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Medical C-sections increasing, risks involved

  1. Nov 4, 2018 #1
    There is a slow but steady progress in creating incidences of c-section deliveries globally across the world.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743929/

    What is the cause of it? Is this alarming and should it be earnestly reversed? Why childbirth is considered to be terribly complicated now, when humanity had had vaginal childbirths for thousands of years?

    Is there a systemic reason apart from saving mothers and children?
     
  2. jcsd
  3. Nov 4, 2018 #2
  4. Nov 4, 2018 #3
    This line of thinking avers that vaginal childbirths which are natural, are considered dangerous now. And there is a distinct March away from such deliveries.

    In order to prevent mortalities is there no other way other than c-sections?

    With the advancement of science we should be able to make the natural childbirth safe. Why this is not happening?
     
  5. Nov 5, 2018 #4

    Ryan_m_b

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    "Avers" is not a word. Did you mean "implies"? In any case vaginal birth is not suddenly being considered dangerous, it was always considered dangerous.

    Why should we? What is it about vaginal delivery that makes you think it automatically should be possible to be completely safe?

    Medical advances have made birth a much safer process. In addition caesareans have made complications in birth much safer to deal with. As your linked paper suggests the exact reasoning why caesareans are more common than they used to be are complicated and go beyond the strictly medical into social practices.
     
  6. Nov 5, 2018 #5
    Following on from Ryan MB
    We have not evolved to be perfect biological machines, we have evolved from what material we had to begin with genetically from our ape like ancestors and natural selection did the rest.


    Refrigeration, warm clothing, central heating, dentistry, sanitization, pasteurization, vaccination, antibiotics, condoms and life-saving surgery are not in any way natural but they save lives.


    That’s why we live till about 80 in the west today compared to about 40 yrs 200 years ago.
     
  7. Nov 5, 2018 #6

    Ygggdrasil

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    While c-sections are essential in some deliveries, caesarian sections carry many short-term and long-term risks to the mother and child. For these reasons, the World Health Organization has published recommendations that ~10-15% of births be done via c-sections. Obviously, in many countries, access to health care has many countries below this rate. However, in many developed countries, the rate of c-sections has increased dramatically, overshooting the recommended rate. There is considerable evidence that many c-sections in developed countries like the US are not medically necessary and provide no benefits to the mother and child. The medical journal The Lancet has referred to this increase as a "global caesarian section epidemic" and published a series of articles examining this issue:

    https://www.thelancet.com/series/caesarean-section

    Popular press coverage of The Lancet's reports:
    https://www.npr.org/sections/goatsa...e-of-c-sections-is-rising-at-an-alarming-rate
    https://www.sciencefriday.com/segments/why-are-more-expecting-mothers-having-c-sections-deliveries/
     
    Last edited: Nov 5, 2018
  8. Nov 5, 2018 #7

    OCR

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  9. Nov 5, 2018 #8

    DaveC426913

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    Access to medical interventions is certainly one reason. If you can go through childbirth without the pain, why wouldn't you? At least, that's the way many people think.

    Interesting that you use that term.
    When presented with interventions, some patients ask if they are necessary, and are often told " Well, we're trying to save your baby."
    Nothing works better on someone in distress than scare tactics.


    Yes. Education. Advocation. Informed consent. Birth plan.

    Natural childbirth is safe.

    Fun fact: pregnancy is one of the precious few conditions you go to a hospital for when you aren't sick.

    It is. But it's a grass roots movement.
    Who will fund it?
     
    Last edited: Nov 5, 2018
  10. Nov 5, 2018 #9

    DaveC426913

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    Posted this here for no other reason than because it just popped up on my wife's news feed, like 12 seconds ago. (She's a childbirth educator, and a strong advocate of natural childbirth. Don't get her started on the rate of C-sections in hospitals!)

    She has witnessed doctors call for a C-section because they're about to go off-shift. (True story!)

    45409199_2102483596469405_404912409812140032_n.jpg?_nc_cat=108&_nc_ht=scontent-yyz1-1.jpg
     
  11. Nov 5, 2018 #10

    DaveC426913

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    Yes. And that has changed now.

    What has not kept up with the times is hospital protocols.
     
