Breathing problems in elective cesarean babies

A new study published in the British Medical Journal indicates that babies born via elective cesarean section prior to 39 weeks gestation are up to four times more likely to have breathing difficulties than babies born vaginally or via emergency cesarean.

In other words, if a cesarean is performed for non-emergency reasons before labor naturally begins, the baby is more likely to have problems breathing. The study notes that stress hormones released when labor begins affects successful infant lung function. When a cesarean is performed before labor begins, these hormones aren’t released.

Interestingly, the researchers included information about the number of mothers in the study who requested their cesarean surgery. This data was only collected for the last four years of the eight-year study, but it seems that only a fraction of the elective cesareans were actually requested by the mothers. So who’s doing the electing for the rest of them?

In the wake of the CDC report of rising c-section rates, it’s important (albeit alarming) to read more evidence of the risks of cesarean. Now if only the doctors would INFORM pregnant women of the risks…

Read the entire study
Read MSNBC coverage of the study

Cesareans reach all-time high… but not by mom’s choice.

Cesarean births have reached a new record high, according to a CDC National Center for Health Statistics report released yesterday. In the report, Births: Preliminary Data for 2006, the NCHS finds the cesarean rate climbed 3 percent from 2005, to 31.6% of all U.S. births. This represents a 50% increase in cesareans over the last decade.

As a nation, we should be shocked and alarmed by this. That such a large number of women and babies are being exposed to surgical risks that far outnumber the risks of normal vaginal birth is nothing short of appalling.

So far, mainstream media is focusing on the other shocking increase found in the survey: Births among teens have increased for the first time since 1991. If news of the cesarean increase reaches the popular media, it’ll be interesting to see how it is spun. In the last few years, there have been many sensational stories about celebrities “too posh to push,” who choose cesarean births, and real-life women who are doing the same. In addition, there was the media coverage of the March 2006 National Institute of Health State-of-the-Science Conference on Cesarean on Maternal Request. This coverage makes it easy to point to mothers as the ones choosing c-sections. The very title of the conference, “Cesarean on Maternal Request,” fuels the erroneous perception that moms are asking for it.

Where is the real c-section story? The VBAC bans, the overuse of medical intervention during labor, the money and politics and litigation that steer so many healthcare decisions?

Here is recent example of media coverage of cesarean. Babytalk magazine announced their 2007 Stinky Diaper Awards to celebrities who display “poopy attitudes” toward children and parenting. One group honored with a Stinky Diaper are moms who schedule pre-term c-sections for vanity purposes. Yes, this can happen. And yes, any mother who knowingly ignores the risks to her baby for the sake of avoiding stretchmarks should be pointed to the nearest child welfare office. However, I suspect it’s a *very* small number of women actually doing this.

So here is my question to Babytalk. Where is the Stinky Diaper for docs who scare moms into sections, then call it “maternal request?”

Knowledge is Power!

Obstetricians and nurses who work in hospital labor and delivery units are notoriously mired in routines and standard operating procedures regardless of scientific evidence that contradict them. Some examples of this are artificial rupture of the membranes, continuous electronic fetal monitoring, and separation of mom and baby following birth. For pregnant women who wish to buck this system, one of the best weapons to have is a knowledge of the evidence. Here are two of my favorite places to gain power, er, knowledge:

• Lamaze Research Summaries for Normal Birth
• Childbirth Connection, featuring A Guide to Effective Care in Pregnancy and Childbirth

These two resources are particularly good because the information is presented in easily-digested language, but with citations for those who wish to go straight to the source for the complete study.

The only way current medical birth practices will ever change is if the consumers themselves demand it. So start demanding better care!

Born in the U.S.A. – The Documentary Film

Born in the U.S.A. is a documentary that was broadcast on PBS as part of the network’s Independent Lens series, and a new chaptered version of the DVD is now available to buy online.

This 60-minute film offers an overview of the birth culture in America from the perspective of an obstetrician, a certified nurse midwife, and a licensed homebirth midwife. Specifically the film focuses on low-risk birth, and compares the type of care a healthy mother might receive in the hospital, a birth center, and at home. The documentary’s website notes, “By examining the culture of birth practices in America, BORN IN THE U.S.A. raises questions about technology, safety and quality of care, and it challenges parents to be proactive about getting the kind of care they want and need. ”

Find out more about Born in the U.S.A., and watch a video clip
BONUS! After seeing the film, if you’re inspired to make a difference in your local area, the web site offers downloadable community and legislative action guides.

