Roundup Redux: C-Sections, Anti-Choice Connecting The Dots


Brady’s daily morning Roundup posts are a must-read for all reproductive and sexual health and rights advocates. If you’re not reading them, you should! Here’s my Roundup Redux for this Wednesday afternoon – there’s just too much going on not to bring you all more.

A new report determines that the rise in births of premature babies in this country can be almost entirely attributed to an increase in Cesarean sections. The March of Dimes, The U.S. Centers for Disease Control and Prevention and the Albert Einstein College of Medicine collaborated on the report. Amazingly, 92% of the increase in pre-term births is due to c-sections. Dr. Alan Fleischman, medical director and senior vice president of the March of Dimes calls both of these issues "increasing problems" and notes that no woman’s labor should be induced before 39 weeks gestation unless there is a clear medical indication for doing so.

While Michigan is hurtling towards a potential abortion ban, the ACLU reports that a court in Virginia struck down the "Partial Birth Infanticide Act" – a law that would have essentially banned all second trimester abortions in that state – which just goes to show you that there is no correlation between outlandish anti-choice legislation titles and the success of said legislation.

And in Pennsylvania, according to The Daily Women’s Health Policy Report, a court dropped all charges against a lay midwife (a midwife who does not necessarily have a nursing degree but who has been trained to deliver babies in healthy pregnancies) ruling that she should be allowed to continue her home birth practice, despite the fact that under state law only people with nursing degrees can be certified to practice midwifery. According to The Report, however, this latest court decision may have a ripple effect leaving the door open to allowing two classes of midwives to practice legally in the state - lay midwives as well as certified nurse midwives.

Finally, from the "interesting facts you uncover when you troll the anti-choice blogosphere" file: I discovered today that our favorite "pro-life" blogger Jill Stanek is far less than six-degrees separated from President Bush. Her daughter is a speech writer for the President penning this Memorial Day Prayer for Peace. This must be why Jill is one of the last remaining Americans still willing to support Bush? 

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  • http://homebirthdebate.blogspot.com invalid-0

    “A new report determines that the rise in births of premature babies in this country can be almost entirely attributed to an increase in Cesarean sections.”

    You fail to mention that this was accompanied by a dramatic fall in the rate of stillbirths after 28 weeks of pregnancy. According to the National Vital Statistics Report on fetal and perinatal mortality, the stillbirth rate declined 29% from 1990-2003. The increase in late prematurity due to C-section delivery is not a mistake. It is, in large part, a deliberate attempt to save lives lost to stillbirth, and it has been successful.

  • invalid-0

    I appreciate you questioning the study, Dr. Tuteur, but I respectfully disagree that this is clearcut – your reasoning does not make sense to me. You are saying that we should raise the risk of premature delivery, increase the risk of death for an infant, and increase the medical risks to the mother in order to avoid stillbirth? I am not a doctor but ACOG and the March of Dimes seem to disagree. This is from the article I linked to above:

    Preterm birth — delivery before 37 weeks of gestation — boosts the risk of death in the first month of life. More than 520,000 babies are born too soon each year in the United States — that’s one in eight. Those born "late preterm," from 34 to 36 weeks, accounted for most of the rise in the preterm birth rates for singletons. And the babies face not only a higher risk of death, but also a host of health problems such as respiratory difficulties, feeding problems, jaundice and delayed brain development.
    Fleischman said the advice about preterm birth from the American College of Obstetricians and Gynecologists is clear. "ACOG says no one should be induced before 39 weeks unless there are clear medical indications," he noted. The March of Dimes is in agreement with that advice, he added.

    Amie Newman

    Managing Editor, RH Reality Check

  • http://homebirthdebate.blogspot.com invalid-0

    Ms. Newman,

    I saw the press release and know what it says, but I also read the actual paper. A lot of information in the paper did not make it into the press release.

    The paper is question is The Relationship Between Cesarean Delivery and Gestational Age Among US Singleton Births by Bettegowda, et. al. in the June issue of Clinics in Perinatology. The authors wrote in their conclusion:

    The overall increase in the preterm birth rate and the concurrent increase in medically indicated preterm births have been accompanied by a decrease in stillbirth and perinatal mortality rates. (my emphasis) Preterm-related obstetric intervention is undertaken for maternal indications and suspected fetal compromise…

    Many high-risk pregnancies have benefited from obstetric intervention at 34 to 36 weeks, as suggested by declines in rates of fetal demise during the same gestational period. As such, the increase in medically indicated preterm birth might be positively viewed in light of the reduction of stillbirths and neonatal mortality… Taken together, obstetric interventions at preterm gestation to reduce risks for the mother and fetus need to be optimally balanced with risks associated with preterm birth…

    Indeed, the most recent US statistics on fetal mortality show a drop of 29% in late stillbirths. The increase is late prematurity is not accidental; it is deliberate. It is an attempt to lower the stillbirth rate, and it is successfully doing so.

  • invalid-0

    and as I wrote above, there is risk/benefit ratio that must be taken into account:

    "Taken together, obstetric interventions at preterm gestation to reduce risks for the mother and fetus need to be optimally balanced with risks associated with preterm birth…"

    There cannot be an either/or dichotomy forced here – to lower the stillbirth rate or to lower the C-section rate. However, as the article states, increased C-section rates are not all due to medical necessity – many seem to be due to a variety of factors: increased medical intervention, the push to medicalize birth, lack of clarity and support for a varety of childbirth options for healthy women, etc.

     

    Amie Newman

    Managing Editor, RH Reality Check

  • http://homebirthdebate.blogspot.com invalid-0

    There cannot be an either/or dichotomy forced here – to lower the stillbirth rate or to lower the C-section rate.

    Correct. The goal of obstetricians is to drop perinatal mortality (stillbirths + neonatal deaths) to the lowest possible level. The rise in late prematurity described by Bettegowda et al. was accompanied by a large drop in the stillbirth rate.

    increased C-section rates are not all due to medical necessity – many seem to be due to a variety of factors: increased medical intervention, the push to medicalize birth, lack of clarity and support for a varety of childbirth options for healthy women, etc.

    Yes, some C-sections are done for maternal request, but that does not mean that C-sections done between 34-36 weeks are done for maternal request. As the authors point out, the majority of C-sections performed at these gestational ages are done for 4 major indications: pre-eclampsia, fetal distress, poor fetal growth and placental abruption.

    If by “medicalizing birth”, you mean saving lives of babies who would otherwise die, then, of course birth has been medicalized. Childbirth is inherently dangerous; only the spectacular success of modern obstetrics has allowed women to forget or pretend that this is not the case. Most people have no idea that the “medicalization of childbirth” saves approximately 200,000 babies and 39,000 mothers each and every year.

    This paper is part of an entire issue of Clinics in Perinatology devoted to the epidemiology of C-section and the neonatal effects of C-section. Obstetricians are constantly working to maximize outcomes, and if that means increasing medicalization, so be it. There is not much value to a “natural” birth of a dead baby.