Tag Archives: birth interventions

1. Pregnancy & Birth, The Editor's Desk

When It’s OK to Induce Labor, and When It’s Not

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By Rita Brhel, managing editor and attachment parenting resource leader (API)

One in five pregnant women will have her labor induced, for varying reasons. Some of these reasons are valid; others are not. Catherine Beier of www.givingbirthnaturally.com weighs in.

When it’s OK to induce labor:

  • Pre-existing medical conditions in the mother – These may include heart disease, a seizure disorder, hypertension, cancer, or another serious health issue, although many women with these disorders can still give birth vaginally.
  • Pre-existing medical conditions in the baby – If the baby is known to have a congenital or other medical condition that requires intervention or intensive care immediately after birth, induction may be the safest way to ensure the baby gets the care that’s needed.

And when it’s not OK to induce labor:

  • Overdue pregnancy – While the American College of Obstetricians and Gynecologists warn against induction before 39 weeks, the average pregnancy worldwide lasts 42 weeks. For medical doctors who don’t want to wait that long, they should consider accuracy of a woman’s due date, which is calculated on a 28-day menstrual cycle with ovulation on day 14; for women with long or irregular cycles or late ovulation, this due date can be significantly inaccurate. For these women, a reliable estimate of the due date, within one day, can be obtained with a transvaginal ultrasound at eight to ten weeks of gestation. As the pregnancy progresses, ultrasound becomes a less reliable predictor of the due date, as the weight estimate can be off by as much as two pounds.
  • The baby is too big – The vast majority of women are able to give birth vaginally to their babies, even those who are larger. Because hormones during labor relaxes and stretches the hips and pelvis, for those very few whose pelvis is too narrow to birth a full-term baby, it’s impossible to know until the time of childbirth.
  • The mother is too tired or uncomfortable – Remember, it’s called labor for a reason. Labor can be rather long and hard with the first baby especially, but it is normal.
  • It’s more convenient to know when the baby will be born – Whether induction on a certain day is better for the baby’s family or the medical provider, this does not take the baby into account and not a true reason.
1. Pregnancy & Birth, The Editor's Desk

The Rising Rate of Cesarean Sections in the U.S.

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By Rita Brhel, managing editor and attachment parenting resource leader (API)

One in three women (31.8%) in America is now giving birth to their children via a Cesarean section. The highest rate in history for this nation, it is also much higher than the recommendation by the World Health Organization of 5% to 10% — not to mention that the rate of Cesarean sections in the U.S. has increased by 50% since 1996.

The U.S. began at 4.5% in 1965, the first year Cesarean section rates were measured here. At 15% or higher, Cesarean section rates indicate that this procedure is being done unnecessarily, according to a study highlighted by the article “Why the National U.S. C-Section Rate Keeps Rising” on www.childbirthconnection.org.

The article outlines several reasons for the increasing rate of this procedure. But, first, there are two widespread myths about the rise in Cesarean sections to counter:

  1. The number of women asking for an elective Cesarean section, without a medical reason, is NOT increasing; and
  2. The number of women who genuinely need a Cesarean section is NOT increasing.

In a 2005 survey by Childbirth Connection, it was found that only one in 1,600 respondents in the U.S. reported she had a planned Cesarean section with no medical reason, at her own request. The article cited a study that revealed this rate to be comparable with other countries.

Reasons given for the higher rates include women waiting to give birth when they’re older and more prone to developing medical complications, and more women giving birth to multiples. But the article reported that researchers show that the rate of Cesarean sections is going up for all women regardless of their age, health problems, race/ethnicity, or number of babies they are having.

What this means is that the reason behind the increasing rate of Cesarean sections is not on the part of the woman but rather lies with changing standards in the medical community. According to the Childbirth Connection survey, one in four respondents who had a Cesarean section said they received pressure from a medical professional to have the procedure.

According to the Childbirth Connection, here are the true reasons behind the increasing rates of Cesarean sections in the U.S.:

  • Lower priority is being given to non-surgical methods of correcting potential birthing complications, such as turning a breech baby or encouraging labor progress through positioning and movement and comfort measures.
  • Higher rates of labor intervention methods that make Cesarean sections more likely, including induction, getting an epidural early or without a high dose of oxytocin, and use of continuous electronic fetal monitoring.
  • Fewer hospitals and/or medical doctors are willing to deliver a Vaginal Birth After Cesarean section, or VBAC. In fact, only one out of ten women who have had a previous Cesarean section has access to medical facilities and/or doctors who would allow a VBAC.
  • The overall attitude toward Cesarean sections is that this procedure is no longer considered the major surgery that it is.
  • Lower awareness of the increased risks associated with Cesarean sections over vaginal births, such as infection, surgical injury, blood clots, emergency hysterectomy, and intense and longer-lasting pain in recovery in mothers in the short term. In the long term, mothers are more likely to have ongoing pelvic pain, bowel blockage, infertility, and injury during future surgeries. Future pregnancies are more likely to be ectopic, result in uterine rupture, or have problems with placenta previa, accretia, and abruption. Babies born by Cesarean section are more likely to have surgical cuts, breathing problems, difficulty with breastfeeding, and childhood asthma.
  • More doctors fear malpractice claims and lawsuits.
  • More doctors are receiving incentives to practice more efficiently. Planned Cesarean sections can organize hospital work, office work, and the medical personnel’s personal lives. In addition, average hospital charges are much greater for Cesarean sections than for vaginal births, which mean more profit is gained by the Cesarean section.

About Childbirth Connection
Childbirth Connection is a national U.S. not-for-profit organization founded as the Maternity Center Association in 1918. Its mission is to improve the quality of maternity care through research, education, advocacy, and policy by promoting safe and effective, evidence-based maternity care and providing a voice for childbearing families. For more information, go to www.childbirthconnection.org.