Cesarean sections have become common over the last 50 years, partly due to the mistaken belief that cesareans are safer than natural births. In cases of a low-lying placenta, cord prolapse, rapidly-occurring pre-eclampsia, heart or kidney disease in the mother, or cases in which the baby's head is too large to get through the pelvis, cesarean sections can save the lives of mother and child. If cesareans were performed only when such life-threatening situations occurred, the cesarean rate would lie between 6-8% (Effective Care in Pregnancy and Childbirth, Iain Chalmers, et-al. eds. Oxford University Press, 1995). Nearly 25% of all births in the US are cesarean at this time. In the book Coyote Medicine, Lewis Mehl-Madrona, MD, writes about working with two doctors whose rates were 48 and 49% several years ago when the national rate was under 10%.
Cesarean sections are major abdominal surgeries. As in any surgery, complications due to anesthesia, infection, hemorrhage, and human error occur. The National Institutes of Health says that cesarean births are 5-10 times more likely than vaginal births to have complications. The more cesareans, the more complications. In her excellent article on cesarean operations, Pat Thomas reports that a British study found that 31 per 100,000 cesarean mothers die compared to 6 deaths per 100,000 among vaginal births. An American study (AM J Ob Gyn, 1981; 139:681-685) found that 60 per 100,000 cesarean mothers die. "These figures," she writes, "may seem small until we note that the death rate for women aged 15-34 from automobile accidents is 20 per 100,000 (Cl Ob Gyn, 1985;28:763-9)."
Too often, cesareans occur for convenience or because a birth is taking longer than a doctor believes it should. Once a woman has had a cesarean, many doctors insist that subsequent births also be cesareans to avoid the possibility of uterine rupture. "A substantial review of medical literature on vaginal birth after cesarean (VBAC) from 1950 to 1980 found that out of 5,325 recorded VBACs there was not a single maternal death related to uterine rupture (Ob Gyn, 1982;59: 135)."
Active management practiced in most hospitals leads to more cesareans. Inducing labor with drugs like syntocinon can cause over-stimulation that will produce erratic, ineffective contractions, making labor more difficult and threatening the fetus' well-being. Pain killers, especially epidurals, slow labor. "Epidurals have been associated with an up to 10 times greater risk of cesarean than other forms of pain relief (AM J Ob Gyn, 1993;169:851-8)."A simple alternative to drugs for pain relief or encouraging labor is having the mother walk, stand or sit upright during labor. Women who stay upright and mobile have shorter labors and need less pain relief.
Women who choose midwifery care are less likely to have cesarean births: "One survey of 84 free-standing birth centers, staffed by midwives, in the US reported an overall cesarean rate of 4.4% (New Eng J Med. 1989,321:1804-11)." With the help of midwives, some women are even choosing to have their babies in the familiar surroundings of their homes.
"Cesarean operations" by Pat Thomas.
Copyright © 1996. The Light Party.
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