Excellent Post Used with Permission from Teresa Howard

Yale Studies Reason for Increase Cesareans

Jun 22 2011

http://www.healthcanal.com/pregnancy-childbirth/18241-Yale-Researchers-Pinpoint-Reasons-for-Dramatic-Rise--Sections.html

So usually I just post the study link on our facebook page and let you go to read about it. But today I wanted to share a bit more about what this study shows.

“New Haven, Conn. — In one of the first studies to examine the reasons for the rising number of women delivering their babies by cesarean section, Yale School of Medicine researchers found that while half of the increase was attributable to a rise in repeat cesarean delivery in women with a prior cesarean birth, an equal proportion was due to a rise in first time cesarean delivery. Among these deliveries, factors such as slowly progressing labor and fetal heart rate concerns were the largest contributors.”

It was not the 8% of women choosing an elective cesarean. It was not the placenta being low or placenta previa. It was not the baby being breech or even twins. It was not the decision to do a cesarean rather than use forceps or vacuum.  In fact the majority of the births by cesarean were done very early before an instrument assist could have even been used. In fact it was the less objective reasons that contributed the most to the increase cesareans.

“while less objective reasons, such as slow progress in labor and concerns about fetal heart tracings contributed large proportions (>50%) to the increasing primary cesarean delivery rate”

So labor arrest- or slow labors- or in other words being in a rush! And I wonder how much of the slow labors were due to the increase use of epidurals in early labor that slowed labor down or caused the baby to be malpositioned. I wondered if inductions were a reason- forcing a woman to evacuate her baby before the baby and mom’s body were ready. I wonder if the heart rate issues were due to the use of epidurals and pitocin when labor stalled.
Can we just leave labors alone? Can we just let them unfold and only use epidurals and pitocin when actually needed? Can we remove the clocks from labor rooms and support women who have long labors without making them feel it is abnormal and something must be wrong? Can we believe that each woman, each baby is different and unique and what is normal for one mom may not be normal for another? Can we throw away the Friedman’s Curve which is 50 years old and considered obsolete?  This article came out in 2003 but I had a doctor quote the Friedman’s curve last week!
Trust birth, trust women’s bodies, trust babies to know when to come. Sure there are times when induction is needed or augmentation is necessary. And if you begin each labor with, “We trust this woman’s body. We trust this woman to labor the unique way she will labor. We trust her baby to make his/her way out safely. We will support this woman and only intercede if really medically necessary. I wonder what our cesarean rate would decline. In fact I know this would work because it is working in a few practices here in Atlanta where the cesarean rate is quite low! Find a care provider who trusts births! But there is one more factor… as a woman you too need to learn to trust your body and birth.
Trusting your body and the labor and birth process is something that will help you avoid rushing into interventions as well. Often women will tell me they plan to get an epidural or will have an induction but they have never had a “real”  contraction before. They begin their labor full of fear and without confidence in their bodies. You can not enter labor with that mind set and then complain if you have a cesarean. You might have well just walked directly into the OR to begin with. Start with TRUST! Take ownership of the decisions that begin your labor.