Keep Babies and Mamas Together After Birth

I was digging around the American Academy of Pediatrics web site today, and found this information on their policy statement on Breastfeeding and the Use of Human Milk:

• Healthy infants should be placed and remain in direct skin-to-skin contact with their mothers immediately after delivery until the first feeding is accomplished.
• The alert, healthy newborn infant is capable of latching on to a breast without specific assistance within the first hour after birth.
• Dry the infant, assign Apgar scores, and perform the initial physical assessment while the infant is with the mother. The mother is an optimal heat source for the infant.
• Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed.
• Infants affected by maternal medications may require assistance for effective latch-on.
• Except under unusual circumstances, the newborn infant should remain with the mother throughout the recovery period.

In other words, the AAP confirms that unless it is medically necessary, there is no reason to separate mom and baby after birth.

Most new moms in my neck of the woods (and probably most other regions of the country) have to fight for the magical first moments following birth. That is assuming they even know to ask for the option of quiet, skin-to-skin time. In most common, medically-managed births, baby warmers are tucked away in the corner of the labor room, and baby nurses are called in during the pushing stage of labor. The mother, if she’s lucky, gets a brief few moments to see and touch her new child before a nurse takes the baby to the warmer for cleaning, initial assessments and swaddling. The warmer may only be a couple of feet from the her, but it might as well be a couple of miles because she cannot hold, and may not even be able to see, her baby. Then, after a few more minutes to bond, the baby is often taken to the nursery for more routines. This can take up to several hours, which can interfere with maternal bonding and breastfeeding success.

Learn more about the benefits of keeping mama and baby together with Lamaze’s Care Practice #6: No Separation of Mother and Baby After Birth with Unlimited Opportunities for Breastfeeding.

Consider Postponing Baby’s First Bath

If it’s important to you that your new baby spends as little time as possible in the hospital nursery, consider declining the hospital bath. Most hospitals require a newborn to spend some time in the nursery soon after birth, and a bath is one of the routine tasks often conducted there. One of the downsides to the nursery bath is the risk of the baby getting too cold, which means the baby usually has to spend time in the warmer to make sure she stays nice and toasty, and which also means more time away from mom.

Most of the birth fluids can be wiped off with a soft towel immediately after the birth, and mom or dad can choose to give baby a gentle sponge bath as soon (or as late) as they want. As with any decision in birth, it’s important to remain flexible. In the case of a cesarean or heavy meconium, your choice of when to bathe the baby may be a little different.

Here’s my first bath story. One of the most pleasant things about having a home birth was that my son wasn’t whisked away to the nursery for his first bath. The thought of bathing him couldn’t have been farther from my mind as we lay in my bed after his birth, getting to know each other. Then my mother, God love her, asked when we’d be giving him his bath. Why? I wondered. He wasn’t especially bloody or goopy, although he had some small patches of white vernix in his hair, behind his ears and between his toes. And he had this warm, salty-sweet smell that I didn’t want to wash away. My midwife chimed in that he didn’t need a bath yet if I didn’t want him to have one. Vernix is actually protective to the skin, and she’s heard of midwives back in the day using the vernix of extra-goopy babes to soften their rough, dry elbows. So it was two or three days before my son got his first official bath.

Consumer Reports: Cesarean a treatment trap to avoid

The November issue of Consumer Reports lists cesarean section among the top 10 overused medical test and treatments. In its investigative article called Treatment traps to avoid, the magazine notes that at $7,000, c-sections cost about 55% more than a natural birth. And in our fee for service medical system, that translates to big bucks for doctors and hospitals. Many cesareans are performed during labors that are progressing slower than the doctor would like, in spite of other less-expensive ways of encouraging labor. For instance, walking, swaying and other upright positions for labor use simple gravity to help give labor a nudge! and they’re FREE!

Infant Safe Haven Laws

The local news in my town today is covering the discovery of a dead newborn in a college dormitory. As a mother, I’m heartbroken to imagine what could have gone on in this young woman’s life to feel that her only option was to abandon her baby to die. Most states in the U.S. have statutes called Infant Safe Haven Laws created to help avoid situations like this. In most cases, these statues allow for the parent or someone else to hand over a newborn to places like hospitals, fire stations, and churches, no questions asked. The specifics vary from state to state. To learn about the Infant Safe Haven Law in your state, search the state statutes at the Child Welfare Information Gateway. Just select your state from the menu, then be sure to check the box for “Infant Safe Haven Laws” about half-way down the page, in the Child Welfare section.