Awareness about Cesarean Awareness Month!
As the month of April draws to a close, it’s time to reflect on the causes and commemorations which made headlines through the month like Earth Day and World Health Day. It is also a time to reflect on some other causes which sadly did not grab the spotlight but are nonetheless equally significant.
One such cause is Cesarean Awareness. April marks the Cesarean Awareness month called upon by the International Cesarean Awareness Network (ICAN) every year. With one in every three births around the world taking place by Cesarean Delivery, the subject touches the lives of millions of women worldwide. It is thus not wise to engage in moral tirades about C-sections anymore, it is also not prudent to shy away from the subject.
The awareness month is a time for women to acknowledge the inevitability of the Cesarean birthing process in certain cases and to question its probability in some others. It is a time for mothers to separate the myths from the facts and make informed choices about this very important aspect of their life. It may be only incidental that the cesarean awareness month follows the month of March in which we celebrate woman hood. However if we concede that motherhood is an integral part of a woman’s life then, a woman’s access to correct information on childbirth is her unequivocal right.
One such cause is Cesarean Awareness. April marks the Cesarean Awareness month called upon by the International Cesarean Awareness Network (ICAN) every year. With one in every three births around the world taking place by Cesarean Delivery, the subject touches the lives of millions of women worldwide. It is thus not wise to engage in moral tirades about C-sections anymore, it is also not prudent to shy away from the subject.
The awareness month is a time for women to acknowledge the inevitability of the Cesarean birthing process in certain cases and to question its probability in some others. It is a time for mothers to separate the myths from the facts and make informed choices about this very important aspect of their life. It may be only incidental that the cesarean awareness month follows the month of March in which we celebrate woman hood. However if we concede that motherhood is an integral part of a woman’s life then, a woman’s access to correct information on childbirth is her unequivocal right.
In my article on Cesarean vs Vaginal Births published on a health & wellness blog, I had focused on this age-old moral debate and how a new breakthrough test promises an end to dysfunctional labor. I am continuing this discussion here with some statistics on Cesarean births and why the rate of C-section deliveries is rising globally. I have also tried to piece together some conventional and non -conventional methods used to avert C-section births, also highlighting one very important medical advancement- Vaginal Birth after Cesarean (VBAC) which has substantially reduced the incidence of C-sections in second-time mothers.
Fact sheet on Cesarean Deliveries
• The World Health Organization recommends that only 15% of total births should take place by cesarean section.
• A survey by World Health Organization (WHO) puts the actual figure of births by C-section in year 2008 at 28%. Current unconfirmed reports point to a global average of over 30%.
• China has the highest reported C-section rate in the world pegged at 46%, in United States the rate is 31% followed closely by other countries across the globe.
• Elective C-sections or cesarean by choice constitute only a minuscule percentage of total C-sections worldwide despite the outcry against “too posh to push" celebrity mothers. Organisations such as electivecesarean.com are actively campaigning to remove the taboo from elected Cesareans calling it a legitimate right of women to choose.
• Planned or premeditated Cesarean deliveries have seen a phenomenal rise in the past few decades. This can be attributed to the changing profile of the expectant mother and the cautious approach of the medical profession.
• Emergency C-section deliveries (those which are neither elected nor planned and are often last resort after a failed attempted normal delivery, constitute 50% of all cesareans, an unenviable statistic considering medical advancements in every field.
What is causing the number of C-section deliveries to rise?
• A survey by World Health Organization (WHO) puts the actual figure of births by C-section in year 2008 at 28%. Current unconfirmed reports point to a global average of over 30%.
• China has the highest reported C-section rate in the world pegged at 46%, in United States the rate is 31% followed closely by other countries across the globe.
• Elective C-sections or cesarean by choice constitute only a minuscule percentage of total C-sections worldwide despite the outcry against “too posh to push" celebrity mothers. Organisations such as electivecesarean.com are actively campaigning to remove the taboo from elected Cesareans calling it a legitimate right of women to choose.
• Planned or premeditated Cesarean deliveries have seen a phenomenal rise in the past few decades. This can be attributed to the changing profile of the expectant mother and the cautious approach of the medical profession.
• Emergency C-section deliveries (those which are neither elected nor planned and are often last resort after a failed attempted normal delivery, constitute 50% of all cesareans, an unenviable statistic considering medical advancements in every field.
What is causing the number of C-section deliveries to rise?
A. Higher average age of the expectant mother
Women are more career oriented now than they were in previous generations. These ambitious women are prioritizing career over marriage and children. The trend is world wide, however urban populations in developed countries are witnessing the largest shift with women marrying in their 30s and having their first child after 35. Medical advancement such as the In-vitro Fertilization (IVF) treatment has made it possible for women to bear children even in their 40s and 50s.
