Posts Tagged ‘ labor and delivery ’

Why C-Sections Should Only Be Performed When Medically Necessary

Monday, April 13th, 2015

In delivery roomThe number of women giving birth via cesarean section has been on the rise for many years now: Approximately 33 percent of births in the United States are C-sections, according to data from the World Health Organization (WHO); however, WHO recently released a statement saying this procedure should only be performed if it’s absolutely medically necessary.

Physicians often turn to C-sections as the safest option when the baby is in an abnormal position or if the mother has been in labor for too long, but they are often performed when vaginal birth could still be viable option.

“For nearly 30 years, the international healthcare community has considered the ideal rate for cesarean sections to be between 10 percent and 15 percent,” the WHO report states.

Related: All About C-Sections: Before, During, and After

Although C-sections are one of the most commonly performed surgeries in the world, they can be harmful when unessentially performed. “As a country’s rate moves to 10 percent the rate of mother and child deaths decreases, but there’s no evidence to show that rates over 10 percent have any effect on mother and child mortality.”

The report also emphasizes the importance of doctors treating every situation individually, and confirms that C-sections effectively save maternal and infant lives when medically required. “Every effort should be made to provide cesarean sections to women in need, rather than striving to achieve a specific rate.”

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Caitlin St John is an Editorial Assistant for Parents.com who splits her time between New York City and her hometown on Long Island. She’s a self-proclaimed foodie who loves dancing and anything to do with her baby nephew. Follow her on Twitter: @CAITYstjohn

Birth Stories: Emergency C-section
Birth Stories: Emergency C-section
Birth Stories: Emergency C-section

Image: Pregnant woman in delivery room via Shutterstock

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Overweight Women May Have Uterine ‘Switch’ that Makes C-Section More Likely

Friday, June 20th, 2014

Pregnant women who are overweight may have an electrical “switch” in their uterine muscle that makes Cesarean section delivery more likely, according to new research published in the journal Nature Communications. The switch is believed to play a role in the progression of labor, and in overweight women is often found to be faulty. More from ScienceDaily:

It’s well known that strong rhythmic contractions of the uterus are needed to allow the baby’s head to dilate the cervix. However little was known about what controls these contractions until now.The groundbreaking research from Monash University, the Royal Women’s Hospital and the Hunter Medical Research Institute, show that a potassium ion channel called hERG in the uterus is responsible.

Acting as a powerful electrical brake, hERG works during pregnancy to suppress contractions and prevent premature labour. However, at the onset of labour a protein acts as a switch to turn hERG off, removing the brake and ensuring that labour can take place.

The team, led by Professor Helena Parkington from the School of Biomedical Sciences at Monash University, found that in overweight women the switch doesn’t work, failing to turn hERG off.

“We’ve known for years that women who are overweight are much more likely to experience complications during pregnancy and labour — but we didn’t know why,” Professor Parkington said.

“Pinpointing the mechanism is a major breakthrough, not only does it ensure a smooth pregnancy, but knowing when contractions kick in at more or less the right time, is crucial to our understanding of the labour process.”

Image: C-section prep, via Shutterstock

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Early, Induced Labor Rate Falling in U.S.

Wednesday, June 18th, 2014

The number of women who are having labor medically induced before their due dates is on the decline, according to a report from the Centers for Disease Control and Prevention–good news for the health of babies who may face risks if born prematurely.  The rate of premature Cesarean sections is also falling, the CDC found.  More from US News:

Rates of induced labor declined across the board since 2006 for expectant mothers at 35 to 38 weeks of gestation, with the greatest decline at 38 weeks, researchers with the CDC’s National Center for Health Statistics (NCHS) found.

This is good news for the health of these babies, who can face serious health problems when delivered preterm, said Dr. Edward McCabe, chief medical officer for the March of Dimes.

Babies born early are 1.5 to two times more likely to die during their first year of life, compared to babies delivered following a full term of 39 weeks or more, he said.

“There’s this feeling that we’ve done so well with our premature babies, we’ve been seduced by the advances and think it’s safe to induce delivery early,” McCabe said. “We’ve ignored the fact that there are significant risks of illness and death in late preterm and early term babies.”

The largest decline in induced labor occurred for early term births at 37 to 38 weeks, which fell 12 percent between 2006 and 2012, the CDC reports. Late preterm births at 34 to 36 weeks of gestation declined by 4 percent.

This decrease comes at a time when medical societies are raising concerns about unnecessary early deliveries.

The rate of induced labor more than doubled between 1990 and 2010, from nearly 10 percent of births to just under 24 percent. While some of these induced births were needed to preserve the life of mother and child, many also occurred to better fit the birth into the busy schedules of the parents or the doctor, McCabe said.

The American Congress of Obstetricians and Gynecologists doesn’t recommend induced deliveries prior to 39 weeks of pregnancy without a clear medical reason.

