becca74
13-04-2007, 18:24
Great article on this!
from: http://www.caesarean.org.uk/articles/Myths.html
<H1>Caesarean Myths Exploded
Debbie Chippington Derrick and Gina Lowdon examine some of the myths about caesarean birth.
Despite the fact that caesareans are far more common than most people realise, the operation is still surrounded by a considerable amount of mystery. It is often difficult to distinguish between reliable up-to-date research-based information and the considerably larger bulk of accepted 'knowledge', much of which is based on opinions and practices that medical research calls into question.
Individual women are often in a position where 'informed choice' is impossible, since there appears to be only one sensible course of action - any alternatives remain hidden from consideration due to inadequate availability of information. For some women this may not be a problem, since they may be happy to trust to the experience of their health professionals and may welcome the freedom from responsibility that this can bring.
However, without full information, a mother may feel that she has no option but to accept the course deemed most appropriate by others. One of the main contributing factors to post-caesarean emotional trauma is a woman's loss of control. Many caesarean mothers feel that they had no alternative but to put themselves fully in the hands of the medical professionals. Good information can go a long way to enabling women to take part in the decision-making process, thus reducing such trauma.
CAESAREAN MYTH NO. 1
A diagnosis of cephalopelvic disproportion (CPD) is a recurring condition always requiring elective repeat caesarean section
A diagnosis of CPD is where the baby's head is thought to be too large to pass through the woman's pelvis. In the 18th and 19th centuries, poor nutrition, rickets and illnesses such as polio caused pelvic anomalies, which resulted in loss of life during childbirth. Indeed initially CPD was the most common reason for carrying out a caesarean. In modern times, however, CPD is rare, since our general standard of living is so much higher and true CPD is more likely to be caused by pelvic fracture due to road traffic accidents or congenital abnormalities.
Often CPD is implied rather than diagnosed. In cases where labour has failed to progress or the baby has become distressed, medical staff commonly assume that this is due to physical inadequacies in the mother rather than look towards circumstances of the mother's care. These problems frequently occur when CPD is not suspected and there are many other causes such as fear and uncertainty, difficulty adjusting to a medical environment, lack of emotional support and non-continuity of carer.
Many women worry about how something as big as a baby will come down such a narrow vaginal passage, so implications of pelvic inadequacy can confirm personal fears, lower self-esteem, affect the progress of any subsequent labour and add greatly to feelings of failure.
CPD is also sometimes suspected when the baby's head fails to engage, although both this and failure to progress have proved unreliable indicators.
When CPD is suspected, x-ray pelvimetry may be suggested, either antenatally or postnatally. This is when the mother's pelvis is measured by taking x-rays to assess pelvic adequacy. Quite apart from the health risks of x-rays,3,4 this method of pelvic assessment has been criticised since it has been shown to be inaccurate and because often the results do not influence the way that the delivery is managed.5 Due to concerns over x-ray exposure of women and babies, some hospitals offer pelvimetry by computed tomography (CT) scan which uses a much lower dose of radiation. However, there is no reason to believe that the resulting measurements will provide a more accurate diagnosis of CPD than conventional x-rays for the same reasons.
A woman's degree of motivation to achieve a vaginal delivery along with the level of support she receives are likely to be more influential on the outcome than her pelvic measurements. Even in undisputed cases of CPD, it should still be possible for a mother to go into labour without compromising the safety of her baby. In fact, a period of labour prior to caesarean section is believed to reduce the occurrence of respiratory distress and can therefore be beneficial for the baby.
In any case, CPD is difficult to diagnose accurately since there are no less than four variables that cannot be measured:
The pelvic girdle is not a fixed, solid structure. During pregnancy and labour the hormone relaxin softens the ligaments that join the pelvic bones, allowing the pelvis to give and 'stretch'. The degree of pelvic expansion achieved will vary from woman to woman and from pregnancy to pregnancy.
Babies' heads are made up of separate bones which move relative to each other, allowing the baby's head to 'mould' and thus reduce its diameter during passage down the birth canal. No-one can predict the capacity of an individual baby's head to mould and, as this is a feature of the normal birth process, should not adversely affect the health and well-being of the baby.
The position that a woman adopts during labour and delivery makes a difference to pelvic dimensions. Squatting, for example, can increase pelvic measurements by up to 30%. One of the most common positions in which women give birth, that of being semi-reclined where the mother's weight is on her coccyx, restricts movement of the coccyx, which can severely compromise a below-average pelvis.
The position of the baby can be crucial, and whether its head is well flexed or tilted can mean the difference between an easy delivery and delivery being impossible.When a diagnosis of CPD has been made, many people still believe that this constitutes a reason for elective repeat caesarean section in future pregnancies, despite the wealth of evidence to the contrary. Indeed, there have been many documented cases where women have been diagnosed as having CPD and then gone on to deliver vaginally a larger infant than the one that was delivered surgically.
