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C-Section and Your Health

1 in every 3 U.S. women have Cesarean sections!

According to the Centers for Disease Control and Prevention (CDC), 33% of all American pregnancies end in major surgery. Roughly one out of every three babies born in this country—or about 1.3 million children each year—are delivered via cesarean section (C-section), instead of vaginally. Yet the clear majority of women prefer to deliver vaginally, according to a January 2017 study in the journal Birth.

So what’s going on?

The intention of this BLOG post is twofold: to outline the facts about how cesarean sections impact women’s health and to highlight the research supporting less birth intervention. As a bonus, to remind us all Birth is Safe, Intervention is Risky.  In the end, educated decisions empower women to birth how they choose.


Defining the surgery:

Cesarean births are a major abdominal surgery in which the doctor slice through skin, the abdominal wall, muscle and the uterus to deliver a baby.

A C-section typically takes 45 minutes to an hour. It may be done with a spinal block where the woman is awake or under general anesthesia. A urinary catheter is used to drain the bladder and the skin of the abdomen and it will remain there for a day after the surgery. The abdomen is then cleaned with an antiseptic. An incision of about 15 cm (6 inches) is then typically made through the mother's lower abdomen. The patient's bladder and intestines are just moved aside – still within the abdominal cavity – so the surgeon can better see and reach the uterus. In rare cases, the intestines may need to be temporarily lifted out of the patient's body if they were harmed during the surgery and need attention. The uterus is then opened with a second incision and the baby delivered. The incisions are then stitched closed.

It is a fact that an emergency C-section can be lifesaving. There are a few scenarios that warrant the surgery:

     1. If the placenta blocks the cervix, a condition called placenta previa  

     2. If the mother has uncontrolled high blood pressure or diabetes

     3. Uncontrolled persistent fetal distress- decrease in fetal heart rate

     4. Umbilical cord prolapse- the cord presents with or before the presenting part of the fetus

However, for most pregnancies, which are low-risk, C-sections are not necessary. Researchers estimate that almost half of the C-sections performed in the U.S. are not required. And performing a surgical birth can pose added risks to the mother and her child and also raise costs.

Other reasons for high C-section rates include the use of epidurals and techniques that induce labor, which may cause complications that could result in the need to perform a surgical delivery.

Factored into the equation is the region of the country you live in.  The rate of C-section deliveries has skyrocketed over the past several decades. While the US national average of these major surgeries is 33%; some states like Mississippi have rates as high as 38.4%.  Whereas states like Utah boast statistics as low as 22.3%.

Additionally, Consumer Reports finds that your odds of having a c-section can be over nine times higher if you pick the wrong hospital. If you live locally here in Atlanta, the “Baby Factory” aka Northside Hospital had the highest c-section rate among metro area hospitals in 2014, with 40 percent of babies delivered by cesarean, according to an analysis by The Atlanta Journal-Constitution. American Congress of Obstetricians and Gynecologists (ACOG) reported the procedure increased 60 percent from 1996 to 2011.


While C-sections have saved the lives of many infants, its overuse has serious consequences. The World Health Organization suggests aiming for 10 to 15 percent. It's important to note that more than 45 countries globally have C-section rates less than 7.5%.

According to the American Congress of Obestritians and Gynecologists, Cesarean sections like any other major surgery can have complications.

Risks to mom:

You have a greater chance of:

  • Heavy bleeding
  • Amniotic fluid embolism
  • Blood clots
  • Infection
  • Injury to other organs
  • Possible blood transfusion
  • Increase susceptibility to endometriosis
  • Prolonged recovery time & pain
  • Risks for subsequent pregnancies- scar tissue, uterine rupture
  • A woman who has already had a C-section for a previous birth has a 90 percent chance of giving birth by C-section again, according to a report from the CDC.

Risks to baby:

  • Respiratory problems
  • Increased likelihood spend time in the neonatal intensive care unit
  • Increased pressure on baby’s neck puts undue pressure on the nervous system
  • Decreased immunity due to lack of exposure to bacteria in the birth canal

During a vaginal delivery, muscles involved in the process are more likely to squeeze out fluid found in a newborn's lungs, which is beneficial because it makes babies less likely to suffer breathing problems at birth. Babies born vaginally also receive an early dose of good bacteria as they travel through their mother's birth canal, which may boost their immune systems and protect their intestinal tracts.

Now, let's outline influences that will lower the risk of a C-section. A 2015 study that compared the care of traditional private practice doctors to Midwives or laborists (salaried doctors who work by shift) within the same community hospital found that women laboring with a traditional doctor were significantly more likely to have a c-section than women laboring with a Midwife or a laborist (31.6 percent vs. 17.3 percent).

