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"Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth." 
-Virginia Di Orio

News Release - If doctors can learn to be patient the cesarean rates will surely fall!
News Release - C-section rates are rising! But, why?

VBAC safety: A closer look at the 2002 JAMA study 
Click here to read this article written by Henci Goer, award-winning medical writer and internationally known speaker. She is the author of 
The Thinking Woman's Guide to a Better Birth and 
Obstetric Myths Versus Research Realities: A Guide to the Medical Literature

She has written many informative articles. For a complete list of her articles go to her website at:

Doctor preaches patience 
Missoulian News Online
May 04, 2002 
By GINNY MERRIAM of the Missoulian 

Specialist says number of births by C section needs to be reduced 
Patience is the most important tool for doctors who deliver babies and want to reduce their numbers of Caesarean section births, a Wisconsin physician and specialist said Friday in Missoula. 

"Certainly patience is a virtue in obstetrics," said Dr. Robert DeMott, who practices "low-intervention obstetrics" in Green Bay, Wis., and is a veteran of 2,044 deliveries in 14 years. "Just because things are progressing slowly, and two hours have passed, doesn't mean you wheel her off to the OR." 

DeMott spoke to a meeting in Missoula of the Statewide Task Force on Caesarean Reduction, which drew about 75 labor and delivery nurses, physicians and related providers to the Holiday Inn Parkside. Started by Western Montana Clinic and Blue Cross and Blue Shield of Montana, it has been meeting several times a year since the fall of 1999. Its goal is to lower the incidence of births by Caesarean section, called for short "C section," in Montana and promote standard vaginal deliveries when possible. 

In 1972, 6.5 percent of U.S. births were Caesarean; in 2001, 23 of 100 babies were C section babies, born by abdominal surgery on their mothers. That was more than 1.2 million babies born surgically - without necessarily better outcomes for mothers or babies, said Lynne Evans, a registered nurse who works as quality care manager at Western Montana Clinic and is coordinator of the task force. 

"It's the most common surgery performed," she said before the conference. "But it's estimated 25 to 50 percent of those are unnecessary." 

In Montana, the rate of C section births last year was 19.1 percent; births in Missoula at Community Medical Center last year matched that percentage. The national health goal set in 2000 is 15 percent. 

Last year, Montana was only one of two states that did not have a rise in C section rates, said Missoula physician Eric Hughson, who is director of the task force. 

"Of course," he said, "we're happy to take credit for that." 

In the short few years the task force has been working, it has attracted a fair number of doctors who will listen, he said. However, it's too soon to be sure the work is affecting doctors' practices. 

Caesarean births carry a death rate for mothers that's three to seven times greater than vaginal births, differing among studies. 

"It is my opinion that Caesarean section is absolutely more dangerous to women than a vaginal delivery," said DeMott. 

As surgeries, C sections carry with them the risks associated with 
anesthesia and the danger of infection, bleeding and pulmonary embolism, a blood clot or air bubble in the blood supply to the lungs. Down the road, studies find increased incidence of endometriosis and scar tissue in the bowel and bladder. 

For the baby, C sections bring more frequent cases of abnormally fast breathing and of hemorrhages in the brain and between the brain and the skull. 

There may be more effects, DeMott said. 

"I think there's things we do not know about the benefits of vaginal birth," he said. 

C section delivery is also expensive, costing about twice as much. 

In some cases - for instance, when a fetus is crosswise or sometimes in a breech position, or in cases where mother or fetus would die without surgical intervention - a surgical birth is necessary. But they are often chosen for the wrong reasons, said DeMott, whose own rate of Caesarean births is 6.2 percent and whose success rate in vaginal births after a first C section is 97 percent. 

In DeMott's study in Green Bay of births at three hospitals from 1986 
through 1994, he looked at the characteristics of doctors with high and low rates of C section births. He found that the lower-rate doctors were more patient - "They simply waited," he said. 

They were less likely to artificially rupture membranes to move labor along and less likely to induce labor with drugs. 

In his own practice, DeMott favors focusing on a due month, not a specific date. He also uses therapeutic rest during labor, in which the mother is allowed to sleep for a few hours. He never tells women their pelvises are too small. He never estimates the weight of a fetus, as studies show that women with large babies are treated differently and are more likely to be rushed into surgery. At DeMott's hospital, Bellin Memorial, 2.5 percent of babies weigh more than 4,500 grams, or about 10 pounds, which is twice the national average. 

