Re: VBAC revisited
From: art fougner, md (evsono@pipeline.com)
Tue Jul 8 07:40:36 2003
Joe
looks as though Frankenstein's Law applies here.
art
At Tue, 8 Jul 2003, DoctorJoe@aol.com wrote:
>
>In a message dated 7/8/03 06:42:40, rbraun@iupui.edu writes:
>
>> Hence the need to teach our residents how to use forceps correctly.
>> Dan
>>
>> <snip>
>>
>> Hence the view of many that preventing that primary CS is key.
>>
>> Lynne Loeffler, CNM, JD
>>
>Well, just add THIS news story to the mix.
>
>Joe P.
>
>--
>
>CIMS Alarmed By Highest US Cesarean Rate Ever
>
>PONTE VEDRA, Fla., July 8 /PRNewswire/ -- The Coalition for Improving
>Maternity Services (CIMS) views with alarm the Centers for Disease Control's report
>that the 2002 cesarean rate reached 26.1%, the highest rate ever for the U.S.
>The World Health Organization states that a cesarean rate greater than 10-15%
>cannot be justified.
>
>"One in four women giving birth by major abdominal surgery is difficult to
>defend," said Deborah Woolley, CNM, Ph.D., CIMS' Chairperson. "For example,
>there has been no decline in cerebral palsy or shoulder dystocia associated with
>the rise in this operation. Furthermore, studies show that healthy women, who
>should rarely need operative delivery, undergo a large percentage of the
>cesarean sections performed in the U.S."
>
>According to The Coalition for Improving Maternity Services, the overuse of
>cesarean section poses considerable danger to the health and well-being of
>mothers and babies. Compared with vaginal birth, maternal risks include increased
>risk of death, surgical injury, infection, hemorrhage, deep venous clots, and
>pulmonary embolism. Women are more likely to experience pain and poor health
>after birth, and to require readmission to the hospital. Women having unplanned
>cesareans are more likely to suffer post-partum depression or post-traumatic
>stress syndrome.
>
>Otherwise healthy babies born by cesarean are more likely to need assistance
>with breathing, be admitted to intensive care for breathing problems, and to
>develop persistent pulmonary hypertension, a life threatening complication.
>Mothers are more likely to have difficulty forming an attachment to their infant
>and to breastfeed.
>
>Long-term and reproductive hazards of cesarean section include chronic pelvic
>pain or bowel problems, infertility, ectopic pregnancy, miscarriage,
>premature birth, placenta previa (the placenta overlays the cervix), placental
>abruption (the placenta detaches before the birth), and uterine rupture. The risk of
>uterine rupture is 1 in 500 even with planned repeat cesarean versus 1 in
>10,000 with an unscarred uterus.
>
>Besides improving maternal-infant health, reducing the cesarean rate to an
>appropriate level would save the national health care system over $2 billion
>annually.
>
>The rise in cesarean rate is attributable both to the rise in first
>cesareans, now at 18%, also a new high, and the precipitous fall in the percentage of
>vaginal births after cesarean (VBACs). CIMS is especially concerned about the
>ongoing increase in first cesareans because most women having a first cesarean
>will go on to have more despite the fact that elective repeat cesarean section
>is more hazardous for the mother and not any safer for the baby.
>
>Each subsequent cesarean incrementally increases the likelihood of most
>cesarean-related complications, including placenta accreta, (the placenta invades
>the uterus resulting in massive hemorrhage at the delivery). The American
>College of Obstetricians and Gynecologists attributes the 10-fold increase in this
>deadly complication over the last decades to the rise in cesareans.
>
>While uterine rupture is slightly more likely with planned vaginal birth (5
>per 1,000 versus 2 per 1,000 for a repeat cesarean), newborn outcomes do not
>differ. With appropriate care, 7 out of 10 women or more laboring after a
>cesarean will birth vaginally.
>
>The decline in the VBAC rate has come about through obstetricians
>discouraging and outright refusing VBAC, a reversal of policy deplored by CIMS. Denial of
>VBAC forces thousands of women into having major operations they neither want
>nor need.
>
>A free copy of The Risks of Cesarean Delivery to Mother and Baby, a CIMS Fact
>Sheet, is available from http://www.motherfriendly.org.
>
>SOURCE Coalition for Improving Maternity Services
>
>CO: Coalition for Improving Maternity Services
>
>ST: Florida
>
>SU: WOM
>
>Web site: http://www.motherfriendly.org
>
>http://www.prnewswire.com
>
>07/08/2003 00:01 EDT
>
--
art fougner, md
ich bin ein New Yorker
