Monday, April 25, 2011

WHO Warns of Cesarean Epidemic

50% of babies born in China are delivered by cesarean
Frankly, the WHO issued this warning several years ago (2007). We are no longer approaching an epidemic, we are in the midst of one. The number of cesarean surgeries throughout the world are increasing (China now delivers 50% of their vast number of babies via cesarean). This is concerning because research has shown that with any given population, a cesarean rate that is below 10% means that mothers who would benefit from the lifesaving technology of a cesarean are probably dying. When the cesarean rate is between 10-15%, maternal mortality goes down and lives are saved. However, when a cesarean rate goes above 15%, there are no overall improvements for maternal or infant health outcomes. The risks of harm increase for both mother and baby, future pregnancies can be endangered, and health care resources are squandered on interventions that do not provide a positive net gain in health outcomes.

According to the WHO's regional office report for 2009, Kuwait's Cesarean rate was 11.9%. These rates may be higher for the private sector, but given the current amount of information available, that is difficult to ascertain.

Let's get back to why this is a big deal. The WHO concludes that cesareans should only be performed for medically indicated reasons. These include placenta previa, malformed or injured pelvis, severe pre-eclampsia, active genital herpes, advanced HIV, transverse (side-lying) baby, twins if the first baby is breech and triplets, certain birth defects, medical problems with the baby or mother (emergency or chronic), placental abruption, prolapsed cord, or uterine rupture.

The following are NOT necessarily a medically indicated reason for a cesarean: prior cesarean, breech presentation, failure to progress, CPD (Cephalo-pelvic disproportion, or your baby's head is too big), twins if the first baby is presenting head down, large baby, fear, convenience, wanting a trendy birthday etc. For example, breech babies can turn during labor, women who are healthy can deliver vaginally after a previous cesarean, labor may be slow- but if both mother and baby are healthy-there is no reason for a cesarean, and CPD is not always accurately diagnosed.



Are there really increased risks for the mother and baby with a cesarean? Yes. If there truly is a medically indicated reason for one, than the benefits outweigh the risks. But if there is not, a mother and baby are unneccarily put at a higher risk for harm. The good news is, more mothers are learning about the real risks of cesarean surgery- it's not just a matter of preference between two equally good choices (vaginal or cesarean). And the more women know, the more they will be able to make truly informed decisions.

Risks to Mother:
  • 4xs higher risk of death than vaginal birth
  • 20%-40% mothers after cesareans have post-operative complications - uterine, wound or urine infections are the most common.
  • increased risk of serious infections such as pelvic abcess, septic shock and pelvic thromboembolism.
  • up to 1 in 10 have a surgical laceration in their uterus.
  • 6xs increase in postpartum depressions three months after surgery.
  • reduced fertility
  • increased risk of ectopic (outside of uterus) pregnancy
  • increased risk of unexplained still birth
  • increased risk of rupture of the uterus before or during labor, 2-4xs higher when subsequent labors are induced or augmented with pitocin.
  • risk of placental problems (placenta praevia or low-lying placenta; placental abruption where placenta separates early; placenta accreta, where placenta won't separate) increased by 2-4xs.
  • 7-15xs increased risk of emergency hystorectomy after birth for the above reasons
  • increased risk of bleeding after birth, severe anaemia, blood transfusion, repeat cesarean, and infection, for all the reasons mentioned.
Risks to Baby (for non-emergency cesareans):
  • 5xs increased risk of needing intensive care treatment after birth
  • increased risk of prematurity; even with ultrasound scans, around 10% of babies are born more than two weeks early
  • increased risk of breathing difficulties after birth: minor problems around 6% compared to 3% vaginal delivery, even when born at term.
  • with ceasareans, 1.6% of babies require a machine for severe breathing difficulties compared to .3% of vaginal births.
  • Persistent pulmonary hypertension. of which 40%-60% of affected babies die, can affect up to 4 per 1,000  cesarean babies, compared to .8 per 1,000 vaginal babies.
  • 1-2% risk of laceration (surgical cut) during the operation
  • risks to baby in all pregnancies following a cesarean include: increased risk of prematurity, low birth weight, poor condition at birth, and death, for the reasons mentioned above.

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