April is Cesarean Awareness Month. And increased awareness is definitely what we need, not only for this month but the whole year round. Because the recent US baby boom seemed to have been accompanied by a C-section boom.

According to the 2007 statistics recently released by the Centers for Disease Control and Prevention (CDC), C-section delivers rates jumped to record high (31.8%), up by 2% from 2006. The good news is that despite this rise in C-section rates, the number of babies with low birth weight rates was slightly down (from 8.3 to 8.2%) in 2007. The preterm birth rate, defined as delivery before the 37^th week of pregnancy, was down as well. However, this decline is mostly late preterm delivery, e.g. between the 34^th and 36^th week of pregnancy. This is reduction of 0.1% is way below than the goal of 15% reduction set during the Prematurity Awareness Month in November last year.

Last year, the not-for-profit organization March of Dimes actively campaigned for prematurity awareness and cited a study showing that C-section is a major factor in preterm delivery. The latest statistics suggests that women and their doctors probably tend to wait a bit longer, beyond the 37^th before performing a C-section. The decrease in preterm delivery, albeit small, is an encouraging step towards the right direction and hopefully will be sustainable.

However, the increase in C-section rates is causing concerns. According to the International Cesarean Awareness Network (ICAN), more than half of C-sections may actually not be necessary. Timed together with the Cesarean awareness campaign this month, ICAN has scheduled the ICAN 2009 International Birth Conference on April 24 to 26 to be held in Atlanta, Georgia.

I was amazed when I read this article outlining steps to make C-sections a little less clinical, and less impersonal especially for Moms. There’s never been anything like it before, and I for one agree that it is revolutionary. The idea was born in Queen Charlotte’s Hospital in London, the brainchild of Professor Nicholas Frisk. In the United Kingdom as well here in the United States, the rate of C-sections have risen due to many factors. A lot of C-sections are planned, a lot are avoidable, and many are emergencies. Regardless the reason or circumstances, Professor Frisk argues that C-sections could do with a lot of change:

“It struck me that all the effort was going into changing normal childbirth but that Cesarean section was still steeped in old surgical rituals,” says Fisk. “In some cases I was horrified; the baby would be dragged out like a tumor and passed to several medical staff before the mother. It was ripe for reform.”

The steps involve increasing parental involvement, revisiting physiological factors, and immediate skin-to-skin contact for the baby and Mom.

I know that in my case, and as per usual standard operating procedure, a drape blocks a Mom’s vision from the surgery that is happening on her abdomen. This is supposed to protect us from all the gore of the operation. Queen Charlotte’s Hospital does away with this drape at the point when baby’s head is emerging. They reason that the Mom’s focus would be too much on the baby and its safe arrival to be much bothered by anything else.

The article describes a “half-delivered” method (which I can’t quite picture still). The baby is allowed to wriggle out and expel the fluids from its lungs by themselves, simulating a vaginal delivery. This emphasizes a slow delivery, and baby starts breathing on its own before cutting off the placenta. Baby is immediately handed to Mom. This is made possible by monitor equipment being plugged to the back instead of the front. I remember when my daughter was born, Dad, who wore a surgical scrub over his outfit, was the first to hold her. She was held up to me, but I didn’t get to hold her until a good twenty minutes later. I would have appreciated holding her much sooner. In fact, all the other changes sound sensible.

This procedure is not applicable for preemie babies with immature lungs, those in the breech position, or in other dangerous situations.

The only concerns that come to mind would be the removal of the drape. I don’t know if I’d be too keen on wanting to see my abdomen cut open, and I hope they emphasize the Mom’s ability to choose. Overall, I hope that more moms and doctors become aware of this method and that it comes to the stateside soon, if it hasn’t already. Studies on long-term effects to gauge any measurable differences between the old-fashioned C-section and this new method are still on its initial stages. Having had a C-section baby though, I know its very possible for me to have another one for the second, though I wish for a Vaginal Birth After C-section (VBAC). It makes me feel a little better that there’s an alternative with some improvements.

