The High Cost of Caesarean Sections

Almost weekly now we are reading news stories in North American main stream media about our appalling maternal and infant mortality rates in Canada and the US, which I've written about many times:

*"Canada’s reputation for low infant mortality takes stunning decline"

*Canada gets a "C" for infant mortality

*Amnesty blows the whistle on Maternal Mortality rates in the US

*"Emotional Impact of Caesareans"

This week is continuing the tradition with yet another article on the High cost of Caesarean Sections- both in loss of life and financially.  You have to wonder if the Medical Machine is ever going to wake up and realize that THEY are the problem right now.  Study after Study has been done to show the increased risks that come with Caesarean Section births, especially elective C/Sections. More and more women and babies are suffering from needless trauma, and horrifyingly our maternal and infant mortality rates just keep climbing.  Various medical organizations have pointed fingers at North America's high preterm birth rates and an increase in multiple births due to fertility treatments as reasons for the decline, but they refuse to accept that the biggest reasons are the use of chemical inductions, epidurals and C/Section.

Do I sound like a broken record?   I really hate sounding like a one hit wonder.  But I'll keep roaring from my soap box and hopefully someone will listen. Even if it's just a pregnant first time mom who needs to hear the truth.

(as usual the highlighted areas are my own)

The high cost of caesareans

By Timothy R. B. Johnson and Judy Norsigian June 28, 2010

FOR A symbol of what ails the US health system, look no further than hospital delivery rooms, where costly caesareans, many for non-medical reasons, are inching closer to a majority of all births.

 

Even though caesareans are associated with higher rates of complications than vaginal births, they are becomingly increasingly common. Problems range from infections, including the more serious antibiotic-resistant ones, to blood clots, prematurity, respiratory problems for the baby, and more complications with subsequent pregnancies. There is even a small but measurably higher risk of death for the mother.

Between 2000 and 2006, while the Massachusetts caesarean rate climbed from 16th to 10th highest among all states, the state’s ranking on neonatal mortality has slipped from 4th best to a tie for 9th. Six hospitals in the state have caesarean rates greater than 40 percent for first time mothers, yet none of these hospitals is designated as a high-risk center. So much for the argument that high-risk pregnancies are the reason for these rates.

There are also cost consequences for taxpayers — the caesarean rate for Massachusetts mothers on Medicaid is increasing at a faster pace than among privately insured mothers. Nationally, in 2008, average hospital charges for an uncomplicated caesarean section were $14,894, while such charges for an uncomplicated vaginal birth were $8,919.

What can we do to lower the caesarean rate? Considerable media attention has focused on how extreme obesity can raise the risk of having a caesarean, but more emphasis is needed on these system-based approaches:

■More hospitals need to institute policies that restrict the induction of labor, unless there is a good medical reason. Unfortunately, labor is now sometimes induced solely for the convenience of the physician or the mother, and labor induction increases the likelihood of a caesarean section in many women. Almost all the recent increase in late preterm (34 to 36 weeks) births was related to planned caesareans carried out too soon, and the rise in premature and low-birth-weight babies has required more expensive hospital-based care to address the medical problems of these infants.

■Obstetricians and hospitals should follow the new National Institute of Health recommendations to offer the option of vaginal birth after a caesarean for those women who want to avoid repeat surgery. As noted in a recent NIH press release, “Although as many as 60 percent of hospitals in some states routinely prohibit vaginal delivery by women who have had a caesarean section, that practice is out of step with current medical research.’’

Expanding this option would require that the American Congress of Obstetricians and Gynecologists amend a recommendation that hospitals have 24/7 presence of an anesthesiologist if they choose to offer vaginal births after a caesarean. Because of this recommendation, many hospitals concerned about liability refuse to allow them. Yet those same hospitals find it acceptable to call in an off-site anesthesiologist when mothers need an emergency caesarean for any other reason.

■Hospitals could expand access to nurse-midwifery care. In Boston, statistics for hospitals that care for women facing the same risk of complications show that hospitals with nurse-midwifery services tend to have lower caesarean rates than those without a significant midwifery presence.

 HERE to read the entire article

Global MOMS Act

	Tell Congress: No women should die during childbirth. Urge your Representative to co-sponsor the Global MOMS Act today!

		Hundreds of thousands of women die each year from pregnancy-related complications. The vast majority of these deaths are unnecessary and preventable, caused by a lack of access to timely, quality health care. The Global MOMS Act, supported by Amnesty International USA, will have a lifesaving impact. In some countries, it truly could mean the difference between life and death for a woman. Urge your Member of Congress to co-sponsor the Global MOMS Act. The Global MOMS Act will support activities that help expand access to better quality maternal health services, remove barriers to such services, and ensure that they meet international human rights standards.
		Women dying during pregnancy and childbirth is not just a public health emergency, it is also a human rights crisis. Amnesty International has identified obstacles to lifesaving treatment faced by pregnant women around the world. In Peru, poor, rural and indigenous women face language barriers and too few accessible clinics. In Burkina Faso, women die because they cannot reach a health facility capable of treating them or because they arrive too late. Two years ago, the U.S. House of Representatives passed a resolution affirming "commitment to promoting maternal health and child survival both at home and abroad through greater international investment and participation." It's time to match commitment with action. The lives of millions of  women are at stake. Tell your Representative to co-sponsor the Global MOMS Act today! Thank you for joining our cause. In solidarity, Daphne Jayasinghe Advocacy Director, Women's Human Rights Amnesty International USA

"Mother dies 20 seconds after giving birth"

Tragic mother dies 20secs after birth

A mother who had just cradled her newborn son died seconds later from an unknown cause.

