By Shelagh McNally for Uterus1“Too posh to push” mothers-to-be might want to review the latest findings about cesarean delivery on maternal request (CDMR). A new scientific review sponsored by the Office of Medical Applications of Research (OMAR) and the National Institute of Child Health and Human Development (NICHD) recently looked at the growing trend of CDMRs in the United States. While commenting that the available information makes defining a single recommendation for or against CDMRs difficult, the panel did suggest that every CDMR should be carefully considered.
| Think About It |
Know the Risks of CDMR:
Breathing distress for baby
Reactions to medications by both mother and child
Mother unable to breastfeed due to pain
Difficulty bonding
Increased bleeding which may require a blood transfusion
Infection in the incision or uterus
Injuries to bladder and bowels
Blood clots in legs, pelvic or lungs
Increased risk of placenta previa and placenta accreta in other pregnancies
Longer hospital stays due to longer recovery
Higher hospital bills
Visible abdominal scars
Know the Benefits:
Decreased risk of hemorrhaging during births
Reduced risk of certain birth injuries for the baby
Decreased pain during childbirth, but not afterwards
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“Until quality evidence becomes available, any decision to perform a CDMR should be carefully individualized and consistent with ethical principles,” wrote the panel. In the United States, nearly 3 in 10 U.S. mothers are giving birth by cesarean section (or C-section) which adds up to 1.2 million C-sections. This includes first-time mothers at a very low risk for childbirth problems: 21 percent of women under the age of 30 and 47 percent of women age 30 to 40.
“We all have noticed that women are asking for cesareans more often. I don't think they always have the best information in making that decision,” said Dr. Cathy Spong, pregnancy chief at NIH's National Institute of Child Health and Human Development and chairperson of the panel.
While it can’t be denied cesarean deliveries have saved lives in emergency situations, the panel pointed out there is no evidence indicating that CDMRs reduce the possible trauma and risks of childbirth. In fact, cesarean births raise the risk of respiratory distress in newborns who lose the benefits of a going through the vaginal canal where respiratory organs are massaged and mucus is eliminated. There is the additional risk of removing the baby before its lungs are developed and the panel recommended CDMR should not be done before 39 weeks.
Cesarean delivery has a high incidence for post-traumatic stress syndrome for mothers and babies. Many mothers need to overcome the psychological stress of missing the birth and may experience emotions of guilt. Mothers-to-be should also be warned about the potential for complications in later pregnancies, particularly with placental displacement. "If a woman is planning to have several children, we clearly feel women should not opt for cesarean delivery at maternal request," says Mary E. D'Alto, M.D., head of obstetrics and gynecology at Columbia University and chairwoman of the panel.
Many women don’t understand that a CDMR is major abdominal surgery that poses serious and occasionally life-threatening side effects such as hemorrhage, infection, and blood clots. So why the growing trend? Convenience and control appears to be the two major reasons. For some women CDMR was a way of minimizing their fear of pain over childbirth. But the panel warned “CDMR should not be motivated by unavailability of effective pain management and efforts must be made to assure availability of pain management services for all women.” The panel recommends that healthcare professionals educate their patients about labor and delivery management as well as the medical risks so an informed consent can be made.
CDMR appear to appeal to the affluent, busy modern woman trying to juggle motherhood and a career who would therefore like the idea of being able to control the time of birth. But Dr. Jacques Moritz, chief of gynecology at St. Lukes Hospital in New York warned, “There's a risk in all of this control, and the risk can be death. This is a major operation. It’s not like going to the beauty salon, or getting your nails done, or getting a bikini wax. This is a big, big deal.”
The lure of a quick recovery from childbirth is also making CDMR appealing, but some medical professionals are warning that even this is an illusion. “The super-mom syndrome has expanded from working and having kids, to working and having kids and having a body like a super model after birth,” said Dr. Jan Christilaw, a Vancouver obstetrician-gynecologist and head of specialized women's health at the British Columbia Women's Hospital in Canada. “It is not attainable in most women's lives –nor should it be.”
Dr. Michael Silverstein, assistant professor of obstetrics and gynecology at New York University, says, “The truth is that the incision is often less attractive in the abdomen than after a vaginal delivery. The return to aerobics and exercise is much shorter after a vaginal delivery. So the patient that wants to get back into the gym and get slender and fit again is probably going to have the greatest chance of doing that following a vaginal delivery.”
Education appears to be the key to a safe and healthy birth. "Women deserve to know that. Whatever their decision, they need to know what the data is," said Spong. The panel has called for more research into the issue.
Read more about the report at http://consensus.nih.gov or by calling 1-888-644-2667.
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