MDNews - Greater Boston

O NE IN THREE American women who gave birth in 2011 did so via C-section, according to a 2014 Obstetric Ca re Consensus paper published jointly by the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. This volume exceeds recommendations from the World Health Organization, which suggest C-sections account for no more than 10–15 percent of hospital births. A longitudinal study published in Maternal and Child Health Journal reveals that up to 11.6 percent of C-sections performed in the United States are considered non- medically indicated. One of the most common reasons for C-section without medical indication is maternal request. While many physicians honor maternal request, others do not, citing unnecessary surgical risks. However, the Norwegian study suggests that women who prefer a C-section but deliver vaginally are more likely to develop symptoms of post- traumatic stress. According to a statistical analysis of data taken from the medical records and questionnaire responses of 1,700 women who gave birth between 2009 and 2010 at Akershus University Hospital in Norway, those who had REDEFINING BEST PRACTICES THE MOST COMMON reason for medically indicated Caesarean section is labor arrest. However, physicians may be diagnosing labor arrest and proceeding with C-section too quickly, according to an Obstetric Care Consensus paper published jointly by the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. Physicians should wait until the cervix has dilated to 6 centimeters or the patient has pushed for more than three hours before considering labor arrest, according to Vincenzo Berghella, MD, Director of the Division of Maternal-Fetal Medicine at Thomas Jefferson University Hospital and President of the Society for Maternal-Fetal Medicine. This may help prevent primary C-section and — more importantly — potentially complicated subsequent C-sections. no birthing preference and a vaginal delivery had a 1.54 percent likelihood of developing such symptoms. In contrast, women who requested a C-section but delivered vaginally had a 4.46 percent chance of developing post-traumatic stress symptoms following parturition. Addressing Maternal Fears Fear of labor and childbirth is the most common reason women request a C-section. Identif ying women who are afraid of childbirth, listening to their concerns, and referring them for counseling or childbirth classes may address this fear. If these efforts are unsuccessful, however, the impact of vaginal delivery on maternal mental health may need to be considered. " I b e l i e v e it i s i m p o r t a nt f o r p h y s i c i a n s t o i d e n t i f y w h y a woman prefers to have a C-section," says study author Susan Garthus-Niegel, Ph D, Head of t he D epa r t ment of Occupational, Social and Environmental Epid em iolo g y a t T U D re s d en i n Dresden, Germany, and researcher for the Department of Psychosomatics and Health Behavior at the Norwegian Institute of Public Health in Oslo. "For instance, if a woman suffers from a severe fear of childbirth due to previous sexual abuse, a vaginal delivery may trigger diffi cult memories. In this case, I would consider it reasonable to grant her wish for a C-section." ■ Study THE LINE BETWEEN MEDICALLY INDICATED AND NON-MEDICALLY INDICATED CAESAREAN SECTION IS BECOMING LESS CLEAR, DATA FROM A NORWEGIAN STUDY PUBLISHED IN THE JOURNAL BMC PREGNANCY & CHILDBIRTH SUGGESTS. By Tiffany Parnell C-section Debate Further Complicates 1 4 | Greater Boston MD NEWS ■ M D N E W S . CO M

• Cover