Cesarian epidemic...very interesting
American Journal of Maternal/Child Nursing (MCN)
Editorial
Is It Just Me?
When I have strong feelings about an issue but find that many others
feel differently, I often
wonder, is it just me? Why don't others see what I see? Am I somehow
off base, or are my
beliefs correct? Can there be multiple "right" answers, or is this a
moral issue for which only
one answer is possible? Lately I've been struggling with this feeling
about the rising cesarean birth rates.
It seems so fundamentally wrong to me that over 30% of women now give
birth by surgical intervention
that I can't even imagine how all this came to be and why anyone would
believe it's okay. When
did the whole "natural childbirth" movement that I grew up in as a
nurse give way to maximum intervention
childbirth? Of course there's no answer to this question, and a
cultural shift such as this takes
decades to take hold, but somehow the general public now seems to
think that it is acceptable-and
even necessary-for one third of women to be cut open to birth their
babies. I know that society's beliefs
about childbirth in general have changed; women want analgesia and
other such interventions in
labor, and I believe we should meet women's needs when we're sure they
understand the consequences
of their choices. But now childbirth is controlled by the
interventionists, and that seems to be perfectly
fine with a majority of women. This is
Alice-Through-the-Looking-Glass, upside-down thinking to me.
Many factors have contributed to this, as the literature describes.
Was analgesia the slippery slope leading
us to where we are? Was it the epidural?
Was it the women's movement itself, which
might make it seem acceptable to consider
childbirth just another scheduled appointment
in women's busy lives? Was it the
growth of maternal/fetal medicine as a subspecialty
of OB/Gyn, fueling the impression
that every pregnancy is filled with dangers
waiting to happen? Was it the introduction
of electronic fetal monitoring? Perhaps it was just the perfect storm
of these and other cultural and
medical events, but there is no doubt now; despite the best efforts of
the vocal midwifery community,
the nursing community, and some few public health advocates,
childbirth is now a medical/surgical
event, and everyone is anticipating a dangerous occurrence that will
necessitate the operating room.
Young nurses starting out in maternal-child health may not even
understand that only a few short
decades ago (in 1970) the cesarean birth rate was 5% (Bettegowda et
al., 2008). By 1980, it had
risen to 25% and now stands at 30.3%. What has happened in those few
decades? Could it be that
30.3% of women have become incapable of giving birth vaginally? There
are major consequences to
this incredibly high rate of cesarean births-consequences for the
mothers, the babies, and society.
Because many of the cesareans are done before 39 weeks (despite ACOG's
recommended GA for
elective cesarean), often for convenience, too many babies are being
born between 36 and 39 weeks
("late preterm"). We used to think these babies would be fine, but now
we know that they have
much higher risk for many health problems (see the article by Riesser
Shaw in this issue of MCN).
Alarming statistics (Bettegowda et al., 2008) have shown that the
rising preterm birth rate in the
United States (now 12.7%) is heavily influenced by cesarean birth and
that 92% of the increase in
singleton preterm birth is due to birth by cesarean. These babies are
"almost exclusively late preterm
births" (Bettegowda et al., 2008, p. 310). This figure-92%-is astounding.
Is it just me? I think not. I believe that the escalating cesarean
birth rate is dangerous. It's not okay to
put so many women at danger for the health risks of surgery, and it's
not acceptable to endanger so
many newborns by allowing them to be born before term. We can't assign
blame; there's blame enough
for everyone. What we need to do now is advocate for change. Cesarean
birth before 39 weeks must
be reserved for women who have grave medical indications or for
infants who simply must be born
due to true medical complications. The Bettegowda paper is a wake-up
call. I urge you all to read it.
It's not just me. <
Reference
Bettegowda, V. R., Dias, D., Davidoff, M. J., Damus, K., Callaghan, W.
M., & Petrini, J. R. (2008). The relationship between
cesarean delivery and gestational age among US singelton births.
Clinics in Perinatology, 35, 309-323.
Margaret Comerford Freda, EdD, RN, CHES, FAAN
EDITOR
margaretfreda@yahoo.com
From:
http://www.mcnjournal.com/pt/re/mcn/pdfhandler.00005721-200809000-00001.pdf
Editorial
Is It Just Me?
