Elective cesareans--recent controversy.With the national cesarean section cesarean section (sĭzâr`ēən), delivery of an infant by surgical removal from the uterus through an abdominal incision. The operation is of ancient origin: indeed, the name derives from the legend that Julius Caesar was born in this rate already over 26 percent (1) , it is very alarming that some physicians may now offer healthy women the option to choose birth by cesarean cesarean /ce·sar·e·an/ (se-zar´e-an) see under section. ce·sar·e·an or cae·sar·e·an or cae·sar·i·an or ce·sar·i·an adj. Of or relating to a cesarean section. surgery. In a press release on October 31, 2003 (2) , The American College of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 49,000[1] and represents 90 percent of U.S. (ACOG ACOG American College of Obstetricians and Gynecologists. ACOG American College of Obstetricians & Gynecologists ) left it open to the physicians' discretion whether to offer their patients elective cesareans without any medical indication. In the last several months there have been many articles used to support the option of elective cesarean surgery, as well as many articles supporting the view that cesarean section is major abdominal surgery carrying significant risk, and should only be performed when there is a clear medical indication. In the following pages, we present short summaries of several of these articles with references to the complete article, as well as responses to the current controversy from several birth organizations, to help you effectively address this issue with your clients. We have also included a fact sheet on the risks of cesarean delivery to mother and baby developed by the Coalition for Improving Maternity Services (CIMS CIMS Courant Institute of Mathematical Sciences (New York University) CIMS Center for Integrated Manufacturing Studies (Rochester Institute of Technology) CIMS Chemical Ionization Mass Spectrometry ). You are welcome to reproduce this fact sheet to use as a handout for your clients. Cesareans Sections Increase Maternal Death Rate In August of 2003, Harper et al., published an article titled "Pregnancy-Related Death and Health Care Services" (3) in Obstetrics & Gynecology, ACOG's journal. The focus of the study was to determine if there is an association between pregnancy-related death and health care service variables, such as use of nutritional services, source and use of prenatal care prenatal care, n the health care provided the mother and fetus before childbirth. and method of birth. Women who gave birth by cesarean section had a four times greater risk of dying than women who birthed vaginally. This does not support the option of elective cesareans and women should be informed of this risk before choosing a cesarean birth. Urinary Incontinence ACOG refers to an increased risk of urinary incontinence as a reason to justify elective cesarean surgery. In the same issue of Obstetrics & Gynecology as the above referenced, Dietz et al., published an article titled "The Effect of Childbirth on Pelvic Organ Mobility" (4) that showed women who birth vaginally versus by cesarean section have increases in organ mobility at two to five months postpartum. This suggests, but does not prove, that vaginal birth could be a contributing factor to urinary incontinence and pelvic-organ prolapse prolapse Protrusion of an internal organ out of its normal place, usually of the rectum or uterus outside the body when supporting muscles weaken. The membrane lining the rectum can push out through the anus, most often in old people with constipation who strain during . Among vaginal births, use of vacuum or forceps showed the greatest increase in pelvic organ mobility, with forceps having a two-fold increase in pelvic organ mobility above normal vaginal birth. (Refer to the CIMS' press release on the following page for interesting information and references regarding this issue.) An article published in the February 2003 issue of Obstetrics &Gynecology discussed the benefits of "Pelvic Floor Muscle Training During Pregnancy to Prevent Urinary Incontinence." (5) This article was not cited in ACOG's press release discussing the pros and cons pros and cons Noun, pl the advantages and disadvantages of a situation [Latin pro for + con(tra) against] of elective cesarean sections (6), although the above article suggesting that vaginal birth increased the chance of future urinary incontinence was referenced. Although ACOG does seem concerned by the problems some women have with urinary incontinence, it does not appear interested in prevention through education and exercise, only through major abdominal surgery. The International Randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. Term Breech breech (brech) the buttocks. breech n. The lower rear portion of the human trunk; the buttocks. breech, britch the buttocks of an animal; the backs of the thighs. Trial (7), showed a relatively small absolute reduction in incontinence with a cesarean birth versus a vaginal birth (7.3 percent versus 4.5 percent). These results suggest that at least 35 cesarean surgeries would have to be performed to prevent one case of incontinence. The small benefit of reducing urinary incontinence seems far outweighed by the many risks of cesarean surgery to mothers and babies, particularly when a simple exercise also reduces urinary incontinence. Cesarean Sections Double the Risk of Stillbirth Stillbirth Definition A stillbirth is defined as the death of a fetus at any time after the twentieth week of pregnancy. Stillbirth is also referred to as intrauterine fetal death (IUFD). in Future Pregnancies A recent study published in The Lancet showed that women with one previous cesarean birth had double the risk of having a stillborn stillborn /still·born/ (-born) born dead. still·born adj. Dead at birth. stillborn, n an infant who is born dead. stillborn born dead. in the subsequent pregnancy than did women whose first birth was vaginal. While the absolute risk is still low (1.1 per 1,000 for women who had a prior cesarean and 0.5 per 1,000 for women with a previous vaginal birth), women considering an elective cesarean should be informed of this increased risk. References (1.) National Vital Statistics Report. National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services. NCHS is the United States' principal health statistics agency. . Final Data for 2002. (www.cdc.gov/nchs/releases/03news/teenbirth.htm.) (2.) ACOG News Release. October 31, 2003. New ACOG Opinion Addresses Elective Cesarean Controversy. (www.acog.org/from_home/publications/press_releases/nr10-31-03-1.cfm.) (3.) Margaret A. Harper, MD, et al. Pregnancy-Related Death and Health Care Services. Obstetrics & Gynecology. August 2003; Volume 102, Number 2, pages 273-278. (www.greenjournal.org/cgi/content/abstract/102/2/273.) (4.) H.P. Dietz, MD and M.J. Bennett, MD. The Effect of Childbirth on Pelvic Organ Mobility. Obstetrics & Gynecology. August 2003; Volume 102, Number 2, pages 223-228. (www.acog.org/from_home/publications/green_journal /wrapper.cfm?document=2003/ong14512fla.htm.) (5.) Siv Morkved, MD, et al. Pelvic Floor Muscle Training During Pregnancy to Prevent Urinary Incontinence: A Single-Blind Randomized Controlled Trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. . Obstetrics & Gynecology. February 2003; Volume 101, Number 2; pages 313-319. (www.acog.org/from_home/publications/green_journal /wrapper.cfm?document=2003/ong13957fla.htm.) (6.) ACOG News Release. July 31, 2003. Weighing the Pros and Cons of Cesarean Delivery. (www.acog.org/from_home/publications/press_releases/nr07-31-03-3.cfm.) (7.) Mary E. Hannah, MDCM MDCM School of Media and Communications (School at University of New South Wales, Australia) MDCM Medicinae Doctorem et Chirurgiae Magistrum (Latin: Doctor of Medicine and Master of Surgery) , et al. Outcomes at Three Months After Planned Cesarean vs Planned Vaginal Delivery for Breech Presentation at Term. Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world. . April 2002; Volume 287, Number 14, pages 1822-1831. (http://jama.amaassn.org/cgi/content/abstract/287/14/1822.) (8.) Gordon Smith, et al. Caesarean Section and Risk of Unexplained Stillbirth in Subsequent Pregnancy. The Lancet. November 29, 2003; Volume 363; Issue 9398; pages 1779-1784. (www.ncbi.nlm.nih.gov/entrez /query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14654315&dopt=Abstract.) |
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