I read that Rachida Dati, France’s Justice Minister, returned to work a mere 5 days after her daughter was born via c-section.  Incredibly, she showed up for work in high heels and a beautiful business suit.  In photos I’ve seen, she looks absolutely beautiful.

Her return to work has set of a fire storm of controversy, as can be expected.  In France, according to reports, women receive 16 weeks of paid maternity leave.  Here in the United States, women can take up to 12 weeks of unpaid leave if they work for a company that is large enough.

I returned to work 2 days after birthing my 4th child, mostly because I had no choice.  I had a difficult pregnancy and had to take time off during the pregnancy because of health issues.  I simply couldn’t afford to take any more time off.  I do remember driving to work and thinking, “this probably isn’t the best idea”.  I felt horrible, but you do what you have to do.  In other pregnancies, I’d taken time off and found that my duties and accounts had been transferred to other workers during my absence.  However, I was not given those accounts back upon my return.   I remember thinking that I was being penalized for having a child, and in retrospect, that’s exactly what happened.

Of course, we don’t know “the rest of the story” behind Ms. Dati’s early return to work.  Was her return simply because she felt well enough to return to work, or did she have no choice but to return to work?

Whatever the reason, I wish Ms. Dati and her daughter the very best.

Another health problem attributed to vitamin D deficiency has been identified. And it has something to do with baby delivery. About a hundred years ago, the condition of rachitic pelvis or rickets of the pelvis lead to fatal complications during children. This bone disorder is almost non-existent today because of the discovery of its cause  vitamin D deficiency.

Recent studies, however, indicate that vitamin D deficiency is becoming widespread in industrialized countries, leading health experts to recommend increased vitamin D supplementation.

Boston University researchers report that pregnant women who are vitamin D deficient have 4 times increased risk of having a C-section delivery compared to those who are not vitamin D-deficient. However, it’s not rickets anymore that is the problem but weakness and poor performance of certain muscles. This “suboptimal muscle performance and strength” seems to be linked to vitamin D deficiency.

Vitamin D deficiency has been linked to many health disorders, including heart disease, neurodegenerative disorders, and bone disorders. Vitamin D deficiency during pregnancy has been linked to softening of the baby’s skull and unhealthy baby teeth.

I have a friend who had this long-lasting grudge against her OB because the doctor ordered an emergency C-section while she was laboring, thus denying her the privilege of delivering her first born naturally. I have to hand it to her, she was determined to do it “right” the second time and thus delivered her second-born the normal way – with another OB understandably. Still, I couldn’t understand this continuing anger at her first OB – anger which manifests in her maligning the doctor to every body she knows. Though I didn’t know the full details of the story, I always thought there must have been some mitigating circumstances why the OB ordered the emergency procedure.

My sister labored for almost 24 hours before her doctor decided for a C-section. By then, the baby had fetal stress and had to be taken out fast. She had a difficult recovery afterwards, not from the C-section, but from the prolonged labor. On her second delivery, she went for the C-section right away. She’d rather spare herself the pain and the baby the stress, she said.

Then came my turn. I really wanted to go for the natural way, what with this talk (and research studies!) about bonding and feeling of fulfillment. However, my doctors (yes, there were several of them) advised me against it for 3 reasons: I was one of those 35+ mommies, I was pretty small (still am actually), and I was carrying twins.

Yet in the end it was all up to me whether to try it the natural way or immediately go for the cut-and-out procedure.

The considerations are as follows:

1. The ideal scenario: I’d go for the natural way and get the babies out successfully, we will have our bonding moment and I will be proud and feel truly fulfilled.
2. The not-so-ideal (and very likely scenario): I’d go for the natural way, and with luck manage to get one baby out after a couple of hours of labor. By then the other one would be truly stressed by weight of his brother and the pushes of his mom. With luck, he will survive the ordeal and make his way out as well.
3. The not-so-perfect recommended scenario: I’ll a have schedule C-section that will take out the babies in a couple of minutes, one after the other, to be taken straight to the neonatal station where incubators have been prepared for them. However, I won’t have that emotionally overwhelming bonding moment and (since it was my first and last pregnancy) will never experience natural childbirth, said to be the most beautiful and self-fulfilling life experience.

