Cesarean Rates

Assumption: It would be beneficial to lower cesarean rates in the US.

TRUE
This study, published in the Obstetrics & Gynecology journal this month enumerates the reasons cesarean delivery can have negative consequences in mothers: “increasing incidence of placenta accreta associated with multiple uterine scars requiring the need for emergency cesarean hysterectomy, blood transfusion, and maternal mortality due to obstetric hemorrhage” and babies: “elective repeat cesarean deliveries performed before 39 completed weeks of gestation have demonstrated increased respiratory and other adverse neonatal outcomes.”  Most importantly, with the rising cesarean rate, there has *not* been improvement in neonatal morbidity or maternal health.  Cesarean delivery does have its place, but physicians are encouraged to avoid surgery unless there are true medical indications.

http://journals.lww.com/greenjournal/Abstract/2011/09000/The_Rising_Cesarean_Delivery_Rate_in_America__What.28.aspx

My Views:
Much is made these days of decreasing the cesarean rate, but many women seem to prefer surgery to a vaginal delivery.  Many women feel that a vaginal delivery presents more of a risk than a cesarean and that cesarean deliveries are the safer route.  This study shows that this is not necessarily the case.  I am glad that we have the option of delivering our babies surgically and that the surgery is usually safe.  But I am afraid that we have overused surgery and have begun using it at times when the risk does not outweigh the benefits.  As with any surgical procedure, there are risks to a cesarean birth and I believe they should only be used when truly medically necessary.

Cord Prolapse

Assumption: Walking can cause umbilical cord prolapse (cord coming out before the baby) if waters have broken.

UNPROVEN
Risk factors for cord prolapse include low birth-weight, prematurity (presumably because of small size), breech or transverse presentation (upside down or sideways baby), polyhydramnios (an excessive amount of amniotic fluid) and premature rupture of membranes (water breaking before baby is engaged)

http://www.ncbi.nlm.nih.gov/pubmed/16538441

My Views:
When a client told me she was required to remain in bed (no walking) during during almost all of her labor because her water had broken and they did not want the cord to “fall out,” I was intrigued.  (I often use my clients’ experiences to enhance my own learning about birth!)  I knew that the gush of the breaking water could bring the cord down if the baby was not engaged, but I wondered if, in fact, walking (gravity) would bring the cord down on its own.  I’ve been researching this topic for several days and I have found no evidence that this happens.  However, I also found no evidence that it does not.  What I *did* find is that typing “cord prolapse” into Google results in a great number of websites for … LAWYERS.  These lawyers are apparently anxious to sue any doctor whose patient’s baby experiences complications (often cerebral palsey or death) of cord prolapse.  I guess we can all draw our own conclusions from there.