  12. Nov 6, 2018 #11

    Ryan_m_b

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    Words die out all the time. I am reasonably sure that it I spoke this word to 100 English speakers more than 90 wouldn’t recognise it.
     
  13. Nov 6, 2018 #12
    I think this is the key part, when required to save lives.
    Having a C Section as some sort of life choice is obviously wrong.
     
  14. Nov 6, 2018 #13

    DaveC426913

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    Only wrong if the decision is made in the shadow of ignorance of the benefits, risks and consequences.
     
  15. Nov 6, 2018 #14
    Its always popular to think people make decisions based on ignorance, I don't believe a word of it. In fact most women know less about vaginal birth than caesarean and don't understand the risks of natural births. Like all surgery caesarean's carry some risks but they are in fact less likely to cause as much pain, injury to the vagina, heavy bleeding soon after birth, or shock caused by loss of blood. Vaginal births are more associated with longer term sexual problems and continence issues, these risks increase with age and people are having babies later.
    In the UK NICE which produces the evidence based guidelines has changed its position and no longer thinks a vaginal birth should be the default or even preferred option, they think it should be a matter of choice.

    This is an interesting court decision which will also effect the issue.

    https://www.newscientist.com/articl...y-starting-warning-women-of-childbirth-risks/
     
  16. Nov 6, 2018 #15

    Ygggdrasil

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    There are also a number of risks associated with birth by Caesarian section. For example, see this article in the journal The Lancet:
    (emphasis mine)

    Sandall et al. 2018 Short-term and long-term effects of caesarean section on the health of women and children. The Lancet 392: 1349-1357.
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31930-5/fulltext
     
    Last edited: Nov 6, 2018
  17. Nov 6, 2018 #16
    I read that the baby is less stressed from a cs birth although nhs data states mortality and morbidity is increased. Can't post Links right now but will do
     
  18. Nov 6, 2018 #17
    You make the point from the lancet article that "The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth." This is a good example of the problems with this sort of research, remember a lot of Caesarian sections are carried out as emergency procedures when a birth becomes complicated, this often occurs when there are less staff available. It is also the case that most CS are also planned when difficulties are anticipated with the birth. Basically the outcomes are not comparable but the general view is that both types of delivery are very safe and following practice guidelines makes them safer. There seems to be more debate about the long term adverse outcomes which seem to be more noticeable in the vaginal births, in fact its the changing patterns of the age of the mother at the first child and the reduction in the number of children that favours CS. Like it or not, these days there is a cosmetic dimension to some of the decisions.
    Its also worth remembering that the idea that a vaginal birth is the same as a natural birth can be misleading a considerable number of births are induced, this may be to facilitate certain types of analgesia, like spinal analgesia where specific expertise is needed, to reduce some risks and almost invariably when a pregnancy goes into the 41st week.
     
  19. Nov 6, 2018 #18

    DaveC426913

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    Some complications from (voluntary) C-section:

    Mother:
    • any surgery causes an inflammation response
    • wound dehiscence (breakdown)
    • increased recovery time
    • increased risk of endometriosis
    • placenta accreta (from scar tissue - increases risk of subsequent fetal demise)
    • placental rupture
    • post surgical depression
    • breastfeeding difficulties

    Baby:
    • longterm problems with gut development (normally picked up in birth canal and breastfeeding - including autism and bipolar disorder)
    • asthma & other respiratory diseases
    • longterm neurological complications (from lack of vaginal birth)
    • risk for obesity
     
  20. Nov 7, 2018 #19
    Pretty glad I am reading links now rather than when my son was born (emergency c section)

    Negative links with CS birth in this study also, stress/lack of and gut bacteria mentioned by DaveC426913

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597642/

    https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(99)02549-0.pdf
     
  21. Nov 7, 2018 #20

    Ygggdrasil

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    That's a fair criticism. Studies that attempt to control for these factors, such as the UK NICE study you cited earlier are more mixed on the relative costs/benefits of each delivery method:
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31930-5/fulltext

    CS does appear to have adverse effects on subsequent pregnancies, and while some of these could be due to selection bias for women who would need an initial CS delivery, it does seem likely that some of these effects are due to the lasting effects of the surgery:
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31930-5/fulltext

    In general, I agree that doctors should discuss more the risks and benefits associated with each mode of delivery and that ultimately the choice should be up to the mother.
     
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