Thursday, February 4, 2010

Rise in California Maternal Death Rate Linked to Cesarean Sections: Why Aren't They Telling Us?

My brother, Richard, alerted me to an article in the San Francisco Chronicle yesterday with the head line "Pregnancy Related Death Rate on the Rise". It turns out a task force headed up by a scientist in the California Department of Public Health started a study back in 2006. There were gasps from the audience and basic disbelief when they reported their findings at an American College of Obstetricians and Gynecologists' conference in 2007. The attending doctors seemed to think it was implausible that in this day and age with all our current technology we could possibly be getting worse outcomes for mothers. (A side note is that we are also getting worse outcomes for our babies. The rate of "premature" babies that end up in our neonatal intensive care units is growing too!) They don't seem to see or perhaps they don't want to see that there is actually a link between the increase in technological birth and the bad outcomes. In 2008 a second study confirmed the initial study's findings.

And here it is 2010 and the California Department of Public Health has still not released this study to the public. In other words the very people, who most need to know about this study, the women every day who are getting cut open to give birth in our country, are being kept in the dark. We continue to be sold the myth that a cesarean birth is completely safe, even in some ways preferable to a vaginal birth. Our culture continues to promote the idea of choosing dates and scheduling inductions or cesareans without even any labor at all. Women continue to think this is a safe way to escape the pain of labor. Do you think this would be happening if women were advised by their doctors that their chance of DYING while giving birth would more than DOUBLE if they are induced or schedule a cesarean?

Although the study's findings have still not been released, a California Task Force has begun pilot projects to bring down the death rate. What are they doing? Encouraging the reduction of the induction rate! Why? Because studies show that an induction DOUBLES your chances of "needing" to have your baby come by major abdominal surgery.

In 2002 the Medical Director at one Orange County hospital instituted new guidelines for elective inductions; no inductions before 41 weeks of pregnancy. That means no scheduling an induction because that’s when Grandma will be in town or because the next week your O.B. is going on vacation. It also means women don't get to their 39 week prenatal visit and have the doctor cheerily inform them that they will put them on the schedule to be induced if they haven't had their baby by week 40. From my own experience I can tell you how critical that last week is for moms' bodies to prepare for labor. Their body chemistry is slowly building toward a perfect hormonal balance to begin and support a labor that will progress until their baby is born.

And what has happened at the Orange County hospital? They have fewer babies who need to spend their first days in a neonatal intensive care unit separated from their parents instead of bonding and breastfeeding at home. They have fewer maternal hemorrhages which is the leading cause of death for mothers during the birth process. And they have fewer emergency hysterectomies which is what they have to do to save her life if a woman is bleeding to death. The hospital has also seen its profits go down. Full O.R.s and neonatal units, and longer hospital stays for recovering moms equal big bucks. Remember having a baby by cesarean surgery is at a minimum twice as expensive.

Here it is by the numbers ladies:
California Maternal Death Rate 1996: 5.6 mothers die per 100,000 live births.
2006: 16.9 mothers die per 100,000 live births.
California's rate is even worse than the national rate which is 13.3. My guess as to why we are higher is a deadly combination of cultural factors, fear of liability by doctors and Hollywood stars fueling a "too posh to push" mentality.

Here is a question I would like answered. Where does the fact that we have gone back to the “once a cesarean always a cesarean” policy fit into this picture? How can a woman be an informed consumer when choosing between the risks of having a repeat cesarean versus the risks of trying for a vaginal birth after a cesarean if they are keeping the facts about the risks from us?

So if someone is recommending to you to schedule an induction simply because you are at week 40, or you are thinking about just picking a day for your baby's birth by signing up for a trip to the Operating Room, don't make your decision lightly because your life may depend on the decision you make. Consider first do you have any other indications that your health or your baby's health needs you to take this risky step? Is your blood pressure too high? Is your baby no longer growing or showing other clear signs of being in distress? Women will often be frightened by stories of healthy placentas magically turning into degrading placentas the moment they are at 40 weeks plus 1 day. Yes, all placentas will begin to break down at some point. For some women it will start at week 38 and for others at week 43. The only way to know about your placenta is to monitor the health of your baby through nonstress tests and ultrasound. Remember there are times when the very best choice for you and your baby is an induction or cesarean surgery but only if there are clear indications of current risk.

Read "Bodie's Birth" to hear a couples' story of a necessary cesarean section and how our system should work.

1 comment:

  1. It is absolutely amazing to me how this type of information is not widely disseminated, so pregnant women cannot truly give "informed consent." With such invasive procedures presented as the norm, with only advantages and no risks, the lack of information combines with women's fear to work against them. It makes me crazy, but I find that trying to share this type of information with most pregnant women is futile. All too often, they do not have the information validated from their doctor or any other source so it ends up sounding like crazy talk from the fringe. Keep up the good work, Jennifer, by providing empircally based facts that are cited to the original source, so pregnant women and their partners can truly make informed decisions.