Posts Tagged ‘c-section’

Childbirth classes no longer needed?

December 3, 2007

Busy times, as usual. Classes are hectic, the holidays brought guests and much-enjoyed socialization and much-appreciated camaraderie and closeness, and traveling is on the horizon. Little time right now for the essays, my book. Now and again only can I check in with the listservs or email groups. Here is something of interest you may have already seen, though I see the blog is still getting comments even today. Columnist Tara Parker-Pope reports on her Well blog that pregnant women “cutting childbirth class.” Before going to the content, I must say how grateful I am to see her use of the word “women” rather than the usual “ladies” (yes, truly!) that I am seeing all the time on certain email groups. Ladies! Parker-Pope says:

Although women are more obsessed than ever with health during their pregnancies, they seem to have lost interest in learning about the end of pregnancy, also known as childbirth, reports the November issue of Fit Pregnancy magazine.

“Fewer women are taking classes,’’ said Jeannette Crenshaw, president of Lamaze International. Ms. Crenshaw told the magazine that she believes several issues explain why women aren’t as interested in learning about childbirth. Many women, she says, are convinced they can’t deliver a baby without epidural pain relief. Television shows often depict birth as a dangerous event, even though serious problems are exceedingly rare among women delivering in the United States. And because many women work until nearly the last day of pregnancy, busy schedules often prevent them from scheduling a birthing class.

Marjie Hathaway, co-director of the American Academy of Husband-Coached Childbirth, which teaches what’s known as the Bradley Method of natural childbirth, also told the magazine that interest in childbirth classes has waned. “Today, women are more focused on prenatal testing and monitoring the pregnancy than in learning how to give birth,’’ she said.

Research shows that there’s no real difference in pain, labor interventions or birth outcomes among women who take childbirth classes and those who don’t, the magazine reports. The classes appear to attract women who are the most vigilant about their health during pregnancy. Women who enroll in a childbirth class are more likely to have quit smoking, keep prenatal appointments and to breastfeed after birth, the magazine notes.

But today hospital-based classes tend to focus more on a tour of hospital facilities rather than techniques to cope with labor pain. The magazine argues that women’s declining interest in childbirth classes is worrisome because it’s happening even as childbirth has become more “medicalized’’ than ever. During childbirth, a number of variables can arise and women have to make informed decisions about procedures like epidurals, episiotomies, induction and C-sections. “That’s where you reap the dividends of having had a teacher who explained each possible intervention and showed you how to be your advocate,’’ the magazine reports.

What is most instructive and interesting, however, as is often the case, is to be found in reading the comments.

Cyberbullying — thinking, part II

October 3, 2007

Online, some good information on bullying in the midwifery profession provides insight into how this may work with women on email lists, listservs, or groups. This comes from Midwifery Today .

So many times I hear it characterized as conflict among “powerful women”—as though we are bullying one another simply because we are so strong. The truth is that our bullying reflects the fact that we are powerless and fearful.

Horizontal violence — hostile and aggressive behavior by individual or group members towards another member or groups of members of the larger group

“Bullying is not about anger. It is not a conflict to be resolved. It is about contempt—a powerful feeling of dislike toward someone considered worthless, inferior or undeserving of respect. Contempt allows [bullies to harm others] without feeling empathy, compassion or shame.” This sense of contempt frees a bully to feel “[a] sense of entitlement…an intolerance to difference…and a freedom to exclude, bar, isolate, and segregate others.”

Identifying the fact that [midwives] are an oppressed group with the fears endemic to counterculture groups—such as isolation, ridicule and economic suppression—allows us to develop a language to prevent mimicking the painful behavior of the dominant medical hierarchy.

And so, to the last, substitute women who have felt victimized in place of midwives, and it is quite well understood how this can take place, this mimicking of the painful behavior — this redirection of aggression onto  other women. All in the guise of “not being politically correct” or “not sugar-coating,” as I have heard such excuses made.