"That's why we have such a good football team," he joked. "It's beer, cheese and bratwurst." 

The main reason given for C sections in U.S. hospitals is "failure to 
progress," given in 22 percent of cases, said Missoula obstetrician and perinatalogist Lynn Montgomery. Montgomery's residency was at Baylor University in Houston, which saw 50 births a day and simply did not have the time and the staff to do unnecessary C sections, Montgomery said. Using what he learned, his five-year practice in Fargo, N.D., before coming to Missoula contributed to a C section rate of 9 percent for all providers there. 

A disturbing trend that is a growing concern on both U.S. coasts but has yet to come to the heartland is elective C sections, in which a woman demands birth by surgery to avoid labor or to be able to schedule a birth, DeMott said. 

Studies in London and in Israel found that significant percentages of 
obstetricians thought mothers should be given the choice, he said. This raises ethical and philosophical questions. 

"Is there a right to choose a more harmful route of delivery?" he said. 

"Is it ethical to even offer the choice?" he said. "Or is it ethical to be 
silent? I'm not telling you the answers to these questions because I don't know." 

DeMott reminded his audience that pregnancy, labor and vaginal delivery are normal physiologic processes. 

"Why have we turned it into a disease?" he said. "We've turned our labor and delivery units into intensive care units. I think we should get back to a more normal method." 

Reporter Ginny Merriam can be reached at 523-5251 or at 

The National Women's Health Alliance (NWHA) is dedicated to providing women with important information about their health care. Its purpose is to enable women to make meaningful choices on medical procedures and devices, over-the-counter medications, prescription drugs, physicians and health care providers. 

U.S. Caesarean Births Rapidly Rising
Thu Jun 6, 2002

Almost one in four women who gave birth last year had a Caesarean
section, the highest rate in 13 years - an increase fueled by repeat
operations and also women who schedule C-sections for convenience.

C-sections had dropped in the early 1990s after an outcry that American women were getting too many. But in 1997, they started inching back up again. Last year brought the biggest jump yet, a 7 percent increase that "was certainly a surprise," said Joyce Martin, co-author of the Centers for Disease Control and Prevention (news - web sites) birth report that was released Thursday.

That made C-sections account for 24.4 percent of U.S. births last year, the CDC found. The nation's high was 25 percent in 1988. The annual birth report also found:
-Teen-age birth rates continued their decade-long drop, hitting a record low of 45.9 births for every 1,000 girls ages 15 to 19. That is 5
percent lower than the rate of 48.5 births per 1,000 girls in 2000.
-4.04 million babies were born in the United States last year, a slight
drop from the previous year.
-The rate of low birthweight babies has remain unchanged since 1998, at 7.6 percent.

Caesareans can be life- or health-saving for many mothers and babies. But a C-section is major abdominal surgery so avoiding unnecessary ones also is important.

Women's risk of death, although small, is three to seven times higher
than during vaginal delivery, says the American College of Obstetricians and Gynecologists. They also have longer hospital stays, a higher risk of post-delivery infection and increased pain.

Almost 17 percent of first-time mothers had a Caesarean last year, a 5 percent jump, the CDC reported.

Part of the reason is that more women are opting for a Caesarean even though they are healthy enough to avoid one. There is no data on exactly how often this happens, although "patient-choice Caesareans" are being done around the country.

Some obstetricians say it is wrong to operate without a medical reason while others say it is paternalistic not to let women choose.

But most Caesareans are repeats. Women who had one C-section are very likely to give birth that way again. Last year, the number of
prior-Caesarean mothers who succeeded in giving birth vaginally
plummeted by 20 percent.

Studies at teaching hospitals sparked the trend of "vaginal birth after
Caesarean," or VBAC, in the early 1990s, showing it was safe to try if
the previous surgical cut had been made in the lower, not upper,

There is a 1 percent risk of a uterine rupture during VBAC, but the few
women who do suffer it fare well if they give birth at hospitals
prepared to do emergency Caesareans, said Dr. Bruce Flamm of Kaiser
Permanente Medical Center in Riverside, Calif., a spokesman for the
obstetricians and gynecologists group.

But by the late 1990s, more women who had had Caesareans were having their subsequent deliveries at community hospitals, which are less prepared to offer emergency surgery, he said.

With the growing crisis of affordable malpractice insurance an
additional factor, "I don't see any counterbalancing that is going to
bring the C-section rate down" any time soon, Flamm said.

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