Skin-to-Skin in the O.R. after a C-section

Being born vaginally is good for babies, in part because it colonizes them with the mother’s good bacteria, setting them on the road to health; a C-section bypasses this normal process and may be part of the reason why babies born by Cesarean have higher rates of things like asthma. But putting the baby skin-to-skin with the mom, especially after a Cesarean, can restore some of this good colonization; otherwise, the baby will be colonized only with hospital bacteria. Skin-to-skin contact is also beneficial in facilitating breastfeeding. Typically, when babies are born, they have an innate ability and desire to get to the breast and self-attach; wrapping babies up in a blanket like a burrito prevents this. All too often, whether the baby is born vaginally or by C-section, babies are only briefly shown to the mom right after birth, and then are taken across the room for the newborn assessment and procedures, before finally being returned to their mothers securely swaddled in a hospital blanket. Then, many times, babies are taken to the nursery soon after birth for a bath, then kept in the nursery under the warmer for a few hours to warm back up, and then finally taken back to their mothers… just in time for them to fall asleep for a few hours. But it doesn’t have to be that way. Healthy babies can — and should — be placed skin-to-skin with their mothers immediately after birth, even with a C-section.

Update: Here’s a video showing skin-to-skin after a C-section

If you had a C-section, were you able to have your baby put skin-to-skin in the operating room? Did you even know that was a possibility? If you are a nurse or midwife, do you ever put babies skin-to-skin on their moms, even if they have a C-section?

Weigh in on this topic on the Breastfeeding with Comfort and Joy fan page [currently, it’s the most recent post, dated May 28]. Laura Keegan, the author of Breastfeeding with Comfort and Joy, will be giving Grand Rounds in June/July, so will have the opportunity to talk about this important topic to attending physicians, L&D nurses, and residents in OB, pediatrics, and family practice. She would love to have input from women about their experiences with skin-to-skin contact (or the lack thereof) after both vaginal and Cesarean births, to pass along to the doctors, nurses, and doctors-in-training. What did it mean to you to be able to hold your baby with nothing between you, and just a blanket put over both of you? What did it mean to you to be denied this? Please comment on the fan page post, and also spread the word (blog, share on facebook, Tweet about it, etc.), so that doctors and nurses can find out from you and other women what they otherwise might not hear.


Informed refusal = lose the baby?

This post disturbed me, but I was unable to find independent verification of it — no other news reports, no online articles, nothing but this blog’s post. Can anyone confirm or deny this?

Here is the first post, and here is the second post.

In brief, a New Jersey mom went to a hospital with a 50%+ C-section rate, and was asked to sign a consent form for a possible C-section (I think this was upon admission — but definitely with no medical indications that a C-section might be necessary), and the woman and her husband were turned over for an investigation for child abuse and neglect, although the woman gave birth vaginally and the baby was perfectly fine. They had a hearing where their parental rights were terminated — because the judge thought if the woman got argumentative with the hospital staff over an unnecessary C-section, she might argue with the child’s pediatrician or school teacher in the future. Um, yeah.

I daresay I would be more than a little argumentative — doctors and teachers are fallible, so it would be ridiculous for all parents to just meekly submit to whatever the “authorities” say, particularly when they might be wrong. I would think if this were me, I’d be in contact with any and every news service I possibly could to tell my story and generate publicity in my favor and negative publicity for the hospital. Which makes me wonder why I couldn’t find anything else but this one blog that told the story. Of course, there may have been some sort of “gag order” or the parents may be private people and not wanting to draw so much attention to themselves.

So… what do you all say? “Impossible — it must be a prank”? “Horrifying, but I could see that happening”? What?

Study shows fear of lawsuit drives up C-section rates

At ACOG’s annual meeting, Dr. Elizabeth Platz presented a study which demonstrated that fear of lawsuit (and particularly in states that have high lawsuit pay-outs for malpractice during birth) increase the rate of C-sections. Specifically, “for every $10,000 increase in insurance premium there was a 15% increase in the rate of cesarean delivery.”