Women are more career oriented now than they were in previous generations. These ambitious women are prioritizing career over marriage and children. The trend is world wide, however urban populations in developed countries are witnessing the largest shift with women marrying in their 30s and having their first child after 35. Medical advancement such as the In-vitro Fertilization (IVF) treatment has made it possible for women to bear children even in their 40s and 50s.
The consequence has been that the average age of the expectant mother has risen to 29 compared to 25 a few decades back. Though this has opened the door to many possibilities for women it has also meant that most of these older women would be recommended a C-section. The understanding is that higher the biological age of an expectant mother, the lesser she is likely to score on levels of fitness. She is also more likely to get tired during labor and suffer from diseases which affect prenatal health.
B. Health of the expectant mother
Both biologically and medically, women who opt for children after the age of 35 needs increased prenatal health screening and monitoring. Lifestyle factors such as smoking, incorrect diet and high stress levels have markedly increased in women in recent times. These factors lead to higher incidence of gestational diabetes, obesity, pre-eclampsia (high blood pressure with protein in the urine) and other conditions which make vaginal birth risky and necessitate a planned C-section.
C. Mother’s expectations about delivery
As women become more aware about their rights, they demand greater accountability from doctors and caregivers. Women are also more vocal about factors such as pain, scarring, timeliness, place of birth and post natal care. These factors sometimes lead to doctors planning out a C-section to meet the mother’s heightened expectations for a perfect delivery.
D. Doctor’s reluctance and concern about lawsuits
The medical profession has of late been the target of lawsuits ranging from negligence, misdiagnosis and even malpractice. The situation is worst in developed countries such as United States, England and Australia. As a consequence, doctors are wary of taking risky decisions. In childbirth, this translates into a planned C-section to avoid risks associated with a normal delivery.
E. Economic factors -Costs and Afford ability
In countries where health care is not sponsored by the State, the cost difference between a C-section and a normal birth is substantial. The lure of earning more by recommending a Cesarean delivery instead of a normal delivery adds to the count of C-sections which were unnecessary and avoidable.
Further, an easy access to surgical facilities and health care centers gives patients the option of C-section delivery, hitherto impossible. Higher spending power of individuals and lesser number of children per family also make people choose the costlier option of C-section over a low-cost normal delivery.
What Can Mothers Do To Increase Chances of a Normal Delivery?
B. Health of the expectant mother
Both biologically and medically, women who opt for children after the age of 35 needs increased prenatal health screening and monitoring. Lifestyle factors such as smoking, incorrect diet and high stress levels have markedly increased in women in recent times. These factors lead to higher incidence of gestational diabetes, obesity, pre-eclampsia (high blood pressure with protein in the urine) and other conditions which make vaginal birth risky and necessitate a planned C-section.
C. Mother’s expectations about delivery
As women become more aware about their rights, they demand greater accountability from doctors and caregivers. Women are also more vocal about factors such as pain, scarring, timeliness, place of birth and post natal care. These factors sometimes lead to doctors planning out a C-section to meet the mother’s heightened expectations for a perfect delivery.
D. Doctor’s reluctance and concern about lawsuits
The medical profession has of late been the target of lawsuits ranging from negligence, misdiagnosis and even malpractice. The situation is worst in developed countries such as United States, England and Australia. As a consequence, doctors are wary of taking risky decisions. In childbirth, this translates into a planned C-section to avoid risks associated with a normal delivery.
E. Economic factors -Costs and Afford ability
In countries where health care is not sponsored by the State, the cost difference between a C-section and a normal birth is substantial. The lure of earning more by recommending a Cesarean delivery instead of a normal delivery adds to the count of C-sections which were unnecessary and avoidable.
Further, an easy access to surgical facilities and health care centers gives patients the option of C-section delivery, hitherto impossible. Higher spending power of individuals and lesser number of children per family also make people choose the costlier option of C-section over a low-cost normal delivery.
What Can Mothers Do To Increase Chances of a Normal Delivery?
In certain cases Cesarean birth may be unavoidable but for women who are keen on a normal delivery, here are some time tested methods, both medical and non-medical which have been proven to increase the chances of a healthy normal delivery;
• Hiring a Doula- A doula or a labor coach is a trained professional who provides non-medical support to a laboring mother. A doula helps the mother push, breathe and relax as the situation demands it. Doulas are efficient in massages and breathing techniques. Doulas have been known to also turn breech babies around to enable vaginal delivery.
