Labor is Good for Babies

A nice concise summary of Why Labor is Good for Babies.

Cesarian Sections

The Academic OB/Gyn has an interesting, if somewhat technical, discussion of single vs. double layer suturing to close up the uterus after a c-section. For what it's worth, my birth plan includes a request for double-layer suturing should surgery be necessary.

And speaking of surgical births, the Philadelphia Inquirer this week published Dangerous delivery shows peril of multiple C-sections:

The case points out a fundamental truth about surgical delivery: a first cesarean for most women leads to a cesarean with every pregnancy. And while a first section is quick, easy to perform, and rarely complicated, each repeat surgery carries greater risk.

A risk which, sadly, most women are not made aware of.

Early Caesareans Pose Risks to Newborns

Research is catching up to what we knew all along: babies born by elective c-section prior to 39 weeks are at a significantly higher risk of medical problems. Even just a week can mean a huge difference for a baby's health. Complications of being born too early include respiratory distress, infections, and hypoglycemia. This is in addition to the normal risk of being born by c-section, as the New York Times article points out,

Doctors noted that even when babies born by Caesarean are delivered at the same week of pregnancy as babies delivered vaginally, they are at higher risk of respiratory difficulties because the process of labor and delivery primes the fetal lungs for breathing air.

Although the increasing prematurity rate in the US is often blamed on women with little to no prenatal care and poor nutrition, a large chunk of the problem is inductions or c-sections scheduled too early - perhaps in combination with incorrect due dates. Read between the lines of this quotation:

But Dr. Alan Fleischman, medical director of the March of Dimes, said the findings should reinforce the message that "every week counts" in a pregnancy. The women who were more likely to deliver early were white women with private health insurance, and the medical centers were all top-notch hospitals, he noted.

"These are not preterm babies, and these are pregnancies that should have good outcomes," he said.

Keep in mind that the research deals with "elective" cesareans, meaning there was no medical indication for the surgery. The National Partnership for Women and Families' article on the same study reports:

John Thorp, professor of obstetrics and gynecology at the University of North Carolina-Chapel Hill, said that there are differences between infants delivered at 37 weeks vaginally and those delivered via elective c-section. He said, "We would not worry about a 37-and-a-half week baby born vaginally with the onset of labor" because in that situation, "there is some signal from a baby to his mother that says 'I'm ready'"

More discussion and links are available at the Citizens for Midwifery blog. And check out a related press release from Lamaze International, Best Practices in Maternity Care Not Widely Used in the United States.

And as for my opinion, God (or Mother Nature, if you prefer) knew what He was doing. If a 37 or 38 week baby was ready to be born, he would have been born already. Anytime you force a baby to come early, whether through drugs or surgery, you have got to expect a baby that is not completely ready to face life "on the outside".

When doing nothing is the best course of action

Many C-Sections Can Be Avoided By Waiting Out Stalled Labor for an extra two hours, according to a new study:

"One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year," said [study author Dr. Aaron] Caughey, who is affiliated with the UCSF National Center of Excellence in Women's Health. "In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach."

The cesarean delivery rate reached an all-time high in 2006 of 31.1 percent of all deliveries, according to the UCSF study. Arrest in the active phase of labor has been previously shown to raise the risk of cesarean delivery between four- and six-fold.

"Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection," Caughey said. "After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture."

The study also notes that ACOG already recommends waiting at least two hours before proceeding with a cesarean when adequate contractions in active labor produce no progress , but "it is routine practice in many clinical settings to proceed with a cesarean for 'lack of progress' before those ACOG criteria have been met", according to Caughey.

HT: Unnecessarian

The Unnecessarian

Check out this relatively new blog dedicated to avoiding an unnecessary cesarean - the Unnecesarean.

Oxytocin

Hathor's been doing some neat comics lately on Oxytocin - the "Love Hormone". She just came back from the Trust Birth Conference which I really wish I could have gone to. She heard Michel Odent speak, and he really rocked her world, as he did mine when I heard him speak a couple years ago at a local conference. Hathor came across this article, over a year old and just a rat study, but still important:

The massive surge in the maternal hormone oxytocin that occurs during delivery might help protect newborns against brain damage, a new study in rats suggests.

Researchers say the findings should encourage scientists to investigate whether elective caesarean sections, which lack this oxytocin surge, disrupt normal brain development.

