Caesarean rates follow-up

My friend Robin is very involved in birth advocacy, particularly in educating women (and the health system!) about the advantages of vaginal birth for breech babies. I admit it sounded a bit wild to me when I first heard about it, but when you actually look into it, it turns out that, for certain breech babies, the risks of vaginal delivery are no higher than C-section deliveries. (You can find out more about this at the Coalition for Breech Birth website: www.breechbirth.ca.)

Anyway, I am bringing Robin in here because The Ottawa Citizen ran a story very similar to the CBC story I posted earlier, and she wrote an excellent letter to the editor about the risks of having a high C-section rate. You can read her letter without having read the related Citizen article, but if you're interested in it, here's a link.

Good afternoon!

I was delighted to read your article this afternoon regarding concern over the rise in caesarean rates.

I am one of the co-founders of the Coalition for Breech Birth, an Ottawa-based grassroots coalition working for the re-normalization of breech birth.

I admit that I was shocked to read that Andre Lalonde suggested "there has been a recent push to encourage women with breech babies to deliver vaginally." It is nearly impossible to achieve a vaginal breech birth in Ottawa, especially in the hospital (homebirth with a midwife is an option most women are not aware of). Just this past Monday, a woman who contacted us was forced to fight tooth and nail to achieve a vaginal breech birth at the Civic. She was lectured, coerced, and threatened by the doctors, residents, and nurses, and told (incorrectly, according to the published evidence) that she was endangering her baby. How is this "encouraging" a woman to birth vaginally? It's not even "supporting" an intelligent woman who has already done her research and has made an informed decision about the best birthing mode for her baby. In addition, unless there has been a very recent change, the guidelines of the Society of Obstetricians and Gynaecologists of Canada still state that the standard of care for breech birth is Caesarean surgery, and most obstetricians fear professional censure should they openly offer options that go against their organization's recommendations.

I was also astonished and disturbed to read your quote by Dr. Walker: "Is a 25-per-cent C-section rate a bad thing? I don't think there's the data out there to qualify that it's bad ... What we want is healthy mothers and babies. That's the outcome we want." While it cannot be argued that "healthy mothers and babies" is the basic goal of childbirth, this is the most basic of goals, and "healthy" is a subjective term. A mother who experiences surgical birth unnecessarily walks into the hospital healthy, and leaves the hospital permanently injured, with a uterine scar that makes many obstetricians recommend that she not attempt vaginal birth in the future.

The long term physical and emotional ramifications of surgical birth go far beyond the limited 6 week follow up period for which obstetricians typically follow women. Every surgical birth a woman experiences increases the liklihood of another surgical birth; and with every subsequent surgical birth, the risks grow higher for the mother. Ultimately the number of babies a woman can carry is limited by surgery; a woman who has had 3 surgical births is generally told not to have more children, because her uterine strength has been compromised by the repeated surgeries. Peer-reviewed evidence shows that women who experience surgical birth are more likely to suffer from post partum depression, experience difficulty bonding with their babies, are much more likely to have difficulty breastfeeding, develop painful or even debilitating scar-tissue adhesions, experience bowel or bladder incontinence, have varying degrees of permanent nerve damage, and are three times more likely to die in childbirth. The World Health Organization has stated that no developed nation should have a caesarean rate of over 15%. This means that nearly half of the surgical births in Canada are not needed, at great detriment to the families trying to adjust to a new baby and recover from major surgery simultaneously. What data Dr. Walker is still waiting for is very unclear.

As a woman who experienced both an unmedicated vaginal birth, and surgical birth for no medical indication other than encountering an obstetrician on call who was not qualified to catch a breech baby, I can attest that a "normal" recovery from this surgery, and the recovery from normal vaginal birth, are worlds apart. Mothers are often very traumatized by surgical birth, especially if they have done their homework and know, or even suspect, that the surgery was not needed. Doctors who treat surgical birth as "equal to or better than" vaginal birth demonstrate that they are exceptionally short-sighted and out of touch with the needs of birthing families. There is far more to having a baby than the simple extraction of the child. Treating birth as a pathology that needs to be cured, and that has no merits of its own, is a fundamental disrespect of a natural and safe process of the female body, and demonstrates a paternalistic and condescending attitude towards the woman and her family. The complete, accurate information, and the choices, belong in the hands of the people who live with the consequences of the birth.

I invite you to visit our website and read our stories, as well as the peer-reviewed research presented on the Articles page regarding the safety of vaginal breech birth. I would be delighted to discuss the issue further, and would be deeply grateful for any exposure you can give to this issue.