• Massage –Massage by a partner or caregiver can relax the mother, increase circulation and strengthen muscles that can help an expectant mother withstand a prolonged labor.
• Meditation- Regular meditation and breathing exercises can calm the nerves, help the mother through contractions and manage labor pain.
• Ante natal exercises- Antenatal exercises and yoga during pregnancy and the first stage of labor can help prepare the body for the vigor of a normal birth. Some of the exercises and yogic postures are specifically targeted to strengthen abdominal muscles and help with childbirth.
• Water-birth- Water births make use of water’s gravity. The mother gives birth while immersed in a pool or tub of warm water. This methodology is gaining popularity as research indicates that water births are safer and less painful.
• Hiring a Doula- A doula or a labor coach is a trained professional who provides non-medical support to a laboring mother. A doula helps the mother push, breathe and relax as the situation demands it. Doulas are efficient in massages and breathing techniques. Doulas have been known to also turn breech babies around to enable vaginal delivery.
• Massage –Massage by a partner or caregiver can relax the mother, increase circulation and strengthen muscles that can help an expectant mother withstand a prolonged labor.
• Meditation- Regular meditation and breathing exercises can calm the nerves, help the mother through contractions and manage labor pain.
• Ante natal exercises- Antenatal exercises and yoga during pregnancy and the first stage of labor can help prepare the body for the vigor of a normal birth. Some of the exercises and yogic postures are specifically targeted to strengthen abdominal muscles and help with childbirth.
• Water-birth- Water births make use of water’s gravity. The mother gives birth while immersed in a pool or tub of warm water. This methodology is gaining popularity as research indicates that water births are safer and less painful.
HypnoBirthing- Another unconventional method which is getting popular involves the process of birthing through self-hypnosis technique by the mother. HypnoBirth classes by skilled practitioners teach the mother the technique to allow a natural, relaxed childbirth experience.
• Research – The doctor or the health center you choose for your delivery is important too. It is necessary to research what percentage of total deliveries in the health center were C-section deliveries. This can fairly assess your own chances of having one.
• Avoiding Interventions- Saying no to induction of labor and unnecessary interventions during labor can reduce the chances of an emergency C-section.
Vaginal Birth after Cesarean (VBAC)
In recent times, the spotlight has been on vaginal deliveries which are now possible for mothers who have children previously delivered by C-section. VBAC was almost impossible till a few years back with planned C-sections the only option offered to second time mothers with a history of C-section(s).
The factor which has made this possible is the change in style of incision made in the mother’s abdomen. Historically, a vertical incision was made in the woman’s abdomen to deliver the baby that posed a risk of rupturing during labor in a subsequent vaginal delivery. In recent years however, the incision is horizontal and the position is lower in the abdomen which substantially reduces the risk of rupture making it possible to deliver vaginally again.
It is now recommended that a woman with a history of C-section deliveries be given the option of a vaginal delivery if she is otherwise healthy and has an uncomplicated pregnancy. VBAC has been instrumental in reducing the incidence of C-section births in second-time mothers.
Awareness is the key
Many women go through pregnancy filled with the notion of a perfect childbirth experience. This leads to poor adjustment and post natal depression in case there are last minute complications and digressions from the birth plan. A traumatic childbirth experience can make one wary of future pregnancies and in general of hospitals.
Awareness leads to knowledge, realistic expectations, mental preparedness and a positive childbirth experience.If you are an expectant mother, read books like Dr Benjamin Spock's "What to Expect When You Are Expecting", . Surf the Internet and download useful information on pregnancy and childbirth. Register for antenatal classes, join support groups and forums like baby center. Find out about hiring doulas if you think you need that extra support. Finally, trust your instincts as a human and as a mother because you are the closest to your child and your instincts can guide you to a safe and positive childbirth experience.
Awareness leads to knowledge, realistic expectations, mental preparedness and a positive childbirth experience.If you are an expectant mother, read books like Dr Benjamin Spock's "What to Expect When You Are Expecting", . Surf the Internet and download useful information on pregnancy and childbirth. Register for antenatal classes, join support groups and forums like baby center. Find out about hiring doulas if you think you need that extra support. Finally, trust your instincts as a human and as a mother because you are the closest to your child and your instincts can guide you to a safe and positive childbirth experience.
To know more visit;
http://www.childbirth.org/section/ICAN.html
http://www.electivecesarean.com/index.php?option=com_frontpage&Itemid=476
Please view this blog entry only as an attempt to encapsulate some aspects of cesarean deliveries in the awareness month and not as medical advice. The post is guided by my personal traumatic birthing experience which resulted in an emergency C-section. Please refer to medical advice and medical sites for more information.
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