Thursday, July 24, 2014

Rally decries unnecessary C-sections

September 02. 2013 11:25PM

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FORTY FORT — Danielle Coolbaugh says there was no evidence to support three of the four Cesarean sections she had when giving birth to her children, and she wants to see the practice stopped when unnecessary.

Coolbaugh, 27, of Dallas, joined thousands of concerned families, doctors and other professionals across the country Monday in the 2013 Rally to Improve Birth, held locally in the parking lot of the Hugh B. Hughes Funeral Home on Wyoming Avenue, Forty Fort.

“One in three women are having Cesarean sections and about half those can be prevented,” Coolbaugh said. “We’re advocating for maternity care that’s based on scientific evidence rather than care that is guided by profit or convenience or liability concerns,” she said.

Coolbaugh said the state’s C-section rate of 32.8 percent is well above the 15 percent suggested by the World Health Organization as a highest recommended rate. The rate for area hospitals is even higher — 33 to 34 percent.

And while some point to older, more obese, less healthy mothers as the reason for such high rates of C-section surgery, a study by the University of Minnesota School of Public health shows C-section rates vary most among low-risk women.

Many authors have shown that “physician factors” — rather than patient characteristics or obstetric diagnoses — are the major driver for the difference in Cesarean rates within a hospital, according to The Joint Commission, an organization that accredits and certifies health care organizations and programs in the United States.

Coolbaugh said she had a C-section for her first pregnancy because “it was deemed a failure to progress after four hours labor — no fetal distress, no maternal distress. Being a first-time mom, I really didn’t know any better, so I went with it.” She agreed to C-sections for her second and third pregnancies because the doctor was “less than supportive” of natural childbirth “despite the fact that there was no medical need.” She felt a C-section for her fourth child was warranted.

On the flip side, most patients and health care providers who prefer C-section over vaginal delivery cite the fear of perineal injury, including anal and urinary incontinence, sexual dysfunction, fetal injury, control and convenience, according to a paper published by Dr. Ashwin Ramachandrappa and Dr. Lucky Jain, pediatricians at the Emory University School of Medicine in Atlanta, Ga. They also note the risk of respiratory distress of the newborn, surfactant deficiency and pulmonary hypertension is increased with elective C-sections.

Angel Kelsey, a 33-year-old mom and a doula from Wilkes-Barre, said women who have a doula for their births are two-thirds less likely to have a C-section.

A doula is basically a trained labor coach. And while evidence shows that services of a doula during and after birth are beneficial, they are used in only 3 percent of pregnancies.

Abigail Ziegler, a 28-year-old mom and a doula from Factoryville, said nurses used to provide the services of a doula, but hospitals now are “just too busy … They may want to, but it’s just difficult when a nurse has five different women laboring at the same time that she has to tend to.”

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