Risks of a Cesarean Section July 5, 2007

This list is copied straight from Childbirth.org — a great site!  Check it out!

“Other risks for the mother include the following:

• Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
• Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth. However, blood transfusions are rarely needed during a cesarean.
• Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
• Respiratory complications. General anesthesia can sometimes lead to pneumonia.
• Longer hospital stay and recovery time. Three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth.
• Reactions to anesthesia. The mother’s health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
• Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.

In cesarean birth, the possible risks to the baby include the following:

• Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
• Breathing problems. Babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth).
• Low Apgar scores. Babies born by cesarean sometimes have low Apgar scores. The low score can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. Or perhaps the baby was not stimulated as he or she would have been by vaginal birth.
• Fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.”

News article: U.S. study to track Caesareans July 5, 2007

From the Akron Beacon Journal

Area hospitals to share data as doctors aim to improve care, re-establish protocols

By Tracy Wheeler, Beacon Journal medical writer

Nearly one in every three babies born in the United States in 2005 was delivered by Caesarean section.

The question is, should so many babies be delivered surgically instead of naturally?

The National Institutes of Health is hoping to find out, by tracking 200,000 births over the next two to three years at 12 hospitals nationwide, including Summa Health System and MetroHealth Medical Center in Cleveland.

“The main thing they’re looking for is how long should a woman stay in labor who gets stuck,” said Dr. James Fanning, Summa’s chair of obstetrics and gynecology. “If the cervix starts to open up and then stops, or if she starts pushing and gets stuck, when should we quit? When should we say enough is enough, let’s go with a C-section?”

It’s a difficult decision, he said. If doctors stop the woman’s labor too soon and opt for a C-section, she may be put through a surgery (and its associated risks of infection and bleeding) that she doesn’t need. And if doctors let the woman wait too long to decide on a C-section, she may be in unnecessary pain.

It doesn’t help, Fanning said, that today’s doctors are still trained to follow protocols established in the 1950s, long before fetal monitoring or medications to induce labor were in use.

“It’s not always easy to say when is enough enough and when is it too much,” he said.

According to the U.S. Centers for Disease Control and Prevention, the Caesarean rate for 2005 was 30.2 percent, up from 29.1 percent in 2004 and 27.6 percent in 2004. Since 1996, the number of C-sections in the United States has risen by 40 percent.

Ohio has a lower C-section rate than the nation, with 28.1 percent of deliveries coming by Caesarean in 2005 and 26.9 percent in 2004.

For the national study, known as the “Consortium on Safe Labor,” the NIH chose only hospitals with fully electronic medical record-keeping of deliveries to simplify data collection. Participating hospitals were awarded $80,000 grants.

The NIH will analyze the data to “identify a time point when the benefit to perform a Caesarean delivery may begin to outweigh the benefit to continue the labor,” the grant application says. In other words, Fanning said, the study may be able to say “this is probably the cut-off, right around this number of hours,” when a C-section is needed.

The study, though, will go beyond the timing of Caesarean deliveries, said Dr. Jennifer Bailit, an obstetrician/gynecologist at MetroHealth.

It will also look at outcomes, comparing newborns’ condition scores and maternal infection rates of those using Caesarean and those delivering vaginally. The study may also address appropriate doses of medications during delivery and how labor differs among women of different ages or cultural backgrounds.

“The point is to see if there are things we can do better,” Bailit said.

The International Cesarean Awareness Network points out that it is not always the doctors’ or the mothers’ choice of whether to have C-sections. More than 300 hospitals have banned vaginal birth for women who have had a prior cesarean, based on cost concerns and fears over liability. Since 1996, the number of women who have delivered vaginally after having a cesarean has decreased 67 percent.

Kudos! July 5, 2007

OK – just so that people don’t think I’m always mad at different employees or managers around the city, I have a good story to tell.

We’re going on vacation tomorrow, and my husband asked me to get the oil changed in the van this week. I really hate that job because I’m easily up-sold, and a simply oil change can get pricey…

Well, I went to the Valvoline right up the road, and was waiting…. and waiting…. They had 2 cars in there and there was a big sign about it taking under 10 minutes. And I waited. I don’t mind waiting, but they usually come and greet you and tell you which door to park near…. Nothing.. I waited.

So – I left. And found another Valvoline and was greeted by the Will, who as a found out later just returned from a fascinating trip to India. He never tried to up-sell me, and even recommended that I wait on a service that I thought I wanted. He saved me money, was polite, did a good job, and didn’t tease me too much when I “failed” the right-&-left-turn-signal-test test (apparently, I don’t know my right from my left today).

So today, the Valvoline near Stoneybrook gets a round of applause. Just when I thought all stores and restaurants were out to get me, Will and the gang proved me wrong! And that makes me happy!