Deaths and severe complications in pregnancy and childbirth are increasing
in the United States, according to an article, "Rising Maternal Mortality
Rate Cases Alarm, Calls for Action," published Sunday in the Los Angeles
Times. Experts on maternal health think there are several reasons for this
trend: More pregnant women today are older and obese, and childbirth
practices have changed greatly over the past two decades with more cesarean
sections and induction of labor. The death of a new mother at what should be
a joyous time is unspeakably sad. We profiled a Los Angeles man, Matt
Logelin, whose wife died unexpectedly a day after giving birth to their
daughter.
Why is having a baby today less safe than it was two decades ago? Two
studies published Monday in the journal Obstetrics & Gynecology, one on
vaginal birth after C-section and one on childbirth-related hysterectomy,
make suggestions for addressing the crisis in obstetrics.
The first paper summarizes the findings of a government consensus conference
that took place in March at the National Institutes of Health. Researchers
concluded that vaginal birth after cesarean is "a reasonable choice for the
majority of women." The paper is based on a large database of births and
finds that although both elective repeat cesarean section and VBAC are
highly safe, maternal death was higher for elective repeat Cesarean sections
(0.013% versus 0.004% for a trial of labor). The rates of hysterectomy,
hemorrhage and transfusions did not differ between the two groups. Uterine
rupture -- the complication that is usually given for discouraging VBACs --
was rare but higher in the trial of labor group (0.47% compared with 0.03%
in the repeat C-section group). Infant death was higher in the trial of
labor group (0.13% compared with 0.05% in the repeat C-section group).
About one-third of all births today in the U.S. are cesareans, and the most
common reason for needing a C-section is that the mother has already had
one. But recent studies show that two or more cesareans increase the risk of
dangerous complications of the placenta that may be contributing to the
increase in maternal deaths in recent years. That complication may prove to
be more significant than the risk of uterine rupture in a woman attempting a
VBAC, said Dr. James R. Scott, the editor in chief of Obstetrics &
Gynecology, in an editorial accompanying the study.
It's time to start reversing C-section rates in part by allowing VBACs in
carefully selected patients, Scott wrote. For that to happen, he said,
hospitals and insurance companies need to lift their flat-out bans on VBACs.
"Instead, the patient should be allowed to make that choice after she has
been informed of the facts and has been counseled by her physician
thoroughly," Scott said.
Source : latimes.com