In the end I went for scenario # 3 and I think I made the right decision. F, who was the smaller of the 2 had breathing problems and had below-normal APGAR scores when he taken out. But the little fighter caught up with his bigger and more robust twin brother R in no time. The doctor said that from the way they were positioned in my uterus, it was likely that R would have made it out first naturally, while F had to wait till his brother got through. At any rate, it was doubtful whether he would have survived the waiting time.

There are many reasons why a C-section delivery is performed. It may for convenience, it may be to avoid pain, but most of the time, there are sound medical reasons behind choosing this option

A friend who had her 3^rd C-section a few months ago says she sometimes feels guilty, at the same time resentful when she hears and reads about natural birth experiences of other moms. In her playgroup, she feels unfulfilled, inadequate, and left out when other moms talk about labor experiences.

What about me? Did I regret the decision not the try? Do I long for that fulfilling bonding moment? No, I don’t. I feel proud of delivering my boys minus the pain and the pushing. I was convinced and still am convinced that though C-section may not have been the best experience for me, it was definitely the best for my boys’ well-being. If I were to do it all over again, my decision wouldn’t have changed.

A C-section doesn’t make me less of a mother. We are all moms regardless of the method of delivery.

This is a horrible story. But it?s also a wonderful story.

On Monday, August 18, 2008, a woman in Israel went into premature labor at 23 weeks of pregnancy. Finding no pulse in the fetus, and with the mother hemorrhaging, doctors performed a surgical abortion–a c-section–apparently to save the mother?s life. The baby girl weighed just 610 grams (that?s about 1 lb. 5 ? oz. by my calculation), had no vital signs, was pronounced dead, and was taken to the hospital morgue?s freezer. About five hours later, the baby?s mom asked to hold her one more time. Hospital officials allowed the visit.

The prospect of holding my deceased child is not one I can fathom. But what happened to this mom is wonderful, bizarre, horrible?all at the same time: she found the baby breathing.

The baby?s father is understandably angry, suggesting the hospital declared his daughter dead too early. The hospital?s deputy director, Dr. Moshe Daniel, defended his doctors, saying they were not hasty.

The baby, now in the hospital?s NICU, has been given a 10% chance of survival, based only on her weight and gestational age. The fact that she was frozen is actually being credited with saving her life, rather than risking it. Lowering her body temperature may have “kept the baby’s metabolism rate and use of oxygen low.”

Impressively, she is still breathing on her own (the lungs are often underdeveloped in preemies). Still, her chances of survival?if left to modern medicine?are slim. Then again, she?s already a miracle baby.

I happen to be one that believes all babies are miracles. But this is different. What a fighter.

I spent the last eight posts going through the story of the birth of our daughter for a reason. I wanted everyone who reads this blog to know exactly where we (my wife and I) were coming from with our anticipation (arguably trepidation) of our second.

Since that experience, my wife has seen her obstetrician several times, and discussed subsequent births. Although there was a possibility that she could have a successful vaginal birth after cesarean (VBAC), our concern was that it wasn’t necessarily the R.O.P. that was the cause of all our problems last time. We believe that there is a good chance that my wife’s pelvis may have been the issue that necessitated the c-section.

So, after much internal discussion (and admittedly some tears), we have decided? to have a scheduled c-section for baby number two. It wasn’t an easy decision, but we think it will be the best thing for us.

This decision means we will have a very different experience than last time. There will (likely) be no discussion of whether she’s feeling constipated or contractions. There will be no water breaking in the middle of the night. We will be able to prepare ourselves as well as our daughter for the baby’s arrival, and I think that will work out well for all of us in the end.

What are your feelings about VBAC, or just scheduled c-sections in general? How do you feel about the (supposed) recent rise in scheduled c-sections?

