"African-American Mothers More Likely to Have Unnecessary Cesareans"

[Mekeda7]

http://www.maternitywise.org/cesarean_response.html
3 in 10 U.S. Mothers Gave Birth by C-Section in 2004: Sharp, Continuing Rise Defies Best Evidence and Best Practice

The U.S. c-section rate jumped to 29.1% in 2004. This record-setting preliminary figure from the Centers for Disease Control and Prevention represents a sharp increase of more than 40% over 8 years (Hamilton 2005).

In addition to this alert, please see
advice for pregnant women about c-section, vaginal birth and vaginal birth after cesarean (VBAC) from Maternity Center Association (MCA)
at-a-glance chart - vaginal birth and cesarean birth: how do the risks compare? (PDF)
cesarean myth versus cesarean reality
U.S. c-section vs. vaginal birth charges graph (PDF).

Why is the c-section rate rising?
Many factors are driving cesarean rates up, including:

providers' fear of lawsuits: given the way our legal system works, even when scientific evidence supports vaginal birth, providers may feel that performing a cesarean reduces their risk of being sued or losing a lawsuit

forced cesareans: more and more women who have had a previous cesarean or whose babies are in a breech rather than head-first position are unable to find doctors and hospitals willing to offer vaginal birth due to fear of lawsuits

casual attitudes about surgery: our society is more tolerant than ever of surgical procedures, even when not medically needed
growing belief that c-section is "safe" and vaginal birth is "harmful": these opinions began to form before a careful look at the relevant research, and the research does not support them (see "What are the health costs...", below).

side effects of other common procedures: attempts to start labor artificially (labor induction) and use of electronic fetal monitoring to see how a baby responds to labor interventions are on the rise, and both increase the likelihood that a woman will have a c-section

failure to support normal physiologic labor: care that promotes normal vaginal birth processes - such as continuous labor support from a doula, or use of hand movements to turn a breech baby to a head-first position (external version) - greatly lowers the likelihood of c-section.
With more favorable conditions and more appropriate care, a very large proportion of c-sections that are performed in the U.S. could be avoided.

Why are healthy mothers and babies experiencing surgical birth when there is no medical reason?
Birth certificates are the primary source of national data on cesarean births. A recent analysis found that more and more U.S. women who have c-sections have no sign of any medical need for this surgery on their birth certificate (Declercq 2005).

What is driving these surgical procedures? Many policy, research and media reports assume that "elective" cesareans (with no medical rationale) are "maternal request" or "patient choice" cesareans. Because birth certificates and most other data sources provide no information about decision making processes and the motivation of participants, it is wrong and irresponsible to equate c-sections that had no apparent medical cause with "patient choice" cesareans.

One report that looked at this question found that most cesareans with no medical rationale were proposed by doctors, not mothers (Kalish 2004). When mothers ask for such surgery, it is important to understand their motivation, including whether they had access to balanced accurate information on harms and benefits of cesarean versus vaginal birth, access to choices and support for their choices. We need to better understand why women request a c-section with no medical reason, but this should not divert attention from physician and hospital led influences on escalating cesarean rates (Gamble 2000).

Many obstetricians have begun to support "patient choice" cesarean, but do not support women's right to choose vaginal birth after cesarean (VBAC), vaginal breech birth, and out-of-hospital birth, although the best research suggests that these would be reasonable choices for many women.

This selective support for women's right to choose surgical birth raises important questions about motivation and conflicts of interest. Cesareans may be attractive to providers who feel that the surgical procedures reduce their risk of being sued or help them better schedule and control their professional and personal lives. They may be attractive to hospitals due to increased revenue relative to vaginal birth (see "What are the financial implications...", below). An independent investigation is urgently needed to clarify whether these conflicts of interest are driving cesarean rates up and jeopardizing the health of mothers and babies.

See more info. at:
http://www.maternitywise.org/cesarean_response.html

[Nia Maishani]

Looks like a fine enough Action Alert topic.