Another tragic and heart rending story, as yet another baby will grow up without his mother.  In this case the mother had just had a caesarean section.  An enquiry is under way to discover the cause of her death, but I  strongly suspect that it will be concluded that she died from a Amniotic Fluid Embolism.  

This is a horrifying tragedy for this family- and my heart breaks for them- but it is not a lone event.  Unfortunately this happens a lot more often then most people could possibly suspect. Besides the very real risk of  having an Amniotic Fluid Embolism, caesarean births are major abdominal surgery and carry with it the risks inherent with any major surgery, including death.

I have to wonder if this family, these new parents, were ever told the risks before she was rolled into the surgery?

In the US, Ina May Gaskin- probably the most famous midwife in the world- has started the  "Safe Motherhood Quilt Project".  

The Safe Motherhood Quilt Project is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States, and to honor those women who have died of pregnancy-related causes since 1982.
The Project is the vision of Ina May Gaskin, midwifery pioneer and author of Ina May's Guide to Childbirth and the classic Spiritual Midwifery, who has been instrumental in bringing this issue to the public light.

The Quilt

The quilt is made up of individually designed squares; each one devoted to a woman in the U.S. who has died of pregnancy-related causes since 1982. One quilt square is designed and dedicated to each mother's memory and may mention the date and place of death and the name of the woman. The Safe Motherhood Quilt is the voice for women who can no longer speak for themselves.

To be honored and remembered on The Safe Motherhood Quilt:

• The woman died as a result of a complication of pregnancy or birth
• The woman's death occurred since 1982
• The woman died within a calendar year after the end of her pregnancy (documented by an obituary, death certificate, relative's or witness' account).

We need to bring these stories out from the dark closet that they are hidden in. We need to bring awareness to women that "This Could Be YOU", that no one is 100% safe from the risks that come with unnecessary medical interventions and Caesarean Sections.  We KNOW that the C/Section rates are far too high.  We KNOW that 9 to 5 C/Sections are becoming more and more mainstream.  And we KNOW that most families are NOT being fully informed of the risks before hand. 

Every woman needs to Know their Rights, and they need to educate, enlighten and prepare themselves before heading to the L&D floor. Because chances are, the hospital staff are going to leave them in the dark.

Amnesty blows the whistle on Maternal Mortality rates in the US

Even Amnesty International sees it, yet main stream medical organizations seems to think that there is absolutely nothing wrong with Maternity care in the US (...and don't be fooled, it's almost as bad in Canada). The maternal death rate has almost doubled since 1987- 6.6 deaths per 100,000 births in 1987 to 13.3 deaths per 100,000 births in 2006. And since there is no federal reporting requirements in the US, the actual death rate may actually be much higher.

Amnesty points a finger at the lack of accessible health care as a reason for America's horrifying statistics (They are currently ranked 40th out of 40 developed nations), but also points to the high rates of Inductions and Caesarean Sections causing the maternal mortality rate to be climbing instead of falling. Currently the US spends the most amount of money on maternity care of any nations on the planet.... yet obviously they are spending too much money pushing medical and surgical interventions and not enough money on supportive health care and natural childbirth education- for parents and medical practitioners alike. Instead of encouraging and funding midwifery training and recognising the role of doulas as an essential part of supporting birthing mothers, they have instituted a dictator-like regime that bans mothers from having VBAC births and takes away their human rights to make decisions on how, where and when they will give birth.

Until ACOG , the CDC , and other major health organizations stop meddling in politics and accepting backdoor funding from companies with conflicting interests, the Maternal Mortality rate will only continue to climb. Because right now, these organizations are only interested in the bottom line instead of getting to the bottom of the reason that mothers are dying in childbirth in the 21st Century.

Too Many Women Dying in U.S. While Having Babies

By Jennifer Block

Read more: http://www.time.com/time/health/article/0,8599,1971633,00.html#ixzz0i0Lib1Ry

Amnesty International may be best known to American audiences for bringing to light horror stories abroad such as the disappearance of political activists in Argentina or the abysmal conditions inside South African prisons under apartheid. But in a new report on pregnancy and childbirth care in the U.S., Amnesty details the maternal-health care crisis in this country as part of a systemic violation of women's rights.