Best regards,
Robin Guy
613 820 7995
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Coalition for Breech Birth: www.breechbirth.ca.
Please visit and consider signing our petition to have the SOGC change its breech birth guidelines.

"Refusing vaginal breech birth is a human rights violation in that it forces women to consent to surgery in order to obtain medical care. The right to informed consent is meaningless where there is no access to informed refusal." - Henci Goer, author of "The Thinking Woman's Guide to a Better Birth"

More Canadian babies born underweight, by C-section: report

An article on CBC's website today states that the rate of C-sections continues to increase. While C-sections are, of course, sometimes necessary, it's disturbing to think that part of the reason for the increase is simply that "more obstetrical interventions are becoming accepted".

Here's an excerpt from the article. Click on the article title to go to the full article on CBC's website.

More Canadian babies born underweight, by C-section: report
Last Updated: Thursday, July 26, 2007 2:21 PM ET CBC News

More Canadian babies are entering the world in difficult circumstances — underweight and through caesarean sections, says a new report on birthing trends from the Canadian Institute for Health Information.
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The report also finds that the number of women giving birth by C-section in Canada has risen over the past five years, to 26 per cent in 2005-06 from 23 per cent in 2001-02. Though it is lower than the 29 per cent rate in the United States and Australia, it is higher than England's rate of 24 per cent.

CIHI's analysis found that women who had undergone a previous caesarean section had an 82 per cent chance of having a second one, up from 73 per cent in 2001-02.

Heick says that increasing obesity levels among women are resulting in more C-sections, as obesity can lead to dangerous pregnancy complications that require emergency surgery. She also says changing hospital practices are increasing surgical rates. "More obstetrical interventions are becoming accepted," she told CBC News.

Women having C-sections are on average slightly older than those delivering vaginally, the study indicated.

The World Health Organization recommends that no more than 15 per cent of all births should involve a caesarean section.

Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia

Thanks to local midwife Heather Ashthorn for sharing this recent study conducted in British Columbia.

The article is a bit technical, but the message is simple. For women with normal pregnancies, births attended by midwives involve far fewer medical interventions than those attended by doctors AND they are just as safe. Healthy mommies, healthy babies, and major cost and resouce savings for our medical system -- what more could you ask for?

Birth. 2007 Jun;34(2):140-7, Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia.

Janssen PA, Ryan EM, Etches DJ, Klein MC, Reime B. Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.

BACKGROUND: The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada.

METHODS: All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n=488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n=572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data.

RESULTS: Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39-0.86), narcotic analgesia (OR 0.26, 95% CI 0.18-0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16-0.30 ), amniotomy (OR 0.74, 95% CI 0.56-0.98), and episiotomy (OR 0.62, 95% CI 0.42-0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04-0.83) in the midwifery group.

CONCLUSIONS: A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity.

PMID: 17542818

Health & Social Services met with Community Services

Everything slows down for the Government of Yukon in the summer because so many people take this time to have some holidays. Despite that, I'm pleased to announce that the Policy Analyst we've been working with at Health & Social Services sent me an e-mail to inform me that she and her supervisor were finally able to meet with some representatives at Community Services on June 28th.

According to her: "The meeting was very useful and we have received their approval (with a few minor tweakings) for the plan I developed. I anticipate being able to provide a further update in the later part of July or early August."

Write to your MLA

It's important for the government to know that midwifery is important to Yukoners. If you support having midwifery services integrated into our health care system so that all Yukon women will have more choice, then write a letter to your MLA to let him or her know!

Below is a sample letter that you can copy and paste. Remember to fill in your MLA’s name and your name You can find your MLA’s email address at http://www.legassembly.gov.yk.ca/contact.html.

To the Hon. ------

I am a member of your constituency and part of the group Yukoners for Funded Midwifery (www.yffm.ca). I am contacting you to let you know that the integration of midwifery services into the Yukon health care system is very important to me. All women in the Yukon should have choices in high quality maternity care, and funding midwifery services would allow all Yukon women access to the option of midwifery services.

Our group has been meeting with a policy analyst from the department of Health and Social Services, and as midwifery would have to be regulated to funded, the department of Community Services is involved as well, since it is responsible for regulating health professions under the Health Professions Act. We are in the first stage of regulation, which is asking the question, “should midwifery be regulated?” This question will be put to cabinet after an information gathering process.

I’m hopeful that midwifery services will be integrated into our health care system in a way that meets the unique needs of the Yukon. Thank you for your involvement in representing my voice on this important issue.

Sincerely,

Your Name Here