Whether you like it or not, here’s how insurance premiums work in America — insurance companies are for-profit companies, which means that they’re in the business to make money; this means that if they just break even, they’re not happy. So, they have to charge more than they pay out (not rocket science — this is the way it works in every business, from restaurants to grocery stores to car dealerships — if they don’t make money, they close). This means that if they insure a doctor who ends up costing them a million or two due to a dead or injured baby or mother, then they have to recoup that money somehow. Which means that they have to raise premiums on all doctors they cover. Or, raise premiums on the doctor who got the negative judgment. It’s just like car insurance — you have a car wreck (even if it’s not your fault) or a traffic ticket, or have some other indication that you may cost the insurance company money, or even worse, that you did cost them money, then they will raise your premiums. If you have too many tickets (or pay-outs or settlements), they may even drop coverage. As a driver, that means you aren’t legally allowed to drive, which is a difficult thing; as a doctor, that means you can’t work! Don’t you think that would make you ultra-cautious in attending births? (This doesn’t even take into consideration the human feelings one might have at attending a birth with a negative outcome, whether the attendant was at fault or not. But even if there were no lawsuit, I could see that such a birth could make you err on the side of caution the next time. Just as a mother who had a term stillbirth or intrapartum death might opt for a medically unnecessary C-section to avoid the risk of a repeat of her first birth, a doctor who attended such a woman might be more prone to choose an unnecessarean for the next woman.)

But this can be a thorny problem. I don’t think that doctors should be sued unnecessarily. But arbitrary lawsuit caps may be unjust for victims of malpractice. Most insurance companies will settle most lawsuits, preferring to take the known settlement than the risk of a jury handing down a possibly disastrous multi-million dollar verdict. The amount of money it takes to bring suits to court is also quite high. And although a jury may be legally and technically impartial, they may also be too ignorant (not using the term in a pejorative sense, but objectively) to hand down a just verdict. What if the doctor didn’t do anything wrong, but still got ruled against because of the sympathy factor of grieving parents? I suggest a special medical court that would try medical cases, with the pool of jurors or judges or justices being people with medical knowledge so that they can rightly decide fault. Unfortunately, this might unfairly favor medical personnel (the “old boys’ network” and feeling of shared experience), so it would have to be entered into cautiously, but I think it would work better than the current system. Perhaps some form of arbitration would work, rather than an actual trial.

Regardless, there is now evidence that what we’ve long suspected (though some refuse to admit) is true: defensive medicine is real, and it is driving up the rate of unnecessareans.

My thanks to “Sydney Midwife” for bringing the story to my attention.

Scars that Run Deep

As Cesarean Awareness Month draws to a close, here is a very deep and thoughtful post on the phrase that makes so many C-section moms shudder — “At least you have a healthy baby — that’s all that matters.” She delves deeper into that phrase, and why it is so hurtful to so many women.

Thanks to Nursing Birth for the link.

Fun and flirty… post-op panties?

This one is a new one on me, but click here to see what I’m talking about. It’s designed with the post-surgical mother in mind, and I assume is meant to be an alternative to the old-fashioned “granny panties” that would likely be most C-section moms’ only choice of underwear, because they don’t put pressure on the incision site like bikini-cut panties would.

So, go take a look and tell me what you think. Especially those of my readers who have had C-sections — would you buy these, or would the chipper and cheery “fun and flirty” line put you off? Or, do you feel like having trendy-looking underwear would have helped you feel better about your C-section?

Personally, I have mixed feelings about it. On the one hand, I’m glad they exist if they are helpful to women who have C-sections; but part of me is pretty irritated that 1/3 of all women who give birth this year will find themselves “needing” these. It also seems to downplay the seriousness of major abdominal surgery, sounding like, “Ooo, look, and if I end up with a C-section, I can get some of these panties — aren’t they cute?!?” That also bugs me.

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The Trouble With Repeat Cesareans

Woo-hoo!!! Finally! An article — in Time magazine, no less — that highlights the burgeoning number of women who are being forced to undergo “elective” repeat C-sections, since they are not allowed to attempt a vaginal birth.

