letter to the editor- beating the odds

article on c-sections and my letter to the editor

BEATING THE ODDS Local C-section stats better than most

While Web sites like www.childbirth.org and www.childbirthconnection.org document national increases in women who give birth by cesarean section, women in Natchez are below the national average. Natchez Community Hospital Birthing Center Director Marie O'Neal said of 600 women that gave birth in Natchez in 2008, 33 percent of women gave birth by c-section. Of those who gave birth by c-section, 15 percent gave birth to their first birth by c-section. In comparison, 23 percent of women in Mississippi and 17 percent of women across the country had their first child by c-section. O'Neal said the primary birth is important when examining statistics because almost, without exception, a woman that has her first birth by c-section will have all of her subsequent births the same way. "It's almost unheard of (to deliver vaginally after a c-section)." me:(WHAT?!) continued: Natchez Regional Medical Center Nurse Practice Leader in the Women's Center Theresa Cole said once a woman delivers by c-section the internal uteran incision left behind is likely to rupture in subsequent vaginal births. "It can be very dangerous and it's generally avoided," Cole said. Cole said unborn children that are not positioned to leave the womb head first, or mothers with sexually transmitted diseases, are prime candidates for primary c-sections. And potential danger prompted Miranda Nealy to have her second child by c-section. Nealy, due to issues with high blood pressure, had to have a c-section for the birth of her first child. And since she was aware of the dangers associated with vaginal birth after a c-section, she had her second child by c-section also. "It's not a risk I wanted to take," she said. And while Nealy said recovery is slow and sometimes painful, she's glad she had her second child, Madison, born May 18, by c-section. "She's doing great," she said. "I'm doing fair." And at Regional, like Community, of 600 children born in 2008, the percentage was lower than the national average. Of Regional's 600 birth's, 16% percent were done by c-section.


my response:
Dear Editor,
I believe the article titled "Beating the Odds" in the special health section of Sunday's paper was very misleading. Expectant moms and women who plan to give birth in the future all across the Miss-Lou, probably once again let out a sigh of disappointment, as this article depicted vaginal birth after cesarean as an impossibility.
Marie O'Neal's comment, "It is almost unheard of (to deliver vaginally after cesarean)", and Theresa Cole's comments, "It can be very dangerous and is generally avoided", along with her statement that "once a woman delivers by c-section the internal uterine incision is likely to rupture in subsequent births" were just not factual statements.
There is at least one obstetrician in Natchez who continues to do VBACS under the right circumstances. He is working in line with what the American College of Obstetrics and Gynocology recommends for VBACS. (Their latest position being that women can be offered a VBAC, if there is an anesthesiologist on call at all times to assist if the need arises for a c-section) The ACOG's 2004 Practice Bulletin (no 54) lists uterine rupture risk as less than 1%, and much lower when induction agents were not used. In the cases of uterine rupture fetal and maternal mortality are not certain either. Again, while uterine rupture has been proven to be scarce, other studies verify that death from uterine rupture is also not common. Many women, unfortunately are coerced into repeat cesareans because they are not given an accurate depiction of the risks involved with repeat cesareans.
It is disappointing that information on the risks involved in a VBAC are not given equally with the risks involved in repeat cesareans, and woman are not given the opportunity to weigh out what is best for them. For instance, The Nisenblat study on multiple cesareans found a hysterectomy rate of 1.1% and overall "major complication" rate of 4.3% for second cesareans and 8.7% for third or more cesareans.
Unfortunately, even with proof of safety, in 2006, 90.3% of women with a previous cesarean delivered by repeat section. This has to be only because women are not given the choice to decide for themselves based on truthful information regarding the risks and benefits of both procedures.
There are many more stats that also point to the high risks involved with c-sections and repeat c-sections, of which I do not have space to include. A couple that stand out to me are as follows: The risk of death to a newborn delivered by C-section to a low-risk woman is 1.77 deaths to 1,000 live births. The risk of death to a newborn delivered vaginally to a low-risk woman is only 0.62 per 1,000 live births. (Marian MacDorman, PhD, et al., "Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk," United States, 1998-2001 Birth Cohorts," Birth: Issues in Perinatal Care 33, no. 3 -September 2006) Between one and two babies per 100, will be accidentally cut during a c-section, according to The Coalition for Improving Maternity Services, (CIMS)
The title of the article, "Beating the Odds" is sad. Now, pushing one third of all births in the US are cesarean sections. It's a shame to pat ourselves on the back for being on target locally with that terribly high rate. Not when the US is tied for second-to-last place with Hungary, Malta, Poland, and Slovakia for neonatal mortality in the industrialized world.(Save the Children, 2006)
I am not an angry person who is seeking debate on this matter. I am merely another woman in the miss-lou who is hoping our local maternity care is finally leaving behind the technological birth machine with it's one size fits all mentality. Are we moving into options for birthing women, some who desire to bid farewell to the high risk interventions they feel forced in to, or are we still running our hospitals and offices based on fear of litigation, greed, and sheer convenience, much at the expense of our area moms and babies?

Thanks,
Calley Reed