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Monday, July 11, 2011

The rise in c-section rates

In a recent journal article, one of the reasons for the increase in rising c-sections is arrest of dilation.  I had a hard time reading about this because I really feel like many in the medical community do not understand the normal progression of a labor that is not medically treated.  Part of the problem has come from the dependence on Friedman's curve.  More recent research has shown that normal labor progression is only .5cm/hour, not 1cm/hour as many medical personnel are taught.  Active labor should also be considered to start at 4 or 5cm, not 3cm.  So up until 5cm, it is perfectly normal for labor to progress very slowly, especially if someone is being induced or is a first time mom.  It is also perfectly normal for dilation to stay the same for two hours if it is still less than 7cm.

Another indication given for the rising c-section rate is a rise in the diagnosis of a non-reassuring heart rate.  This is a subjective diagnosis and different physicians will interrpret it different.  There are some patterns that are easier to interpret than others.  Here's an example:

The heart rate is at the top.  This one has no variability(the heart rate does not fluctuate) and is very flat.  There are no accelerations(the heart rate does not rise intermittantly) and it is a little high.  But even a tracing like this can be questionable.  Maybe the baby is just asleep.  Here's the deal with fetal heart rate tracings.  If you have a good one, than the baby is more than likely doing well.  If you have a bad one, then we don't really know if it's doing ok or not.  We have have a good idea, but it's not always right.  Check out my link on the right under the discussion of fetal heart rate.  Here's another good link:

In situations involving a non-reassuring heart rate, there is a difficulty in deciding whether or not a baby is better in labor, or just coming out by c-section.  I sympathize with the medical people who have to make these decision calls.   The fact is, the c-section rate is rising without an increase rise in good outcomes for the baby and mom.  Therefore, we are needing to find better ways of assessing the health of the baby in the womb.  I also wonder how much the fear of being sued plays in the physicians decisions. 

Other indications listed in the article were multiple gestation and macrosomia(big babies).  Both of these are based off of the assumption that giving birth vaginally to these types of babies is more hazardous than having a c-section.  I disagree with both of these assumptions also.  Though, I think that a lot of it may depend on the situation of the particular mom and baby involved.  The diagnosis of macrosomia is particularly disturbing to me because there is no reliable way of knowing how big a baby is. 

All in all, most c-sections are a tough call.  But I will come back to the idea that more information should be given to the mom to help her make the decision.  It should also be presented in a way that helps her understand that many indications for c-section are subjective.  Giving the mother information and a choice is the best way to deal with situations like this.

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Birth is a Journey: Does it have to be life changing?

  • One woman might have to climb on an overfilled boat, risking her life and nearly dying as she escapes over the ocean to come to this land. This experience could certainly be life altering. It may very well color the rest of her life, positively or negatively. (I overcame this amazing struggle and here I am triumphant! OR Holy crap, that was SO hard I don’t know if I can go on! By the way, neither response is “right”. No one would judge the woman with the 2nd response.)
  • One woman may buy an airplane ticket, sit on a comfortable 747 and fly to America with a nice smooth flight and landing. She is happy to be in America. Those welcoming her are glad she is here safe and sound. She may only travel by plane 2-4 times in her life, so it is pretty memorable. But the journey itself probably wouldn’t be life changing; it would simply be a journey.
  • One woman may learn to fly an ultra-light plane to lead a flock of geese into America teaching them to migrate. This experience could certainly be empowering and life altering.