We are in an era of middle-aged moms even though teen pregnancies are always in the limelight. This is the reason why the rate of Cesarean sections has been steadily increasing. The longer women delay in having children, the higher is the risk of having a Cesarean delivery due to impaired womb function. These findings were based on a large body of data collected in Scotland by scientists at Cambridge University.

The research team examined more than 500,000 record entries from 1980 to 2005 to evaluate the relationship between maternal age and labor outcome. Here are some of their results:

• There was a 7-fold increase in the proportion of women aged 35-39 entering their first pregnancy
• There was a 10-fold increase for women aged 40 or older also having their first pregnancy.
• The rate of Cesarean sections has also more than doubled in the same period of time.

This trend seems to be the same in many developed countries as well.

The researchers went on further and looked into the women’s womb. Samples of myometrium which is the muscle from the middle of the uterine wall were taken from 62 women who had elective C-sections.

Their analysis showed that older women tend to have impaired uterine function which results in reduced ability of the uterus to spontaneously contract as well in changes in the type of contraction. This impairment in contraction leads to problems during delivery which eventually ends in a C-section.

C-deliveries can present a lot of risks for the mother and for the child and can lead to a lot of complications, including preterm delivery and low birth weights.

Denmark’s Aarhus University Hospital recently released information stating that babies who are born via elective C-sections before the 39^th week are delivered too early. Their research shows that these babies ?have a three- to fourfold higher risk of breathing trouble than do babies whose mothers have a normal vaginal delivery.? Startlingly, their research also shows that these babies have a five times higher chance of needing mechanical breathing assistance for more serious respiratory problems.

This research comes from studying over 34,000 babies between 1998 and 2006.

Anne Kirkeby Hansen, MD, and colleagues at Denmark’s Aarhus University Hospital, states “Mothers who choose elective cesarean section should be aware that the risk of respiratory problems is four times raised at 37 weeks’ gestation versus full-term, intended vaginal delivery. The rate of respiratory problems is 10% for elective C-section at 37 weeks, but it is 2.8% for intended vaginal deliveries. That is why we say you should never do elective cesarean section at 37 weeks.”

Reasons for the results include the fact that each week during the last trimester really counts a lot in terms of the baby?s development. In addition, doctors have found that the actual labor process may play a part in helping the baby prepare for the outside world. For example, during labor, the mother secrets stress hormones, triggering stress hormone release in the baby, which actually affect the baby?s lungs. In the baby, the hormones both speed the absorption of liquid and they increase secretion of surfactants.

For more information on this report, visit:

http://www.webmd.com/baby/news/20071211/elective-csection-38th-week-too-soon?src=rss_amerpregnancy

Your sleeping habits can definitely impact your pregnancy, and now, according to a new study by the University of California, it can impact your delivery as well. According to the new study, women who got less than six hours of sleep late in their pregnancy averaged a 29 hour labor. Women who slept for more than seven hours each night labored on average for only 17.5 hours. Another significant finding in the study was that women who slept for less than 4.5 hours on average each night had a 4.5 times greater chance of delivering via C-section.

Even if your sleep is interrupted by trips to the bathroom, leg cramps, and a kicking baby, maximizing your opportunity for rest will help you achieve a longer night?s sleep. Make a consistent effort to go to bed earlier than usual, and?if your boss, other children, or dog will let you?sleep in later than usual.

Other tips to help achieve a peaceful night?s sleep include the following, offered by the Mayo Clinic:

• Set a schedule and stick to it; varying your sleeping schedule disrupts your brain?s pattern of a sleep-wake cycle.
• Make your bedroom cool, dark and quiet.
• Choose a comfortable mattress or pillow (many pregnant women swear by body pillows).
• Create and stick to a bedtime routine, such as reading or bathing; a routine helps your body know that it?s time to sleep.

References:

http://www.mayoclinic.com/health/sleep/HQ01387

http://babyfit.sparkpeople.com/articles.asp?id=701