The report, titled "Deadly Delivery," notes that the likelihood of a woman's dying in childbirth in the U.S. is five times as great as in Greece, four times as great as in Germany and three times as great as in Spain. Every day in the U.S., more than two women die of pregnancy-related causes, with the maternal mortality ratio doubling from 6.6 deaths per 100,000 births in 1987 to 13.3 deaths per 100,000 births in 2006. (And as shocking as these figures are, Amnesty notes that the actual number of maternal deaths in the U.S. may be a lot higher, since there are no federal requirements to report these outcomes and since data collection at the state and local levels needs to be improved.) "In the U.S., we spend more than any country on health care, yet American women are at greater risk of dying from pregnancy-related causes than in 40 other countries," says Nan Strauss, the report's co-author, who spent two years investigating the issue of maternal mortality worldwide. "We thought that was scandalous." (See the most common hospital mishaps.)

According to Amnesty, which gathered data from many sources, including the Centers for Disease Control and Prevention, approximately half of the pregnancy-related deaths in the U.S. are preventable, the result of systemic failures, including barriers to accessing care; inadequate, neglectful or discriminatory care; and overuse of risky interventions like inducing labor and delivering via cesarean section. "Women are not dying from complex, mysterious causes that we don't know how to treat," says Strauss. "Women are dying because it's a fragmented system, and they are not getting the comprehensive services that they need."

The report notes that black women in the U.S. are nearly four times as likely as white women to die from pregnancy-related causes, although they are no more likely to experience certain complications like hemorrhage.

The Amnesty report comes on the heels of an investigation in California that found that maternal deaths have tripled there in recent years, as well as a maternal-mortality alert issued in January by the Joint Commission, a group that accredits hospitals and other medical organizations, which noted that common preventable errors included failure to control blood pressure in hypertensive women and failure to pay attention to vital signs after C-sections. And just this week, a panel of medical experts at a conference held by the National Institutes of Health (NIH) recommended that physicians' organizations revisit policies that prevent women from having vaginal births after having had a cesarean. Such policies, designed in part to protect against litigation, have contributed to the rise of the U.S. cesarean rate to nearly 32% in 2007, the most recent year for which data are available.

The Amnesty report spotlights numerous barriers women face in accessing care, even among those who are insured or qualify for Medicaid. Poverty is a major factor, but all women are put at risk by overuse of obstetrical intervention and barriers to access to more woman-centered, physiologic care provided by family-practice physicians and midwives.

Amnesty is calling on Obama to create an Office of Maternal Health within the Department of Health and Human Services to improve outcomes and reduce disparities, among other recommendations. The report also calls on the government to address the shortage of maternal-care providers.

"Access is only one factor," cautions Maureen Corry, executive director of Childbirth Connection, a research and advocacy organization that recently convened more than 100 stakeholders, including members of the American College of Obstetricians & Gynecologists and the NIH, in a large symposium on transforming maternity care. "We need to make sure that we reduce the overuse of interventions that are not always necessary, like C-sections, and increase access to the care that we know is good for mothers and babies, like labor support."

Read more: http://www.time.com/time/health/article/0,8599,1971633,00.html#ixzz0i0LSUPmk

Birth is a Human Right issue

Birth Is a Human Rights Issue

by Jan Tritten

© 2009 Midwifery Today, Inc. All rights reserved.

[Editor's Note: This editorial originally appeared in Midwifery Today, Issue 92, Autumn 2009/2010.]

“We hold these truths to be self-evident, that all men [and women] are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”(US Declaration of Independence)

Every mother and baby has the right to be treated with reverence and respect during the birth process, including pregnancy and beyond.

When a woman becomes pregnant, she and her baby have unalienable rights. First, the right to life: In June of this year, the United Nations Human Rights Council adopted a landmark resolution acknowledging maternal mortality and morbidity as a human rights issue.(1) The adoption of this resolution prods governments to “change the way they view maternal death—that is, as a human rights issue no less serious than executions, arbitrary detentions, or torture.”(2)

Next, the right to liberty: The word “liberty” contains aspects of freedom, independence, autonomy, emancipation. These concepts are not usually considered in relation to the childbearing year. It is time to declare that mothers and babies have the right to liberty in pregnancy and birth.

Finally, the pursuit of happiness is of utmost importance to those of us who care for mothers and babies. Most births around the world lead to some varying degree of preventable trauma for the mother and baby. I say it is preventable because much of it is iatrogenic, caused by the doctor or midwife. In many cases, if the mother, baby and birthing process had been treated with respect, the trauma would possibly have never taken place. Instead, the mother likely would have had the most miraculous experience of her life. At the very least, she would have felt a part of the decision-making process if things still did not go as planned. Birth today is a doctor dictatorship in many practices and in many hospitals. Mothers and babies are missing the healthiest possible beginning, both physically and emotionally. Their human rights are being violated.

Pregnancy and birth are usually the most crucial and powerful passages in a woman’s life. This can be perceived by the mother as either a powerfully great experience or a traumatic ordeal. Mom will generally have one of these reactions and those feelings will last her entire life, even if they are buried in the busy job of mothering. She will either soar at the thought of her birth or be driven to the depths of sorrow, especially in this age of the cesarean cut. The same is true of the way the birth experience imprints on the baby. Though he or she may not consciously remember it, the experience will have many life-long effects on the child.

HERE to read the complete article