While I had some quibbles with the wording of the article (doctors don’t perform VBACs — the mothers do!! Doctors perform C-sections! They attend vaginal births), it was an excellent and timely article.

Why plan?

One of the things that is often discussed is whether or not a woman should make a birth plan. There are a few different schools of thought on this. One is, “Women don’t need any plan other than, ‘Go to hospital; have baby.'” Another is, “Birth can’t be planned, so you shouldn’t even try.” Another might be, “You can plan if you want to, but it won’t turn out that way so you’re wasting your time.” There are also some more positive constructions, obviously.

Some people are consummate planners — they have the Day Planner in which they put everything, and are super-organized, and know how they’re going to spend every minute of every day for the next year. They may even be called “obsessed.” Others are the polar opposite — even trying to figure out what to eat for supper that evening, or what to wear the next day to school or work is too restrictive on their “freedom.” Most people are in the middle.

Apparently, my father-in-law was (and still is) very much a planner when it came to family vacations. He would literally have the whole time planned — they would leave home by such-and-such time, and drive so far, eat in this town, drive some more, get to the destination by suppertime, eat, and go to bed. And every day of the vacation was similarly planned. Spontaneity was not smiled upon. There may be some slight variations allowed (You want to play ping-pong instead of foosball? Okay), but in general, he had his plan and it was followed.

When I got married, I paid a lot of attention to a lot of little details about the wedding. I planned a lot of things, obviously — you have to do that when you’re organizing a medium-sized church wedding. If you want to stop in at the Courthouse, not so much needs to be planned; but if you’re going to have a couple of hundred people in attendance (and to feed!), you’ll want to be prepared. For all of you who have ever planned anything, whether a vacation or a wedding, or anything that you thought of more than week in advance, I ask you, “Why plan?”

Are the same thoughts screeching through your head that are screeching through mine? “What?? ‘Why plan’?!? Is this person an idiot? Of course these things have to be planned!! I have to know how much food to buy, or clothes to pack, or money to take… I’ll have to take off work or get somebody to watch the kids or….

What if I said, “Well, you can plan, but you know it’s not going to work out the way you plan, so you’re just wasting your time!”? After all, nobody who gets married plans on having the groom pass out, or the flower girl showing off her pretty panties, or the ring bearer picking his nose, or the flowers getting lost, or the cake getting crushed — but all these things happen in weddings every day. Nobody who goes on vacation plans on having a car wreck, or the alternator going out in the middle of nowhere, or getting a stomach bug the whole week, or having the luggage get put on the wrong plane, or finding out the hotel has lost your reservation — but all these things happen, too.

The fact is, there are things that happen that are not planned, but that doesn’t mean that having a plan to start with is a stupid idea. In fact, it’s usually stupid not to plan. The inspiration for this post came from reading this article, “Homework is the Mother of Prevention,” which I first saw on The True Face of Birth.

This Australian author begins by saying that she was not known to “be prepared,” and in fact ended up quite sick when she went to Latin America, completely unprepared because she refused to read any of the travel literature.

But when I was pregnant I managed to break the bad habits of a lifetime. My motivation was hearing about the many apparently normal, healthy pregnancies that spiralled out of control in the labour ward, ending in unplanned and invasive medical interventions. I was told that labour is just like that — unpredictable, chaotic, terrifying. A bit like my Latin American adventure. But while friends and family didn’t hesitate to censure me for my haphazard approach to overseas travel, the opposite was true of my careful preparations for labour. If I had a dollar for every time I was told that birth plans were futile, since things would never come out the way I expected, I could almost have doubled my baby bonus.

I strongly urge you to go read the full article, because it has many salient points. But just to sum up what I’ve already said — just because life is ultimately unpredictable, that doesn’t mean you shouldn’t plan.

Pregnant women already attract unjustified scrutiny and criticism. No woman should ever be judged for the decisions she makes while in labour, given how indescribable and unexpected that experience really is. But how a woman handles her preparation is another matter entirely, and maybe a lack of preparation deserves scrutiny. To just “wait and see” when the stakes are so high is simply negligent — both for the mother’s health and for her baby.