Karen, whose first baby remained high and was caesarean born due to failure to progress in labour, was diagnosed as having CPD following a CT scan. She went on to deliver a healthy 9lb 7oz baby vaginally.The Guide to Effective Care in Pregnancy and Childbirth'The likelihood of vaginal birth is not significantly altered by the indication for the first caesarean section (including "cephalopelvic disproportion" or "failure to progress").'
Some women will be able to accept and concur with a diagnosis of CPD, perhaps even preferring the caesarean way of birth, whereas others will want to be able to come to their own independent conclusions, and some of these may wish to labour again under more conducive circumstances, to have the chance to give labour their 'best shot'. CAESAREAN MYTH NO. 2
Twice a caesarean, always a caesarean
After one caesarean section, VBAC (pronounced vee-back - vaginal birth after caesarean) is widely accepted as appropriate and safe. However, after two or more caesareans, it is common policy for a mother to be automatically scheduled for an elective (planned) caesarean since it is believed that the risks of caesarean scar rupture increase with the number of caesarean operations.
Lack of evidence supporting this theory has led some researchers and obstetricians to question the basis for this accepted practice.8,9 Indeed, the highly respected Guide to Effective Care in Pregnancy and Childbirth concludes that: '...the available evidence does not suggest that a woman that has had more than one previous caesarean section should be treated any differently from the woman who has had only one caesarean section'.10
While the number of obstetricians willing to support a mother through labour after two caesareans is believed to be small, that number does appear to be increasing, leading the authors to believe that the tide may be turning in this respect. However, it is rare to hear of a vaginal delivery after three sections and the authors know of no cases in this country following four or more caesareans, although cases have been documented in the United States.
One reason for such low numbers of vaginal deliveries after multiple caesareans is the low parity in this country and it is known that women who undergo caesarean operations tend to have fewer children than average, although the reasons for this are not clear.
It must also be accepted that many women who have had multiple caesareans will have no desire to embark on a labour, having come to terms with the caesarean section as a mode of delivery, and who may well have come to prefer the caesarean way of birth. Others may well take the attitude 'better the devil you know'.
Consequently, the chances of an obstetrician encountering a woman in her fourth or subsequent pregnancy, who has had three or more caesarean sections and is well motivated to achieve a vaginal delivery, are slim at best, and he is unlikely to do so many times in his career. So few obstetricians are confronted with such a situation that knowledge of the true risks, or rather the lack of them, is sparse, and the confidence that comes with experience totally lacking. Individual mothers who wish to avoid further caesarean operations must therefore have access to information from other sources in order to facilitate truly 'informed choice'.
</H1>
cont. below
from: http://www.caesarean.org.uk/articles/Myths.html
<H1>Caesarean Myths Exploded
Debbie Chippington Derrick and Gina Lowdon examine some of the myths about caesarean birth.
Despite the fact that caesareans are far more common than most people realise, the operation is still surrounded by a considerable amount of mystery. It is often difficult to distinguish between reliable up-to-date research-based information and the considerably larger bulk of accepted 'knowledge', much of which is based on opinions and practices that medical research calls into question.
Individual women are often in a position where 'informed choice' is impossible, since there appears to be only one sensible course of action - any alternatives remain hidden from consideration due to inadequate availability of information. For some women this may not be a problem, since they may be happy to trust to the experience of their health professionals and may welcome the freedom from responsibility that this can bring.
However, without full information, a mother may feel that she has no option but to accept the course deemed most appropriate by others. One of the main contributing factors to post-caesarean emotional trauma is a woman's loss of control. Many caesarean mothers feel that they had no alternative but to put themselves fully in the hands of the medical professionals. Good information can go a long way to enabling women to take part in the decision-making process, thus reducing such trauma.
CAESAREAN MYTH NO. 1
A diagnosis of cephalopelvic disproportion (CPD) is a recurring condition always requiring elective repeat caesarean section
A diagnosis of CPD is where the baby's head is thought to be too large to pass through the woman's pelvis. In the 18th and 19th centuries, poor nutrition, rickets and illnesses such as polio caused pelvic anomalies, which resulted in loss of life during childbirth. Indeed initially CPD was the most common reason for carrying out a caesarean. In modern times, however, CPD is rare, since our general standard of living is so much higher and true CPD is more likely to be caused by pelvic fracture due to road traffic accidents or congenital abnormalities.
Often CPD is implied rather than diagnosed. In cases where labour has failed to progress or the baby has become distressed, medical staff commonly assume that this is due to physical inadequacies in the mother rather than look towards circumstances of the mother's care. These problems frequently occur when CPD is not suspected and there are many other causes such as fear and uncertainty, difficulty adjusting to a medical environment, lack of emotional support and non-continuity of carer.
Many women worry about how something as big as a baby will come down such a narrow vaginal passage, so implications of pelvic inadequacy can confirm personal fears, lower self-esteem, affect the progress of any subsequent labour and add greatly to feelings of failure.
CPD is also sometimes suspected when the baby's head fails to engage, although both this and failure to progress have proved unreliable indicators.