Asante, Sister Militia Mekeda7.

[Mekeda7]

Originally Posted by Nia Maishani

Looks like a fine enough Action Alert topic.

Asante, Sister Militia Mekeda7.

I'm trying to see if i can find an org. we can help support on this issue or any Afrikan women's issues related to this.

I'm also researching the stats on afrikan women and c-sections.

[Mekeda7]

http://www.healing-arts.org/mehl-madrona/mmepidural.htm

Epidural anesthesia has become increasingly popular for childbirth. The popular book, What to Expect when You’re Expecting, for example, portrays epidurals as perfectly safe. The risks, however, may be greatly underplayed.
Note: This is a site in progress. We are interested in detailing all the risks of epidural anesthesia for childbirth. There is currently a selection bias toward the risks. We welcome all readers to send us studies about epidurals regardless of the results, so that we can continue to work toward a balanced site. Our bias is that epidurals have risks and that these risks are under-communicated to women, and that true informed consent is not given.


Overall complications rates for epidural anesthesia
A general estimate of the overall complication rate of epidural anesthesia is 23%.2

1. Effects of epidurals on cesarean rate:

When the dose is too large or when it sinks down into the sacral ("tailbone") region of the body, the perineum and the vagina are anesthetized. Anesthetic is intentionally injected into this area late in labor to deaden all sensation. When it "accidentally" happens earlier in labor, the muscles of the pelvic floor are prematurely relaxed, thereby interfering with the normal flexion and rotation of the baby's head as it passes through the birth canal. This interference can lead to abnormal presentations which are more dangerous for the baby or to what is called "failure to descend," an indication for Cesarean birth.

Thorp, et al3 studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. They compared 447 patients who received epidural analgesia in labor with 264 patients who received either narcotics or no analgesia.

The incidence of cesarean section for dystocia was significantly greater (p < 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p < 0.005) of cesarean section for dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of oxytocin, duration of oxytocin use, maximum infusion rate of oxytocin, duration of labor, presence of meconium, and birth weight.

The incidence of cesarean section for fetal distress was similar (p > 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. They concluded that epidural analgesia in labor increases the incidence of cesarean section for dystocia in nulliparous women.

Frequently the epidural is so effective that it eliminates uterine contractions. The nerves which tell the uterus to contract are all anesthetized. The uterus becomes quiet and must be driven artifically with the hormone oxytocin (Pitocin or Syntocinon).

As the cervix becomes fully dilated and the head descends, the woman (in a normal birth) feels pain and pressure in the lower pelvis and rectum. The last injection of anesthetic during the process of epidural anesthesia occurs after the head has rotated and come down onto the perineum. Higher concentrations of anesthetic are used to assure perineal relaxation. Sometimes the mother is sat upright or at least at a 45 degree angle to be certain that the anesthetic will descend to the sacral nerve roots. When the sacral nerve roots are blocked, the woman looses the urge to push.

After controlling for potentially confounding variables with multiple logistic regression analysis, Adashek, et al4 found that epidural anesthesia was an independent risk factor for cesarean birth among women over age 35 (R = 0.195, p < 0.001).

At the 1997 meeting of the American Society for Anesthesiology, a press release was issued about four studies involving a combined total of more than 22,000 women claiming that labor epidural analgesia does not increase a woman's risk of having a cesarean delivery.5 Three of the studies were presented at the annual meeting of the American Society of Anesthesiologists. The fourth appeared in the September 1997 issue of the medical journal of Anesthesiology.

“The findings have significant implications for physicians, patients and insureres,� said one of the reserchers, Steven T. Fogel, M.D., an anesthesiologist at Washington University School of Medicine in St. Louis. "Some physicians and insurance companies limit patient access to epidurals because they srongly believe thta epidurals can prolong labor, "Dr. Fogel said. "Delaying or withholding an epidural forces the pregnant woman to suffer needlessly and does not lower the cesarean rate."
Each year, about one-million women choose epidural blocks for safe and effective pain relief durig labor.