As recent as in today’s news The Chicago Tribune published an article entitled “Hospital Midwives may mean lower C-section rates”

"More Midwife-attended births may correlate with fewer obstetric procedures, which could lower costs without lowering the quality of care," wrote study co-authors Laura Attanasio, of the University of Massachusetts Amherst, and Katy Kozhimannil of the University of Minnesota School of Public Health. The study findings are based on 126 hospitals in New York state.

"This study is contributing to a body of research which shows that good outcomes for women at low risk in childbirth go hand-in-hand with lower use of medical procedures," Attanasio said in a news release from the universities. In addition, Midwives were tied to less need for a surgical incision called an episiotomy during childbirth, the researchers reported.

/’midˌwīf/

A midwife is a trained health professional who helps women during labor, delivery, and after the birth of their babies. She specializes in pregnancy, childbirth, postpartum, women's sexual and reproductive health (including annual gynecological exams, family planning, menopausal care and others), and newborn care.

Certified nurse-midwives (CNMs) are advanced practice nurses with an RN license and Masters or Ph.D. in advanced practice nursing. Midwives maintain state licensure, and national and hospital credentialing. Lay midwives learn their skills through a less formal education program and apprenticeship.

 “Our philosophy is that pregnancy, labor and birth are natural and normal processes,” says Paula Morelli, CNM (Certified Nurse Midwife) with TriHealth Nurse Midwives, “and we approach them as such."

Benefits to choosing a Midwife:

  • Lower C-section rates
  • Usage of relaxation techniques
  • Usage of proper birthing positions
  • Encouraging laboring moms to stay active during labor
  • Minimize unnecessary obstetric intervention
  • Confidence in the mother’s strength and ability to be successful
  • Encourages the birth companion
  • Advocate for laboring mom

How can Chiropractic care help?

Chiropractic care throughout pregnancy ensures that mom’s pelvis is in the proper position to prepare for birth. Webster Technique is a unique analysis and corrective technique specifically for the pregnant pelvis. It reduces the torsion of the pelvic muscles and ligaments and restores pelvic function by realigning the boney structure. By removing sacral (the bone we sit on) imbalances, we decrease the likelihood that mom may need a c-section. Research also shows that chiropractic care during pregnancy can significantly decrease labor pain and time! Even if the baby is born via c-section, gentle pediatric care can help remove the effects of birth trauma. This allows the baby’s nervous system to heal and function at its full potential.

While this discussion is not exhaustive, the intention once again is about empowering women with the knowledge to make informed decisions. With that being said, below find key actions steps to take to get the desired outcome.

10 steps pregnant Moms can take to increase a natural birth:

  • See a Chiropractor throughout your pregnancy to optimize pelvic function
  • Stay active during pregnancy
  • Ask many, many questions and get your questions answered
  • Attend a child birth class
  • Hire a Doula
  • Ensure you are in alignment with your OB or Midwife
  • Choose a hospital or birth center that supports and listens to your desires
  • Create a Birth Plan
  • Set up your birthing room to bring the most comfort to you, the laboring mom
  •  Labor as long as you can at home


Bonus sage advice from 30-year Midwife veteran Kimberly Storey-

“Think of your birth like the Super Bowl. You don’t just show up on game day and expect to win. You must prepare mentally, emotionally and physically early in the season (pregnancy). You must stay active, educate yourself, ask questions and prepare your body for this one HUGE event. Finally, be prepared to play the game of your life!”


Stay tuned to our next BLOG listing our Pregnancy Resources!!



References:

Molina, G; Weiser, TG; Lipsitz, SR; Esquivel, MM; Uribe-Leitz, T; Azad, T; Shah, N; Semrau, K; Berry, WR; Gawande, AA; Haynes, AB (1 December 2015). "Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality". JAMA. 314 (21): 2263–70. doi:10.1001/jama.2015.15553PMID 26624825.

"Births: Provisional Data for 2017" (PDF). CDC. May 2018. Retrieved 18 May 2018.


https://www.trihealth.com/dailyhealthwire/womens-health/the-midwife-philosophy-care-is-a-partnership/

JAMA. 2015 Dec 1;314(21):2263-70. doi: 10.1001/jama.2015.15553.

Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. Molina G1, Weiser TG2, Lipsitz SR3, Esquivel MM2, Uribe-Leitz T2, Azad T4, Shah N5, Semrau K6, Berry WR6, Gawande AA6, Haynes AB1.

https://www.livescience.com/45681-vaginal-birth-vs-c-section.html

https://www.marchofdimes.org/pregnancy/c-section-medical-reasons.aspx

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