When I have strong feelings about an issue but find that many others
feel differently, I often
wonder, is it just me? Why don't others see what I see? Am I somehow
off base, or are my
beliefs correct? Can there be multiple "right" answers, or is this a
moral issue for which only
one answer is possible? Lately I've been struggling with this feeling
about the rising cesarean birth rates.
It seems so fundamentally wrong to me that over 30% of women now give
birth by surgical intervention
that I can't even imagine how all this came to be and why anyone would
believe it's okay. When
did the whole "natural childbirth" movement that I grew up in as a
nurse give way to maximum intervention
childbirth? Of course there's no answer to this question, and a
cultural shift such as this takes
decades to take hold, but somehow the general public now seems to
think that it is acceptable-and
even necessary-for one third of women to be cut open to birth their
babies. I know that society's beliefs
about childbirth in general have changed; women want analgesia and
other such interventions in
labor, and I believe we should meet women's needs when we're sure they
understand the consequences
of their choices. But now childbirth is controlled by the
interventionists, and that seems to be perfectly
fine with a majority of women. This is
Alice-Through-the-Looking-Glass, upside-down thinking to me.
Many factors have contributed to this, as the literature describes.
Was analgesia the slippery slope leading
us to where we are? Was it the epidural?
Was it the women's movement itself, which
might make it seem acceptable to consider
childbirth just another scheduled appointment
in women's busy lives? Was it the
growth of maternal/fetal medicine as a subspecialty
of OB/Gyn, fueling the impression
that every pregnancy is filled with dangers
waiting to happen? Was it the introduction
of electronic fetal monitoring? Perhaps it was just the perfect storm
of these and other cultural and
medical events, but there is no doubt now; despite the best efforts of
the vocal midwifery community,
the nursing community, and some few public health advocates,
childbirth is now a medical/surgical
event, and everyone is anticipating a dangerous occurrence that will
necessitate the operating room.
Young nurses starting out in maternal-child health may not even
understand that only a few short
decades ago (in 1970) the cesarean birth rate was 5% (Bettegowda et
al., 2008). By 1980, it had
risen to 25% and now stands at 30.3%. What has happened in those few
decades? Could it be that
30.3% of women have become incapable of giving birth vaginally? There
are major consequences to
this incredibly high rate of cesarean births-consequences for the
mothers, the babies, and society.
Because many of the cesareans are done before 39 weeks (despite ACOG's
recommended GA for
elective cesarean), often for convenience, too many babies are being
born between 36 and 39 weeks
("late preterm"). We used to think these babies would be fine, but now
we know that they have
much higher risk for many health problems (see the article by Riesser
Shaw in this issue of MCN).
Alarming statistics (Bettegowda et al., 2008) have shown that the
rising preterm birth rate in the
United States (now 12.7%) is heavily influenced by cesarean birth and
that 92% of the increase in
singleton preterm birth is due to birth by cesarean. These babies are
"almost exclusively late preterm
births" (Bettegowda et al., 2008, p. 310). This figure-92%-is astounding.
Is it just me? I think not. I believe that the escalating cesarean
birth rate is dangerous. It's not okay to
put so many women at danger for the health risks of surgery, and it's
not acceptable to endanger so
many newborns by allowing them to be born before term. We can't assign
blame; there's blame enough
for everyone. What we need to do now is advocate for change. Cesarean
birth before 39 weeks must
be reserved for women who have grave medical indications or for
infants who simply must be born
due to true medical complications. The Bettegowda paper is a wake-up
call. I urge you all to read it.
It's not just me. <
Reference
Bettegowda, V. R., Dias, D., Davidoff, M. J., Damus, K., Callaghan, W.
M., & Petrini, J. R. (2008). The relationship between
cesarean delivery and gestational age among US singelton births.
Clinics in Perinatology, 35, 309-323.
Margaret Comerford Freda, EdD, RN, CHES, FAAN
EDITOR
margaretfreda@yahoo.com
From:
http://www.mcnjournal.com/pt/re/mcn/pdfhandler.00005721-200809000-00001.pdf