The authors' real conclusions are this: If you do everything possible to reduce the cesarean rate for all patients, and then, if you compare epidural anesthesia with high dose, self-administered narcotic analgesia, there is no difference in the cesarean rate. This is not really a very outstanding conclusion, though the popular press read this result as saying epidural anesthesia is now proven safe and unlikely to increase the cesarean rate (without addressing the question, “over what?�

Some infants (0.8%) in the epidural group also required naloxone. Two transfers to NICU occurred in the epidural group and 3 in PCMA group.

Looking just at those who had epidurals vs. those who didn't, epidurals prolonged the first stage of labor and increased the incidence of oxytocin administration. Fever developed in more women during epidural anesthesia. There was no difference in the number of cesareans in the epidural vs. the PCIA group (the range from 3% to 7% cesarean rate).

Regarding other complications, 24% of women having epidurals had fever compared to 6% in PCMA. Nine percent had forceps with epidural compared to 3% with PCMA. There was a15-19% range of meconium during labor (not different between groups), which we find rather high. There was a rate of 1.2-1.8% of infants suffering meconium aspiration (not different between groups), but also rather high in our experience.

(THIS ARTICLE WAS SHORTENED DUE TO LENGTH. PLEASE SEE LINK ABOVE TO READ IN FULL)

[Mekeda7]

African-American Mothers More Likely to Have Unnecessary Cesareans
Category: Women's Health/OBGYN News
Article Date: 01 May 2005 - 19:00pm (UK)
http://www.medicalnewstoday.com/medi...p?newsid=23669




Black women, women aged 35 years or older and women admitted on weekends are more likely to have potentially unnecessary cesarean sections than others, say Tulane University researchers. Their analysis of unnecessary cesarean section deliveries is the first to detail factors correlated with the surgery at the national level. The results are published in the April issue of Obstetrics & Gynecology.(http://www.findarticles.com/p/articl...14085#continue)

“Reducing the number of unnecessary cesareans is a national health goal because of the potential risk to mothers during delivery and subsequent pregnancies,� says senior author Mahmud Khan, professor of health systems management. “In the USA, we spend more on healthcare than any other country of the world and reducing unnecessary cesareans will help reduce the costs as well. There are multiple factors for both the mother and the physician that could lead to unnecessary cesareans.�

Researchers analyzed data on mothers and their deliveries from the 2001 Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database. They considered a cesarean potentially unnecessary if there was no condition mentioned in the patient's record that indicated the need for cesarean surgery. They also studied repeat cesareans and found that white women were more likely than other mothers to have a second potentially unnecessary cesarean.

Overall, the researchers found that 11 percent of mothers had potentially unnecessary first-time cesareans and 65 percent of women with a previous cesarean had a second potentially unnecessary one. Black women had a significantly higher rate of first-time potentially unnecessary cesareans (14 percent) than women of other ethnic groups. Ability to reduce the first time potentially unnecessary cesareans is crucial in lowering the repeat cesareans as well. Other factors related to a first-time potentially unnecessary cesarean included the mother being older than 35 (12 percent), being admitted on a weekend (12 percent) and living in the Northeast part of the country (12 percent) or in a zip code with a median income under $25,000 per household (12 percent).

Repeat unnecessary cesareans occurred more frequently in white women (66 percent) than other groups. In contrast to women with first-time potentially unnecessary cesarean sections, those who had a repeat procedure were more likely to be admitted on a weekday, be younger than 35 years old, and live in the South or West.

“Women who have had a previous cesarean are often advised to have a second one for health and safety reasons,� says co-author Gabriella Pridjian, chair of obstetrics and gynecology at the Tulane University School of Medicine. “Patient choice may also play a role in their decision to have a cesarean that may not be medically indicated.�

[Mekeda7]

Article: "African-American Mothers More Likely to Have Unnecessary Cesareans"
http://www.medicalnewstoday.com/medi...p?newsid=23669