When CPD is suspected, x-ray pelvimetry may be suggested, either antenatally or postnatally. This is when the mother's pelvis is measured by taking x-rays to assess pelvic adequacy. Quite apart from the health risks of x-rays,3,4 this method of pelvic assessment has been criticised since it has been shown to be inaccurate and because often the results do not influence the way that the delivery is managed.5 Due to concerns over x-ray exposure of women and babies, some hospitals offer pelvimetry by computed tomography (CT) scan which uses a much lower dose of radiation. However, there is no reason to believe that the resulting measurements will provide a more accurate diagnosis of CPD than conventional x-rays for the same reasons.
A woman's degree of motivation to achieve a vaginal delivery along with the level of support she receives are likely to be more influential on the outcome than her pelvic measurements. Even in undisputed cases of CPD, it should still be possible for a mother to go into labour without compromising the safety of her baby. In fact, a period of labour prior to caesarean section is believed to reduce the occurrence of respiratory distress and can therefore be beneficial for the baby.
In any case, CPD is difficult to diagnose accurately since there are no less than four variables that cannot be measured:
The pelvic girdle is not a fixed, solid structure. During pregnancy and labour the hormone relaxin softens the ligaments that join the pelvic bones, allowing the pelvis to give and 'stretch'. The degree of pelvic expansion achieved will vary from woman to woman and from pregnancy to pregnancy.
Babies' heads are made up of separate bones which move relative to each other, allowing the baby's head to 'mould' and thus reduce its diameter during passage down the birth canal. No-one can predict the capacity of an individual baby's head to mould and, as this is a feature of the normal birth process, should not adversely affect the health and well-being of the baby.
The position that a woman adopts during labour and delivery makes a difference to pelvic dimensions. Squatting, for example, can increase pelvic measurements by up to 30%. One of the most common positions in which women give birth, that of being semi-reclined where the mother's weight is on her coccyx, restricts movement of the coccyx, which can severely compromise a below-average pelvis.
The position of the baby can be crucial, and whether its head is well flexed or tilted can mean the difference between an easy delivery and delivery being impossible.When a diagnosis of CPD has been made, many people still believe that this constitutes a reason for elective repeat caesarean section in future pregnancies, despite the wealth of evidence to the contrary. Indeed, there have been many documented cases where women have been diagnosed as having CPD and then gone on to deliver vaginally a larger infant than the one that was delivered surgically.
Karen, whose first baby remained high and was caesarean born due to failure to progress in labour, was diagnosed as having CPD following a CT scan. She went on to deliver a healthy 9lb 7oz baby vaginally.The Guide to Effective Care in Pregnancy and Childbirth'The likelihood of vaginal birth is not significantly altered by the indication for the first caesarean section (including "cephalopelvic disproportion" or "failure to progress").'
Some women will be able to accept and concur with a diagnosis of CPD, perhaps even preferring the caesarean way of birth, whereas others will want to be able to come to their own independent conclusions, and some of these may wish to labour again under more conducive circumstances, to have the chance to give labour their 'best shot'. CAESAREAN MYTH NO. 2
Twice a caesarean, always a caesarean
After one caesarean section, VBAC (pronounced vee-back - vaginal birth after caesarean) is widely accepted as appropriate and safe. However, after two or more caesareans, it is common policy for a mother to be automatically scheduled for an elective (planned) caesarean since it is believed that the risks of caesarean scar rupture increase with the number of caesarean operations.
Lack of evidence supporting this theory has led some researchers and obstetricians to question the basis for this accepted practice.8,9 Indeed, the highly respected Guide to Effective Care in Pregnancy and Childbirth concludes that: '...the available evidence does not suggest that a woman that has had more than one previous caesarean section should be treated any differently from the woman who has had only one caesarean section'.10
While the number of obstetricians willing to support a mother through labour after two caesareans is believed to be small, that number does appear to be increasing, leading the authors to believe that the tide may be turning in this respect. However, it is rare to hear of a vaginal delivery after three sections and the authors know of no cases in this country following four or more caesareans, although cases have been documented in the United States.
One reason for such low numbers of vaginal deliveries after multiple caesareans is the low parity in this country and it is known that women who undergo caesarean operations tend to have fewer children than average, although the reasons for this are not clear.
It must also be accepted that many women who have had multiple caesareans will have no desire to embark on a labour, having come to terms with the caesarean section as a mode of delivery, and who may well have come to prefer the caesarean way of birth. Others may well take the attitude 'better the devil you know'.
Consequently, the chances of an obstetrician encountering a woman in her fourth or subsequent pregnancy, who has had three or more caesarean sections and is well motivated to achieve a vaginal delivery, are slim at best, and he is unlikely to do so many times in his career. So few obstetricians are confronted with such a situation that knowledge of the true risks, or rather the lack of them, is sparse, and the confidence that comes with experience totally lacking. Individual mothers who wish to avoid further caesarean operations must therefore have access to information from other sources in order to facilitate truly 'informed choice'.
</H1>
cont. below