But I am much too tired after a long night of work and writing, and must call it a night. I am hoping to be able to return soon to my essay, dealing with my mother and aunt and their strength of support through everything other than speech. For this, I need a quieter head and heart, which means rest and solitude.

Thank you to all my readers. It is fun to watch the stats each day climb higher and higher. I will hope to have useful information  posted soon on all I am learning about VBACs, HBACs, and, of course, c-sections.

Uterine rupture rates for classical c-section

September 26, 2007

I am considering having a baby with my new husband, which means a lot of research for me as a 38-year old with 2 previous c-sections behind me and I will only consider having a VBAC (vaginal birth after caesarean), preferably a HBAC or homebirth. My incisions were classical, meaning long and vertical and not low and transverse, or horizontal, as most are today. It has been about 13 years since the last c-section.

Here I will compile the beginnings of my findings on uterine rupture rates for incisions like mine, of classical c-sections. This is what comes to light through a cursory search, but I will add more as I find it.

As frightening as this sounds, we know through medical research that uterine scar breakdowns (and especially uterine ruptures) are relatively uncommon events, occurring in 5-12% of classical incisions and 1/2 of 1% of low-transverse incisions.

http://home.cfl.rr.com/dahmd/vbac.htm

by D. Ashley Hill, MD,
OBGYN.net Editorial Advisor,
Associate Director – Department of Obstetrics and Gynecology,
Florida Hospital Family Practice Residency, Orlando, Florida

Prior classical uterine incision is associated with a rate of uterine rupture of up to 12%.

http://www.phyins.com/pi/risk/minimize/vbacs.html

Classic cesarean delivery is infrequently performed in the modern era and currently account for 0.5% of all births in the United States (Chauhan, 2002). In a meta-analysis, Rosen et al (1991) reported an 11.5% absolute risk of uterine rupture (3 of 26 cases) in women with classic vertical cesarean scars who underwent an unplanned TOL. Chauhan et al (2002) reported that the uterine rupture rate for 157 women with classic uterine cesarean scars was 0.64% (95% CI, 0.1-3.5%). All patients underwent repeat cesarean delivery, but a high rate of preterm labor resulted in 49% of the patients being in labor at the time of their cesarean delivery.

Landon et al (2004) reported a 1.9% absolute uterine rupture rate (2 of 105 cases) in women with a previous classic, inverted T, or J incision who either presented in advanced labor or who refused repeat cesarean delivery. These rates of frank uterine rupture in women with classic cesarean deliveries are in contrast to the higher rates of 4-9% that the American College of Obstetricians and Gynecologists (ACOG) had historically reported for women with these types of uterine scars. However, Chauhan et al (2002) observed a 9% rate of asymptomatic uterine scar dehiscence (95% CI, 5-15%). This result suggests that disruptions of uterine scars might have been misclassified as true ruptures instead of dehiscences in previous studies; this error may explain the bulk of the discrepancy.

http://www.emedicine.com/med/topic3746.htm

(Australian VBAC study) Major uterine rupture, before or during labour, after a classical Caesarean section is 5%.

http://www.birthrites.org/guidelines.html

On the other hand, Midwifery Today:

There are a number of contraindications to VBACs that the vast majority of obstetricians and most midwives agree on. Most of these involve significantly higher risks to mother and baby due to increased rates of uterine rupture. There are, of course, anecdotes of successful VBACs in these situations, but the statistics reveal accelerated risks.

These situations include: classical (vertical) scar on the uterus, T- or J-incision on the uterus, previous surgery through the full thickness of the uterine muscle (example, myomectomy), truly contracted or deformed pelvis, inability to perform an emergency cesarean delivery if needed, obstetrical complications that preclude vaginal delivery (example, placenta previa), and a woman’s refusal to have a Trial of Labor/VBAC.

http://www.midwiferytoday.com/articles/vbacprimer.asp