Also, I found Hug the Monkey, a whole blog devoted to the subject of Oxytocin; and an article entitled 5 Ways Pitocin is Different than Oxytocin which, in honor of list month, I will include here:

1. Pitocin is released differently. Oxytocin is released into your body in a pulsing action. It comes intermittently to allow your body a break. Pitocin is given in an IV in a continuous manner. This can cause contractions to be longer and stronger than your baby or placenta can handle, depriving your baby of oxygen.
2. Pitocin prevents your body from offering endorphins. When you are in labor naturally, your body responds to the contractions and oxytocin with the release of endorphins, a morphine like substance that helps prevent and counteract pain. When you receive Pitocin, your body does not know to release the endorphins, despite the fact that you are in pain.
3. Pitocin isn't as effective at dilating the cervix. When the baby releases oxytocin it works really well on the uterine muscle, causing the cervix to dilate. Pitocin works much more slowly and with less effect, meaning it takes more Pitocin to work.
   
4. Pitocin lacks a peak at birth. In natural labor, the body provides a spike in oxytocin at the birth, stimulating the fetal ejection reflex, allowing for a faster and easier birth. Pitocin is regulated by a pump and not able to offer this boost at the end.
   
5. Pitocin can interfere with bonding. When the body releases oxytocin, also known as the love hormone, it promotes bonding with the baby after birth. Pitocin interferes with the internal release of oxytocin, which can disturb the bonding process.
   

I knew, like, three of those already. And for some really hair-raising stories, try Knitted in the Womb's Rant on Pitocin (with comments).

Top 10 Childbirth Myths

The Journey Of An Apprentice Midwife posts a very excellent Top 10 Childbirth Myths, with references.

Birth & Pregnancy Briefs

US among worst in world for infant death:

The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.

The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom — but still had a higher rate of infant mortality than any of those nations.

And Memphis fights its infant mortality rate, nearly twice that of the national average.

The risks linked to caesarean births from a study published in the British Medical Journal:

They found that a woman having a caesarean delivery had twice the risk of illness and mortality (including death, hysterectomy, blood transfusion and admission to intensive care) as a woman having a vaginal delivery.

There was a five times higher risk of having to have antibiotic treatment after birth for women who had a caesarean delivery (elective or decided by clinicians) than those who had a vaginal delivery.

Risk of having to stay in a neonatal intensive care unit for newborn babies who were born head-first was doubled after a caesarean delivery compared to a vaginal birth.

The authors also found that the risk of neonatal death was also significantly increased (more than 70% higher) up to hospital discharge for babies who were born head first from both an elective and a clinician chosen caesarean delivery, compared to a vaginal delivery.

However, caesarean delivery had a large protective effect in preventing foetal deaths in cases of breech born babies and reduced overall risks in those cases.

Elective Caesareans put mums and babes at risk of death:

According to a new British study women who opt for non-emergency Caesareans double their risk of dying or developing severe complications following the procedure.

The study by researchers at the University of Oxford has also found that in some cases Caesareans increased the risk of death to newborn babies by as much as 70 per cent.

Common Drug For Stopping Preterm Labor May Be Harmful For Babies

Dozens of studies have been done, but none have had a large sample size or a definitive outcome on the effects of indomethacin. The new analysis of a collection of studies, or a metaanalysis, by University of Rochester Medical Center researchers pulls together enough data to conclude that there is an association between use of indomethacin and babies experiencing periventricular leukomalacia (white matter injury by decreasing blood flow in the brain, which may lead to cerebral palsy).

The analysis also showed an association between indomethacin and necrotizing entercolitis (a condition in which intestinal tissue dies, which can sometimes be successfully treated with antibiotics but can require surgery and even cause death), especially for those babies who were exposed to the drug within days of birth.

And, no surprise, Diet Affects Fertility.

Caesarean risk higher when labor induced

A new Australian-based study shows that first-time moms are more likely to "need" a Cesarian when induced:

In a study of more than 37,700 women, Mary-Ann Davey, an epidemiologist at La Trobe University's Mother and Child Health Research, looked at all uncomplicated first births in Victoria between 2000 and 2005. The mothers were aged 20-to-34 when they were between 37 and 41 weeks' pregnant.

Of those, 9.4 per cent had their labour induced — 6.1 per cent of public patients and 14.1 per cent of private patients.

"These women had no medical indication recorded for induction of labour," Ms Davey said. "Common reasons given were 'social' or 'post dates' (but less than 41 weeks' gestation)."

She also found that more women who were induced had epidurals then those who weren't induced. Although her findings are still preliminary, Ms Davey said there was "a substantial and significant increase in the number of caesareans" following an induced labour.