Cesarean Scar Website

Barb from Navelgazing Midwife has launched a new website dedicated to the “story” your Cesarean scar tells. From the “About” page on the website:

Something told me the cesarean scar needed a place to speak.

As this site was being born, I asked three things:

-1. Take a picture of your scar.

-2. What does your scar say when you look at it?

-3. What does your scar say when you touch it?

What followed was a steady trickle of photos and stories… tender, painful, wonderful, awful stories.

Here, I humbly offer space for the stories to find their way to light.

I’ve read a few of the stories, and already there is a wide range of emotions: “I hate my scar,” “My scar mocks me,” “I’m now at peace with my scar,” “I love my scar because that means my child(ren) are alive,” etc. Everyone has a story to tell…

Inductions and C-section Risk

This was interesting — an article titled, “Inductions might reduce risk of C-section for some women.” There has been much talk over whether or not inductions increase the risk of C-section, but this is the first I’ve seen that might suggest that an induction might decrease the risk of a C-section. My “B.S.-o-meter” is going off full tilt, though, at the implications of this title.

First, inducing a woman with an unfavorable cervix is accepted as being more likely to fail (whether that means the induction will necessarily end in a C-section or not depends — many failed inductions are simply stopped and are started again later when the woman and her baby are more ready for birth), so I would assume that these would not be included in such a study. Perhaps they would be. Or the women in the study may have their cervices artificially “ripened” prior to the induction, which leads to greater success.

Second, the study only shows success for women induced at or after 41 weeks of gestation — a time when many women (if not most) would have already had their babies naturally, or certainly be more favorable to an induction, than when many doctors are now electively or quasi-medically inducing women at 37-40 weeks. So, reading just the headline may make women (and unfortunately perhaps doctors and nurses who might not read beyond the headlines, nor read the actual study) think that they ought to be induced at any ol’ time rather than wait for the baby to be ready, to reduce their risk of C-section.

Third, the article says that women who were not induced were more likely to have meconium-stained amniotic fluid. Not terribly surprising — as fetuses age, they tend to have their first bowel movement prior to birth instead of after birth. But while this may be “significant” from a statistical point of view, the thing I want to know is, does it alter the baby’s health or well being in any way? I’d have to do more research into meconium aspiration syndrome, but my memory of what I’ve read indicates that when a fetus passes meconium simply due to age as opposed some sort of stress or distress, that it is non-problematic. Some people say it may even be the aggressive suctioning of an infant who has passed meconium in utero that causes problems — pushing mec into the lungs, as an example, that would ordinarily have been coughed, sneezed, or otherwise removed from the infant naturally. Again, I haven’t done the research on it myself, but have been in conversations about this topic. But it’s been some time. Bottom line, though — were these babies harmed by being born later, rather than being induced?

Fourth, “More than 22% of pregnant women in the U.S. undergo inductions, more than double the rate in 1990, the Chronicle reports.” The C-section rate has also sharply increased since 1990, so if inductions were a “magic cure” for C-sections, it would seem that the C-section rate would be lower, or at least, not have risen so high.

I’m wondering how many women in these studies that did not have inductions ended up being sectioned for suspected big baby, as opposed to women who were induced “before their babies got too big.” Hmmmm… We know that when doctors suspect a big baby, they’re more likely to call for a C-section than when they believe the baby is of average size. Might this have had something to do with the increased rate of C-sections? Also, doctors may be more quick to call for a C-section in the presence of meconium-stained amniotic fluid, but what if the presence of meconium is simply due to the baby’s age, rather than distress? [The study indicated that there was little if any evidence of harm to the babies due to the meconium.]

Finally, the lead researcher said, “…we want people to realize that it’s not the induction itself, it’s how it’s managed.” Indeed! Unfortunately, there was no indication in either this article nor the study itself as to how better to manage the induction so as to reduce the C-section rate. Often there is a difference in outcomes in real-life situations than what happens in studies. This study mentioned that observational studies showed an increase in C-section rates with induction. So, even if a controlled experiment doesn’t show an increase, and even if it in fact shows a decrease, if that doesn’t translate into a practical decrease in C-section rates, that’s of little or no comfort to women who have unnecessareans.

h/t to Sidney Midwife for the link

C-sections and Type I Diabetes

In an article titled, “Mothers’ birth choices linked to rise in childhood diabetes,” the author linked C-sections to increased rates of Type I or childhood diabetes. Since this disease can cause serious problems, especially starting so young, it is something to be concerned about. The article said that about 700 children in the UK were diagnosed with this disease in 2005, and approximately 250,000 people have Type I diabetes in the UK. (For perspective, the estimated population is 61.6 million.)

Dr Chris Patterson of Queen’s University, Belfast, one of the report’s authors, said the increasing number of cases over time was so rapid that it cannot be related to genetic factors alone.

