'Mum dies of swine flu after her planned cesarean

The Mirror reported yesterday on the news of a 'Mum killed by swine flu after planned caesarean birth'.

It reports: 'The woman, 21, from Monmouthshire was admitted to hospital in Abergavenny for a planned caesarean but her condition deteriorated after she safely gave birth. She was transferred to intensive care and later to a specialist unit in Leicester where she died last week.

'Another women, 43, from Carmarthenshire, also succumbed to the disease but was said to have underlying health problems. The latest cases bring the number of swine flu-related deaths in Wales to three, although another death is being investigated.'

Infection risk
Infection following surgery is an undisputed risk with a planned cesarean. Other cases of infections have been reported too, such as the risk of contracting MRSA after giving birth in hospital. But the risk exists with both planned surgery and emergency surgery, and since emergency mostly occurs after a trial of labor, it means that post-surgery infection is a risk associated with a planned vaginal delivery too.

Mother's death blamed on failures - £410,000 damages awarded

This story is so distressing to read, and evidently, the hospital have admitted that human error was at fault:

"Joanne Lockham, 45, died at Stoke Mandeville Hospital at Aylesbury in October 2007 during the birth of her first child. She was given a general anaesthetic when the baby's heart rate dropped. The oxygen supply to Mrs Lockham, of Wendover, was not put into her windpipe and she suffered cardiac arrest."

The headline of the updated story today reads: 'Payout over nurse Caesarean death', and is an example of when a caesarean delivery can be publicly associated with high risk.

However, it's important to point out that this was not a planned caesarean, and it was not spinal anaesthesia being used (both of which carry fewer risks than an emergency caesarean with general anaesthetic). This birth was a planned vaginal delivery (PVD) that ended in one of the worst birth outcomes of all.

Maternal deaths drop by 59% in China

I am highlighting this article by Wang Zhuoqiong of the China Daily, because I am aware that an increasing number of women in China are now choosing planned cesarean delivery as their preferred birth plan.

The reported 59% drop in maternal deaths has occurred mainly in urban areas as opposed to rural, and while I have no evidence to prove it, I wonder aloud whether this improvement in maternal outcomes may be as a result of increased planned cesareans...?

Obviously in China, women tend to only have one baby, which reduces or even avoids the risks associated with future surgeries, and as I have written about in the past, China could make a very interesting case study of planned primary cesarean risks and benefits. Unfortunately, there is the issue of setting delivery dates due to superstitions related to lucky numbers, but aside from that, the data could be very revealing.

Where cesareans are too few

Amidst talk about the increasing cesarean rates in the developed world, it is all too easy to forget the plight of women in other countries where access to cesarean surgery is dangerously low.

An article this week in the International Herald Tribune, 'Project works to improve lives scarred by childbirth injury', describes the devastating injury fistula that occurs as a result of obstructed labor during vaginal delivery.

Denise Grady writes: "If prolonged, obstructed labor often kills the baby, which may then soften enough to fit through the pelvis, so that the mother delivers a corpse. Obstructed labor can kill the mother, too, or crush her bladder, uterus and vagina between her pelvic bones and the baby's skull. The injured tissue dies, leaving a fistula: a hole that lets urine stream out constantly through the vagina. In some cases, the rectum is damaged and stool leaks out. Some women also have nerve damage in the legs."

She continues: "Fistulas are a scourge of the poor, affecting two million women and girls, mostly in sub-Saharan Africa and Asia - those who cannot get a Caesarean section or other medical help in time."

Deaths of 6 women giving birth raise concerns in the NHS

On February 11th, Madeleine Brindley's report: "Serious concerns raised at NHS trust after six women die" appeared on WalesOnline. It perfectly illustrates the unpredictability of vaginal delivery that exacerabates an already unpredictable Mother Nature. I believe that it is not unreasonable that some women (myself included) decide to opt for a planned surgical delivery with a dedicated, guaranteed-to-be-present during the birth, team of health carers.

"The review team found that there was no common link between the deaths, although in two of the cases, if the women’s deteriorating condition had been spotted earlier and better advance preparations had been in place, the outcomes may have been different... The report revealed:

*The trust had the highest proportion of women reporting that they were left alone and worried, in labour or shortly after the birth of their child;
*Staff from lower risk wards are frequently transferred on shift to the higher-risk labour areas, leaving the areas from which they were drawn under staffed;
*Community midwives are frequently required to work in the hospital throughout their on-call shifts after doing a full days work in the community;
*Low-risk labouring women are sometimes left alone while staff attended to higher risk women - the HIW inspectors heard of occasions when induced labour had been halted to allow staff to be rescheduled to other work;
*The numbers of midwives on the labour ward at the Royal Gwent Hospital appear “inadequate” for the size and activity levels on the ward."

When Childbirth Was Natural, and Deadly

This January 10th article by Druin Burch in Natural History Magazine concentrates on the history of diseases that were associated with deaths in childbirth, but if nothing else, it provides yet another reminder that while women may indeed have been giving birth since the beginning of time with bodies that were designed to do so, natural birth has always been inextricably associated with death too.

Pregnancy is risky; childbirth is risky. It is a woman's progagative to decide which set of delivery risks (vaginal or cesarean) is most tolerable to her.