Don't have a caesar before 39 weeks!

Just the way I like to start my morning...finding a reason to hate Victoria Beckham just a little bit more...

Turns out a new study has shown that scheduling a caesar earlier for reasons of convenience is bad for baby and for mum. In a group of 24,000 babies, those who were born at 37 weeks to mothers who had elective caesars were twice as likely to experience breathing problems and blood infections. Even though babies are considered 'full term' at this stage, the American College of Obstetricians and Gynecologists suggests that women wait until at least 39 weeks. It is also argued that breastfeeding and bonding can be more difficult the earlier a baby is born.

On the other side of the coin, Michael F. Greene of Massachusetts General Hospital in Boston, who wrote an editorial accompanying the study said, "This paper, although it provides important information about risk, does not give us the whole story. It doesn't provide an accounting of how many babies may have died waiting to get to 39 weeks. You have to balance both sides of the ledger."

There you have it. Don't be like Posh and have your baby earlier if you don't need to.

Source: http://tinyurl.com/7eqee5

Camilla Alves talks some sense

Finally some sensible celebrity advice:

Camilla Alves, partner of Matt McConaughey, had this to say about being pregnant and having a caesar in an interview with BabyCenter:

"It’s a hard thing to be pregnant. Your hormones are crazy. Your body is changing. It’s a major change. I really enjoyed being pregnant, but I certainly didn’t love it."

"If there’s any advice I could give to a pregnant women, it’d be to have a natural birth. With c-sections, there’s a lot of pain and recovery is not fun. You already went through the whole pregnancy, and you don’t want to sit around for six to eight weeks in recovery. I don’t understand why healthy women go in and schedule a c-section."

"Women need to give their bodies time to rest. I really recommend that a woman who has the time, take that time to rest, because you’re not getting much sleep."

Source: http://tinyurl.com/524xjj

Insurance companies are evil

Again, sorry. I'm not normally this slack with my blogging. I do feel like I'm heavily pregnant with this damn thesis. I'm about 7 weeks from my due date and it's getting pretty hard to do anything these days without thinking about the birth. My head, hands and feet are swollen with visions of edited chapters, all of the typos still to correct and the insane amount of formatting still left to do.

Anyway, I've been wanting to write about this for awhile but couldn't find the time until now.

Apparently, the push (to not push) for caesarean births has finally come to a head. As impatient obstetricians continue to corral pregnant women into operating theatres, it seems that some American insurance companies are actually refusing to cover women with a history of caesarean births. As we all know, insurance companies will not come near anyone with anything remotely recognisable as a 'preexisting condition', it seems that given the impressive list of health risks associated with caesareans, insurance companies are keeping their hands off.

Women who had had caesars are being charged higher premiums or being denied insurance altogther. This covers both elective and emergency caesars. Given that the caesar rate is at an all time high--31% (eek!)---it is women who are suffering now. That doctors overuse the surgery and often do not allow women who have had previous caesareans to deliver vaginally (VBAC), women are now being labelled as undesirable insurance candidates by no fault of their own.

Some insurance companies have not excluded the procedure from coverage completely: One insurance company, Golden Rule, said they would pay for a caesar only if they would not have to cover another one for at least three years. Similarly, Blue Cross Blue Shield said they would cover caesars but only at the cost of a 25% increase in premiums for the next 5 years.

Nevertheless, in being denied medical insurance women and their babies are being placed at enormous danger. After all, it is only recently that the rates of maternal and infant mortality have increased since 2005 and the US has the second worst rate for newborn deaths of industrialised nations.

Does anyone have any experience with this? Have you been denied insurance?

Sources: http://www.msmagazine.com/news/uswirestory.asp?ID=11061

new elective caesar policy

This article is causing some profoundly mixed emotions for me. On one hand, it's truly fantastic that the NSW government (that's New South Wales, the most populous state of Australia for non-Australian readers) has acknowledged that not only is the rate of elective caesareans increasing but that it is also possibly endangering the lives of women who are uneducated about the procedure.

However, I have strong feelings about taking women's responsibility for their own bodies away from them and giving control over to the government to decide what is best for birth. Clearly, major abdominal surgery is a significant leap from vaginal delivery but is it really fair to insist that women must not have a technologised or interventionist birth if that is what they really want? Sure, some of you might say 'Well, how does she know what she wants if she doesn't know the risks?' That goes without saying but adult decision making is kind of like that. We make decisions about lots of things without knowing all of the associated risks. With birth, it seems like everyone seems to know what's best for pregnant women except women themselves.

We dont have to agree with the choices other women make but I think we need to respect them. I might not choose to have an elective caesar but I don't think my choice not to have one should prevent another woman from having one if that is what she feels comfortable doing. I think it would be a completely different story if for instance, the NSW government decided to ban women from having pain-reducing drugs during labour because pain relief is non-surgical. All of the most common pain killing drugs have side effects and there is plenty of research to support that. Hell, epidurals are injected into the spine. That's a major risk; but women who want to have less pain in labour should never be forced to 'suffer' needlessly and many women are willing to take a risk to be comfortable. I think this is the same issue. Maybe it seems a little strange to some of us that a woman would rather have surgery than give birth vaginally but in my own work, I have interviewed a number of women who have had elective caesars for various reasons. Fear of pain is a primary reason and who can really fault them for that? It's not my place to do so and it's not the government's place either. Women need to make up their own minds about how they have their babies. Caesareans should remain an 'option' because women should have every opportunity available to them to have a comfortable birth and if that means being cut open, who am I to judge?

Caesars can either serve or impair women's agency not so much by the inherent character of the procedure (in terms of obvious physical risks), but in how the politics surrounding elective caesareans coalesces with the needs of variously situated women (economically and politically and also varying by race, class, and sexuality). What is 'good' for some women is not necessarily appropriate for all women.

NSW hospitals move to block caesarean option
7 April 2007, The Age

WOMEN will not be allowed to insist on caesarean deliveries in NSW public hospitals without a medical reason, under a new health department policy. Under the new rules, women must be told in detail about "the benefits and risks of caesarean section compared with vaginal birth specific to the woman and her pregnancy". The policy cites a US study of more than 5 million births, which found that babies born by medically unnecessary caesarean were three times as likely to die in the newborn period as those born vaginally.The new policy also obliges health professionals to advise women about the implications for subsequent pregnancies. A 2005 study of 136,000 second pregnancies across NSW found those women who had had a caesarean first delivery were at much greater danger of a ruptured uterus, hysterectomy orinfection, while their babies were more likely to be premature, have serious breathing problems or need intensive care. Elective caesareans have increased by 25 per cent since 2001, and now account for one in six births. Many of these are for medical reasons, but doctors say more women are opting for caesareans from preference. Andrew Child, a member of the NSW Health Maternal and Perinatal Committee,which drafted the directive, said that while first caesareans were generally safe, dangers escalated steeply with subsequent births. Hannah Dahlen, secretary of the NSW Midwives Association, said: "People are... thinking of it as just another option for birth, rather than major abdominal surgery."JULIE ROBOTHAM