women.

My blog is not designed to debate the pros and cons of home birth versus hospital birth. there are other blogs that do that and i suggest you discuss that thee. I am comparing the risks and benefits of PVD versus PCD in a hospital environment because for more than 9 out of 10 women, this is the reality of their birth experiences.

cynthia - PCD is not all about the mothers, not at all. This is just one post showing a recent research paper on the subject of maternal request. I suggest you read my 'Birth injuries - Risks for your baby' to learn more about the infant morbidity and mortality risks that are reduced or avoided with planned cesarean delivery.

My number one priority was my baby's health when she was born last year, but that does not mean I take away the maternal benefits did not also recognize benefits with PCD for my own physical and psychological wellbeing too.

Christine Fiscer, Birthkeeper said...

I'm sorry - did I every say that vaginal birth was risk free? Please do show me where I said that.

Of course you're comparing planned hospital vaginal delivery to planned cesarean. With as screwed up as hospital vaginal birth is, who wouldn't want to choose a cesarean? The point is, this is NOT TRUE INFORMED CONSENT.

Women need to know that there are options beyond what the hospital and trained surgeons ( err, Obstetricians ) are willing to offer.

Without the broad comparison of all options, women are making ignorant decisions. And skewed and misleading information and conclusions that are seen on this blog, are only fueling that ignorance.

cesarean debate said...

birthkeeper - In the context of out-of-hospital births and no intervention, you have repeatedly used the word 'avoid' in relation to vaginal delivery risks.

Following the advent of hospital maternity wards, women have still had the option of home birthing but the majority have decided against it.

There are numerous websites and blogs that exist to inform women about home births, but they still choose to go into hospital. I am sorry if this frustrates you, but it does not change the fact that some women are now making the legitimate decision to give birth via planned cesarean delivery and they deserve the same respect as women making any other birth choice.

Anonymous said...

Yes, the OB's and ACOG have done a fabulous job of making sure that low-risk care cannot happen and scare tactics abound to keep women from choosing homebirth, including not having proper transfer protocols so that women choosing homebirth are treated well if for some reason they need to transfer in to a hospital. It's illegal in many states to homebirth, thanks to the AMA and ACOG, further limiting women's choices. Women are threatened with CPS if they homebirth even in legal states. They are told that if there was an emergency, transfer could not happen easily, etc. There are so many fear tactics that women are unsure of what is the right choice to make, but NONE of that excuses the hospitals and doctors of their behavior or how they treat women and trying to encourage women to have surgery rather than question how they are being treated is reprehensible.

Anonymous said...

Interesting....YM Lee, of the study, called for and performed my "emergency" cesarean last year. All in all I found the culture at NY Pres extremely pro-intervention and yes, pro-cesarean. The OB resident who removed my staples asked me "how did you like it?" in the tone one usually reserves for asking how someone liked their manicure or massage. "What?" I asked. "The c-section." she replied. I started to say that I was disappointed and in pain, but getting over it, but she cut me off and said "I dunno - it looks so easy! I'll definitely do it that way (if I have a baby)." Hey, at least she didn't pretend to feel otherwise.
I support informed choice in birth, but I was annoyed and hurt that I had to deal with staff basically telling me how I should feel - the same as someone who was happy with their cesarean delivery wouldn't want to hear "oh, I am soooooo sorry! you must be so disappointed!" I had attempted an unmedicated labor, so it's not like no one had a clue what sort of delivery I wanted.
(I did not intend to comment until I saw YM Lee's name on that paper....back to lurkdom!)