In The News

Listening to Mothers Survey Results

"The second national U.S. Listening to Mothers survey was carried out in January-February 2006 among women who gave birth in 2005...1,574 women described their experiences planning pregnancy, being pregnant, giving birth and during the postpartum period." 75

The findings in summary:

• Requesting caesareans for no medical reason - "just one woman (0.08%) among 1315 survey participants who might have initiated a planned primary cesarean without medical reason did so...Applying this to the most recent national figure for annual births, an estimated 2,616 women out of about 4.1 million who gave birth in 2005 had primary no-indication maternal request cesareans."
• Reasons for the increase in caesarean rates in the U.S. - "Numerous legal, clinical, financial, social and other factors contribute to rising cesarean rates. These include professionals' fears of legal claims of malpractice and lawsuits, the failure to offer women care that lowers their likelihood of having a cesarean (such as continuous labor support or hands-on-belly maneuvers to turn babies to a head-first position), and widespread failure to offer women with a previous cesarean or a legs- or buttocks-first (breech) baby the choice of vaginal birth."
• Pressure to have a caesarean - "Nine percent of the mothers reported experiencing pressure to have a cesarean. This pressure from professionals to have a cesarean vastly outweighs the pressure from mothers to have one...Forty-two percent felt that the current system leads maternity care providers to perform a cesarean section that is not really needed to avoid being sued."
• How informed were women prior to their surgery - "The survey asked participants how much they agreed or disagreed with four statements about side effects of cesareans, including shorter- and longer-term effects on mothers and babies. From 42% to 45% of the mothers were "not sure" about how to reply to the four items, and an additional 21% to 33% responded incorrectly. These results raise serious concerns about the adequacy of current informed consent processes for this major surgical procedure."
• Availability of VBAC - "...just 12% of the women with a previous cesarean in the survey had a VBAC in 2005. Of the remaining women who had a repeat cesarean, 45% were interested in the option of having a VBAC, but more than half (56%) of them were denied this option, primarily because their caregiver (45%) or hospital (23%) was unwilling to do a VBAC."

Results from NIH (National Institutes of Health) conference in USA in March 2006

A panel of scientists assembled by the US National Institute of Health earlier this year called for further research into the effects, both positive and negative, of caesarean births and highlighted the need to improve the information available to women making birth choices.

The panel's primary recommendations were:

• That risk to future pregnancies means that women planning more than one or two children should not have a purely elective caesarean. Topping the concern is that a prior caesarean significantly increases the risk of a life-threatening placenta problem in a later pregnancies.
• Newborns are more likely to have respiratory problems if they're born by Caesarean, regardless of the reason for the surgery. So doctors should perform elective C-sections only if they're sure the woman has reached at least 39 weeks of gestation, when foetal lungs are fully mature.
• Full-term pregnancies are typically defined as lasting 40 weeks from the start of the last menstrual period, but gestational age can be difficult to measure correctly. The March of Dimes last week reported that most births now take place at 39 weeks, a change the non-profit group attributed in part to pre-planned C-sections, which it fears also may drive inadvertent delivery of slightly premature babies.
• Doctors should never bring up the option of a purely elective C-section. But if a mother-to-be requests one, the health provider should determine her reason for the request and help weigh the risks and benefits.
• If the woman's reason is a fear of pain during labour and delivery, doctors should help her choose from among the multiple safe options to avoid that; pain-numbing epidurals are the most effective.

Dr. Mary D'Alton, (Obstetrics chief at Columbia University Medical Centre) who chaired the panel said of caesareans, "we don't believe it should be discouraged or encouraged," concluding that there are important pros and cons to the different methods of childbirth. "There's not one right answer for everyone." 84