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Q&A: What are the risks of cesareans?

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Q: “I know the risk of uterine rupture is 1-2% during a VBAC, but do you have any statistics for the risks of a repeat cesarean?”

A: The risk of uterine rupture after one prior low transverse cesarean is 0.4% – 1% depending on whether the VBAC labor is spontaneous, augmented or induced (Landon, 2004). Spontaneous means labor begins naturally. Induced means the woman is not in labor and is given a drug to try to start labor. Augmentation means labor has already begun and drugs are used to make the labor progress more quickly.

Cesareans carry increased risks of […]

Q&A: Single vs. dual layer suturing

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Q: Is there any evidence to support double layer suturing over single layer?

A: Conclusive evidence on single vs dual suture does not exist. Also note that ACOG does not say one form of closure is better than another in their VBAC guidelines.

Bujold (2012) stated, “Although there is a growing body of evidence that the technique for uterine closure can be crucial for uterine scar healing, strong evidence regarding optimal techniques is scarce and there currently exist no national or international guidelines on which obstetricians-gynecologists and surgeons can rely.”

Bujold provides a good review of the literature, so you […]

Why cesareans are a big deal to you, your wife, and your daughter

Surgeon Operating on a Patient

I hear a lot, “What’s the big deal about cesareans? What difference does it really make if you have a cesarean?” Of course, if a cesarean is medically necessary, then the benefits outweigh the risks. But in the absence of a medical reason, the risks of cesareans must be carefully considered. […]

Woman has 4th cesarean, 8 hour surgery, and requires 33 gallons of blood

What a miracle this woman survived!  This was her fifth baby and fourth cesarean.

She had a complication known as placenta percreta which is when “the placenta attaches itself and grows through the uterus, sometimes extending to nearby organs, such as the bladder” (March of Dimes 2012).  The risk of having placenta accreta, increta, or percreta during a fourth cesarean or a VBA3C (vaginal birth after three cesareans) is 2.13% (1 in 47) (Silver 2006).

Most women planning a VBA1C (vaginal birth after one cesarean) are aware of the risks of uterine rupture.  However, women planning their first vaginal birth […]

Chipping away at the “too posh to push” myth

Some new research questions the idea that women who are “too posh to push” are responsible for America’s rising cesarean rate. The work of University of Arizona sociologist Louise Roth has been featured in an University of Arizona UA News article dated April 13, 2012.

Watch for Roth’s research which will be “published in the May issue of the sociology journal Social Problems, published by the Society for the Study of Social Problems.”

I’ve highlighted a few passages for those who like to skim.

By Jeff Harrison, University Communications, April 13, 2012

UA sociologist Louise Roth says the increasing […]

Placenta problems in VBAMC/ after multiple repeat cesareans

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I thought that I would take the data from the Silver (2006) that I’ve previously discussed and share it in a different way that would be helpful to women with multiple prior cesareans.  (You might find it worthwhile to read this article specifically, where you can view the data below in graphs, as well as other articles on placental abnormalities first.)  Remember that accreta is when the placenta abnormality deeply attaches into the uterus requiring surgical removal.  There is a 7% maternal mortality rate with accreta as well as a high rate of hemorrhage and hysterectomy.   One of the […]

Just kicking the can of risk down the road

If primary and secondary cesarean rates continue to rise as they have in recent years, by 2020 the cesarean delivery rate will be 56.2%, and there will be an additional 6236 placenta previas, 4504 placenta accretas, and 130 maternal deaths annually. The rise in these complications will lag behind the rise in cesareans by approximately 6 years. […]

Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science

PushNews from The Big Push for Midwives Campaign CONTACT: Katherine Prown, (414) 550-8025, katie@pushformidwives.org FOR IMMEDIATE RELEASE: August 15, 2011 Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science Majority of ACOG Recommendations for Patient Care Found to Be Based on Opinion and Inconsistent Evidence WASHINGTON, D.C. (August 15, 2011)—A study published this month in Obstetrics & Gynecology, the journal of the American College of Obstetricians and Gynecologists, found that barely one-third of the organization’s clinical guidelines for OB/GYN practice meet the Level A standard of “good and consistent scientific evidence.” The authors of the study found […]

Risk of serious complications increase with each cesarean surgery

Shows the rates of placenta accreta in up to six cesareans (Silver 2006).

Per Silver (2006), “The risks of placenta accreta, cystotomy [surgical incision of the urinary bladder], bowel injury, ureteral [ureters are muscular ducts that propel urine from the kidneys to the urinary bladder] injury, and ileus [disruption of the normal propulsive gastrointestinal motor activity], the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries.” […]

Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries

This article published June 19, 2009 demonstrates one hospital’s experience when they changed their oxytocin (Pitocin) protocol.

I’ve included the entire article below and have emphasized what I consider to be the most interesting parts.

Hospital’s Oxytocin Protocol Change Sharply Reduces Emergency C-Section Deliveries By Betsy Bates Elsevier Global Medical News Conferences in Depth

CHICAGO (EGMN) – The modification of the oxytocin infusion protocol at a large university-affiliated community hospital nearly halved the number of emergency cesarean deliveries over a 3-year period, reported Dr. Gary Ventolini.

As oxytocin utilization declined from 93.3% to 78.9%, emergency cesarean deliveries decreased from 10.9% […]

VBAC & Cesarean Rates of California Hospitals, 2007

This information is so important for any woman seeking VBAC.  It’s not enough that your hospital “allows” VBAC.  In order to see how supportive that hospital is of vaginal birth, you need to know what their VBAC rate is in addition to their primary CS rate.  Be sure to read, “Why if your hospital ‘allows’ VBAC isn’t enough” for more information as well as I’m pregnant and want a VBAC, what do I do?.

From 2006 to 2007, the total cesarean rate increased from 27.9% to 28.8% and the primary cesarean rate grew from 16.6% to 17.1 whereas the […]

VBAC vs. Repeat Cesarean by the American Academy of Family Physicians

This is a great piece for deciding between VBAC and repeat cesarean.  Those who wish to VBAC, but have husbands, family, and/or friends who don’t understand why, might find this document very useful.  I have found that people who are anti-VBAC really seem impressed by what doctors and medical organizations have to say, so I’m thinking they will find this document compelling.  Plus, VBAC has this reputation of being “risky” and repeat cesareans are thought of as the “conservative approach,” and this document challenges both lines of thinking.  Why not write a sweet little note like, “I know you are […]

The cost of getting your medical records

When considering your post-cesarean birth options, it’s good to know what type of uterine incision you have.  The only way to verify this is by getting a copy of your operative report from the hospital where you had your cesarean.  I recommend bringing copies of your operative report when interviewing care providers as most will want to confirm your uterine incision type.

Sometimes women have a different incision on their skin than their uterus, so just because you have a low transverse (“bikini cut”) incision on your skin, doesn’t necessarily mean you have the same incision […]

Cesarean Risks: Adhesions

This is a comprehensive article on adhesions which is a fancy word for scar tissue.  I think the most relevant points of this whole discussion are:

Adhesions “develop in 93% of people who have undergone pelvic surgery” and “they are especially common after cesarean sections.” You get more adhesions with each cesarean. Adhesions can cause: Pelvic or Abdominal Pain Bowel Obstruction Infertility Adhesions impact future cesareans by making the surgery longer which can put your baby at risk in an emergency situation (emphasis mine): “If you have had a cesarean section and are pregnant or planning to have another child, […]