‘Environmental factors are driving this,’ he said. ‘We know children born to older mothers, for example, are more at risk. There is a 20 per cent extra risk for babies born as a result of Caesarean section, while those putting on weight rapidly during the first year of life are also at increased risk. Breastfeeding reduces the risk.

‘In addition there are other environmental issues behind the rising trend, such as children being exposed to fewer germs.

‘Type 1 diabetes is very much involved in the development of the immune system – which, in the case of Type 1 diabetes, turns on the body and stops it producing insulin. But it is still a rare disease.’

So, children not being exposed to enough germs is a risk factor, as is being born by C-section. There is a lot I could say about this, including that perhaps there is a correlation, rather than causation with all the C-section talk — for instance, older moms might tend to choose a C-section for their “premium baby” that they had a hard time conceiving, and they might also tend to overreact a lot little bit with their babies being exposed to all the “nasty” germs (which may actually help to strengthen and build up the immune system). Also, women who do not choose a C-section, but need one (or think they need one) may also be overprotective of their little baby who “almost died” during childbirth. Plus, babies born by C-section tend to have more problems breathing, needing to spend time in the NICU and all of that, so their moms may be a bit overprotective due to that. (And I’m not saying that this is necessarily a bad thing, nor that all protection is overprotection — babies who are already sickly for whatever reason probably should be kept away from the general germy public who may give them pneumonia, the flu, RSV or something. But I have seen some mommies that made me roll my eyes with how overly zealous they were about their healthy kids not coming into contact with any germs, but the kids seemed to be constantly sick anyway; whereas I don’t think I’ve ever wiped down the handle-bar of the shopping cart, and my kids are pretty darn healthy.)

However, I can see a possible causation of C-section along the lines of germs, and that is that babies who are born vaginally are colonized by bacteria in the birth canal, and babies who are born abdominally simply do not get this. Also, babies born by C-section are less likely to breastfeed than babies born vaginally, so then they also do not get the normal bacteria from their mothers’ breasts nor antibodies in the milk that also serves to strengthen the immune system. So, in the absence of normal and healthy colonization, that leaves the baby’s system wide open for colonization by possibly unhealthy bacteria, which can set up a whole load of problems.

Hmm, I wonder if moms are told of these potential problems as part of their informed consent before signing up for an unnecessary and possibly completely elective C-section?

Vaginal Bypass Surgery

Also known as a C-section. I read that in this post (which is just a dang good read anyway, talking about some Florida hospitals having a 50% or higher C-section rate) and thought it was just an excellent terminology for it. Of course, it’s not actually funny because it’s a sad truth… but it was very, very clever.

[And here is the disclaimer to let you know that, yes, I understand that some C-sections are necessary to preserve the life or health of mother and baby, so if yours was necessary, I am in no way saying anything negative about you. Please don’t read more into the post than I meant. However, if you are one of the estimated 50% of women who had an unnecessary C-section, this may be an accurate, descriptive term for how you feel about your surgery.]

Vitamin D and C-sections?

This was an interesting article — a midwife’s take on the recently released study that showed that women who had C-sections were more likely to have low vitamin D. She points out some flaws and potential faults in the study. Quite interesting reading!

C-section Poem

Click here to read a touching poem that demonstrates the feelings a woman was left with after her Cesarean.

While I’ve been reading her blog for many months, and have read other things she and other women have said about the feelings of loss and pain after their C-sections, this poem opened my understanding in a deeper and fuller way.

High-Tech vs. High-Touch — Consumer Reports on Childbirth

In an article titled “Back to basics for safer childbirth,” and subtitled “Too many doctors and hospitals are overusing high-tech procedures,” Consumer Reports finds the same problems with modern birth practices for low-risk women that natural-birth advocates have been reporting for years: overuse of high-tech, often invasive measures, and underuse of high-touch, usually non-invasive measures.

Overuse of high-tech measures

  • Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
  • Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
  • Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
  • Electronic fetal monitoring, unnecessarily adding to delivery costs
  • Rupturing membranes (“breaking the waters”), intending to hasten onset of labor
  • Episiotomy, which is often unnecessary

Underuse of high-touch, noninvasive measures

  • Prenatal vitamins
  • Use of midwife or family physician
  • Continuous presence of a companion for the mother during labor
  • Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one’s back
  • Vaginal birth (VBAC) for most women who have had a previous Caesarean section
  • Early mother-baby skin-to-skin contact

They also have a link to a true-false quiz on maternity care (I scored 100%).

Now that Consumer Reports has jumped on the natural-birth bandwagon, maybe, just maybe, all those people who denigrate natural birth advocates will shut up. Hey, I can dream, can’t I? 🙂

My thanks to Empowering Birth for the link to the article!