2006 Cesarean Statistics Released – it ain’t good

Today I was informed that the CDC released preliminary vital statistics for 2006 which includes state-by-state cesarean birth information.  Here in Montana the 2006 cesarean rate was 28%, earning us a rank of number 37 (of 51).  The national cesarean rate was 31.1%, an all-time high.  Although Montana was 3 percentage points below the national average, the rate still exceeded World Health Organization (WHO) recommendations by 13-18%!  The WHO determined that when cesarean rates exceed 10-15%, the risks of the surgery outweigh the benefits.  It is my understanding from a recent discussion with a hospital administrator that Community Hospital’s (Missoula) cesarean rate exceeded 30% in 2006.  Missoula’s cesarean rate is headed in the wrong direction. 

As a woman with one cesarean scar, these statistics are frightening.  Is cesarean birth becoming “normal” birth?  If one out of three babies is born through major abdominal surgery, then yes, I’d say the norm is swinging that direction.  You need to know that the percentage of birth by cesarean has risen 50% in the past decade.  This is straight from the horse’s mouth!  You also need to know that Montana’s VBAC (vaginal birth after cesarean) rate in 2005 was only 1%. 

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 VBACs should be routine/normal.  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.  Very few Montana women have access to vaginal births after cesarean sections.  Only a handful of hospitals across the state allow VBACs – one of those hospitals is Community Hospital in Missoula

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.  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.  “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.  “Women in the U.S. think they’re getting top notch care, but our death rate for mothers shows otherwise,” says ICAN’s President, Pamela Udy.  The U.S.’s maternal death rate tied with that of Belarus, and narrowly beat out Bosnia and Herzogovena.

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. “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. Click here for a pdf copy of this important resource.

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, to find a local chapter, and to receive support.

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. 

Amniotomy? No thank you!

I am glad to see more attention being given to the problem of artificial rupture of membranes (AROM), also known as amniotomy.  I am encouraged to see this because I believe AROM is what lead to my unnecesarean.

Authors’ conclusions (Cochrane Review, July 13, 2007)

On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We do recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

[Click here to read the review abstract.]

A few articles in the press that piqued my interest:

Childbirth: purposely breaking water does not speed deliveryNew York Times
“We advise women whose labors are progressing normally to request their waters be left intact,” said the lead author, Dr. Rebecca Smyth, a research associate at the University of Liverpool. “There is no evidence that leaving the waters intact causes any problems, and there is not sufficient evidence to suggest any benefit to either themselves or their baby.”

In labor, breaking a woman’s water may be futileLos Angeles Times
“The hormones in the amniotic fluid have been thought to stimulate contractions, but not only does an amniotomy fail to speed up and strengthen labor, it also fails to improve a woman’s satisfaction with the birth experience, an analysis by the Cochrane Review found. Nor does it result in the baby being in better condition after birth.”

Don’t ‘Break the Waters’ During Labor Without Good Clinical Reason, Concludes Cochrane ReviewScience Daily
“This Cochrane Systematic Review found that breaking the waters may be associated with a slightly (non-significantly) higher rate of Caesarean section. Breaking the waters may cause changes in the baby’s heart rate.”

Breaking waters not needed in routine birthsGlobe & Mail
“Yet many medical centres perform amniotomy for routine deliveries. One Toronto hospital does it for 80 per cent of the births under its roof.”
[The "annoying cough" begins a new brief and is not related to this discussion.]

Review Finds That “Breaking the Water” Does Not Speed or Help With LaborHealth Behavior News Service
“However, several American doctors said the findings are unlikely to change the way obstetricians help women give birth in the United States. “Most of us believe it works, so there will be a lot skepticism about this,” said Mark Nichols, M.D., professor of obstetrics and gynecology at Oregon Health & Sciences University.”

The Cochrane Group is an international independent non-profit organization whose goal is to help people like you and me make better-informed decisions about healthcare and interventions.  Archie Cochrane was a British epidemiologist and is the organization’s namesake.  The Cochrane Collaboration was founded in 1993.

In Born in the USA, Marsden Wagner hails the Cochrane Library as “a frequently updated, highly respected electronic library of reviews of the scientific evidence on different obstetric practices”.  Know that doctors (such as Mark Nichols, the man quoted in the Health Behavior News Service bulletin) don’t always practice evidence-based care.  They often “follow the crowd” (ACOG) or repeat unnecessary procedures just because “they work”.  My response to that style of practice is that it is unethical, unfounded, reckless, irresponsible, subversive, and the list of negative modifiers could go on and on for hours.  We all know that cesareans “work”, for instance, but that does not mean that even a significant minority (30% of all live births for example) should be undergoing this procedure.  “It works” is not acceptable.

Something else you should know about the Cochrane group is that several members produced a textbook called A Guide to Effective Care in Pregnancy and Childbirth.  You can download this book  for free from Childbirth Connection.  This is an amazing resource!

ICAN of Greater Missoula

It’s official.  There’s no turning back now.  I have succeeded in starting a local chapter of the International Cesarean Awareness Network.  I consider my area to include Missoula Valley, the Bitterroot Valley (at least to Hamilton), down the Hellgate Canyon (like to Clinton), and out to Arlee.  Really anyone who wants to get to a meeting that is in the area is welcome to attend!  We are the first and only chapter in Montana though I know that there are women in Helena and Billings working to start chapters too.

I wrote down a short list of goals the other day:

  1. Help women (and men) in my area know that there are choices to be made with regard to prenatal care and childbirth
  2. Raise awareness – the cesarean rate at Community Hospital is not good – 30+%; according to hospital sources, there were only 16 VBACs performed at Community last year
  3. Encourage pregnant women to seek out independent childbirth education; be a local facilitator for natural childbirth support
  4. Plant seeds at the University – it is never too early to become educated about the childbirth industry

I’ve started a website for ICAN of Greater Missoula.  There’s nothing there yet, but give me a few sleepless nights, and it’ll look great.  I love Terapad!  Anyone who is interested in knowing more about ICAN of Greater Missoula can e-mail ICANofMissoula ([at]) gmail [(dot)] com.

I’m currently planning a screening of The Business of Being Born, a documentary feature film directed by Abby Epstein (Ricki Lake, Executive Producer).  This will be the inaugural event and fundraiser for ICAN of Greater Missoula.  I’m so excited and nervous about all of this!  I still don’t have a date and venue secured (though one is available to me), and this all has to happen within the next 3 weeks or so.  Aaaah!  Eeeek!  But I know it’ll get done, and I’ve already been offered support and assistance.  Thank goodness for angels!

We will hold monthly meetings.  The first couple of meetings (November & December) will be informational and women can share birth stories and ask questions.  Then I will start a series (beginning in January) called Choices in Childbirth and bring in guest speakers from the community.  Topics I think we’ll start with include Prenatal Care, Selecting Care Providers, and Where to Birth.