Abby Block, CD(DONA), CBC

Doula & Breastfeeding Support ~ Serving Brooklyn & NYC

planned cesarean

The Cesarean Rate Epidemic

Abby BlockComment

This article looks at the current rates, state, and climate of Cesarean Births in the U.S. It provides statistics and rates, reasons for Cesareans, as well as the associated risks. 

Cesarean delivery may be a safe alternative to vaginal delivery but its use in 1 of 3 women giving birth in the US seems to high.
— contemporaryobgyn.modernmedicine.com

An excerpt discussing the rising rates and unusual number of Cesarean rates below:

"One possible reason for the rise in the cesarean delivery rate may be that there has simply been a rise in the need for cesarean. The most common indication for a primary cesarean is cephalo-pelvic disproportion, or arrest of progress in labor. It is unlikely that maternal pelvis size has changed over the past 3 decades, but it is possible that birth weight has increased. In fact, evidence suggests that rates of macrosomia have increased over the past 2 decades.8 Other issues that contribute to increasing rates of cesarean delivery, possibly through the mechanism of birth weight, are maternal obesity and gestational weight gain.9,10 Without question, the proportion of obese women has increased over the past decade and higher weight classes are associated with even higher rates of cesarean.11,12 In addition, increased gestational weight gain has been associated with cesarean delivery and is commonly above standard guidelines.13

Another reason for increasing cesarean rates may be a rise in elective cesarean delivery, also known as cesarean delivery by maternal request (CDMR). Because there was no ICD-9 code for CDMR, it is unclear what proportion of cesareans are due to it. One recent study, however, estimated the proportion as high as 4% in the United States.14 Interestingly, CDMR is more common in other countries, such as Brazil, Taiwan, and Chile. A study in Chile comparing women receiving private care (cesarean rate >40%) to women receiving public care (cesarean rate <20%) found that 8% of those receiving private care and 11% of those receiving public care stated a preference for cesarean delivery, with the vast majority preferring to deliver vaginally.15 Thus, even in this setting, it is unclear that maternal preferences are driving the increase in cesarean delivery rate."

Full article can be read here: http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/cesarean-epidemic-are-we-too-quick-cut?cfcache=true

 

Seeding the Microbiome

Abby BlockComment

This is a relatively new phenomena that has come up in the birth world as more and more research on the significance of gut health and our microbiomes has emerged. In birth, this applies in particular to a vaginal vs. Cesarean birth. During a vaginal birth, the baby is colonized, or "seeded" with bacteria from the mother's vagina, which leads to long term health benefits; in a Cesarean birth, the baby does not have the same bacterial colonization opportunity. It is because of this that some women are looking to simulate this process at the time of a Cesarean.

We are just now beginning to understand that many modern day health conditions, such as colon cancer, Autism, and mental health (just to name a few) are likely affected by the balance, or lack of balance, in good and bad bacteria in our bodies. Think of the recent surge in the understanding and promotion of probiotics, our understanding of antibiotics, and the fermented food movement. 

The recent documentary "Microbirth" focuses on bacterial health in birth, as well as some recent articles below. You can also check them out to understand how some women are choosing to take vaginal seeding into their own hands in the event of a Cesarean.

https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=825

http://www.positivebirthmovement.org/pbm-blog/category/gauze-seeding

http://www.mostlymicrobes.com/vaginal-seeding/

 

The Big Baby Card

Abby BlockComment

Below is an excerpt from When A Big Baby Isn't So Big

"The new study, called Listening to Mothers III, was based on Childbirth Connection’s nationally representative survey of some 1,960 new mothers. It found that four out of five of the mothers who were warned they might have large babies gave birth to infants who were not large, and weighed less than 8 pounds 13 ounces.

Yet these mothers were almost twice as likely to have medical interventions such as having doctors medically induce their labor or attempting to self-induce labor, presumably out of concern the baby would continue growing otherwise. They were also nearly twice as likely as other mothers to have a planned cesarean, though the increase fell just short of being statistically meaningful."