Image: Woman in delivery room, via Shutterstock

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Baby Delivered by 8-Year-Old Girl

Thursday, May 15th, 2014

Jazmine McEnaney, an 8-year-old Florida girl, helped deliver her baby brother when her mother went into rapid labor at home.  More from ABC Action News:

Joseph James Snyder began arriving as [mother] Krystle went into the bathroom to get ready for work.
“I was in the bathroom and my water broke and I yelled for her… ‘Jazmine grab the cordless phone. Dial 911,’” she said.
Jazmine McEnaney called for help at 7:02 a.m. She told the 911 operator, “My mom is pregnant and her water just broke. She is in so much pain.”
Krystle said she was frantic in that moment.
“Even if I called somebody, they are not going to come quick enough,” she said.  “It happened so fast.”
Her baby was two weeks early. All five pounds 10 ounces of little Joseph couldn’t wait.
The operator guided Jazmine in how to help deliver the child. Just 13 minutes after that 911 call started, and before paramedics could arrive, Joseph made his appearance.
The 911 operator asked, “Is your mom pushing or straining yet?”
“Um, mommy are you pushing or straining?” Jazmine asked.
From the background Krystle screamed, “Yes! Yes!”
Talking about what the 911 operator asked Jazmine to do, she told us, “It was like, kind of hard.”
Krystle held the phone as Jazmine worked to deliver Joseph. On the 911 call, Krystle told her, “Come here. Hold the baby’s head please. Hold the baby’s head please Jazmine.”
Krystle says, “She definitely stayed calm when she needed to. I was hysterical.”
Big sister helped her little brother into the world. To that Krystle says, “She did a very good job. I am proud of you.”
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Brain Injuries at Birth Have Many Causes, Report Finds

Tuesday, May 6th, 2014

Brain injuries suffered by newborns at the moment of their birth have long been thought to be the result of insufficient oxygen during delivery, with doctors often held responsible by parents.  But a new report by a committee of experts in obstetrics, pediatrics, neurology and fetal-maternal medicine has found that the full cause of such injuries, which can result in serious complications, are far more complex than that.  The New York Times has more:

The document, called Neonatal Encephalopathy and Neurologic Outcome, updates a version published in 2003 that focused on oxygen deprivation, or asphyxia, around the time of birth. The new report, which highlights significant advances in diagnosis and treatment in the decade since, was published by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. Brain injuries affect about three in 1,000 babies born full-term in the United States, but only half of these cases are linked to oxygen deprivation during labor and delivery, according to the new report. And even in those instances, a problem that occurred long before birth might have exaggerated the effects of a reduced oxygen supply that would have not otherwise caused a lasting brain injury.

According to the 2003 report, fewer than 10 percent of children with cerebral palsy, the most severe such brain injury, showed signs of asphyxia at birth. Unless certain clear-cut symptoms are present then, brain abnormalities are probably not the result of a complication during labor or delivery, the new report states.

Rather, there may be other reasons for neonatal encephalopathy, as brain disorders in full-term newborns are called. These include genetic factors and maternal health problems like hypothyroidism, placental abnormalities, major bleeding during pregnancy, infection of the fetal membranes and a stroke in the baby around the time of birth.

“We know that neonatal encephalopathy has a variety of causes, and we hope this report will enable us to provide more accurate information to affected families and devise better methods of prevention and treatment,” said Dr. Mary E. D’Alton, chief of maternal-fetal medicine at Columbia University Medical Center, who was chairwoman of the task force.

Neonatal encephalopathy is a syndrome of disturbed neurological function that occurs in full-term baby’s first days. It is characterized by impaired consciousness or seizures, often accompanied by breathing difficulties and poor muscle tone and reflexes.

To determine whether an insufficient supply of oxygen and blood during labor and delivery is the likely cause, several factors should be considered together. These include a low Apgar score at 5 and 10 minutes after birth; high acid level (called acidemia) in the umbilical artery; major organ failure; and an M.R.I. scan showing a particular pattern of cerebral injury, according to the new report.

The more of these conditions that are present, the more likely that insufficient oxygen during the birth was responsible for the injury.

Reassuringly, the report pointed out that most infants with low Apgar scores will not develop cerebral palsy. “Even in the presence of significant acidemia, most newborns will be neurologically normal,” the committee said. (A doctor evaluates a newborn on five criteria to arrive at the Apgar score, a fast way to gauge the baby’s well-being.)

The experts noted that “there are multiple potential causal pathways that lead to cerebral palsy in term infants, and the signs and symptoms of neonatal encephalopathy may range from mild to severe, depending on the nature and timing of the brain injury.”

For example, the injury might occur as a result of risk factors at the time of conception or from conditions that develop during pregnancy, like fetal growth retardation or placental lesions.

At this time, there are few effective remedies for those problems, but if certain abnormalities in the fetal heart rate are present when a woman goes into labor, the doctor may be able to prevent a serious brain injury by doing a cesarean delivery.

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