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The REDUCE Campaign: Research and Education to Decrease Unnecessary Cesarean Sections
Back to main REDUCE Campaign page ACNM Holds Media Briefing To
Call Attention to Cesarean Complications March 21, 2006, Silver Spring, MD -- Women are not getting all the facts before having a cesarean section, and new research is shedding light on just how serious the problem of inadequate informed consent has become. Eighty-one percent of mothers stated that before consenting to a cesarean section, it is necessary to know every possible complication, and 17% felt it necessary to know most complications. By contrast, most mothers who had cesareans were poorly informed about specific complications of cesarean section. Close to half of survey participants (42% to 45%) were "not sure" about how to reply to four statements about complications of cesareans, and 21% to 33% responded incorrectly, according to a recent survey conducted by Harris Interactive®, a major market research firm, for Childbirth Connection. "Mothers have spoken: they are not electing to have cesareans without medical reason. Virtually all who had primary cesareans believed there was a valid medical reason for the surgery. This indicates that mothers do not understand the degree to which legal, financial, clinical and other factors are impacting their care. Policy makers, health professionals and women themselves must confront factors leading to avoidable cesareans," stated Maureen Corry, MPH, Executive Director, Childbirth Connection. This new research was unveiled Monday at a media briefing hosted by the American College of Nurse-Midwives (ACNM) as part of the College's ongoing REDUCE Campaign - Research and Education to Decrease Unnecessary Sections. ACNM and its partners warned that the decision to have a surgical birth may have serious consequences for the health of the mother and baby and should not be made lightly. Cesarean sections are the most common surgery performed in the United States, and the cesarean rate rose to an astonishing 29 percent in 2004, according to the National Center for Health Statistics - up more than 40% since 1996. This is twice the rate recommended rate by the CDC's Healthy People 2010 objective, which set a target of a cesarean rate of 15 percent. ACNM President Katherine Camacho Carr expressed concern that the decision to have a cesarean birth is not always for strong medical indications. "As specialists in women's health care, midwives are very concerned that decisions to perform surgery are being made based on circumstantial evidence, misinterpretation of evidence and/or on lack of respect for the short and long term risks of this major abdominal surgery," Carr said. "In some cases, it is the result of coercion based on the preferences of the providers and institutions that find spontaneous vaginal delivery a major inconvenience." Carr cited financial incentives, control of staff schedules, and fear of litigation, as additional reasons some physicians appear to be more likely to perform surgery even when there is no medical indication. (Read Carr's remarks in their entirety.) ACNM is warning women, especially first-time mothers-to-be, that the risks of cesareans are underreported and the benefits are overstated. Unnecessary cesarean delivery is a threat to the health of mothers and babies, ACNM says. Women must be properly informed before undergoing the surgery. To track the long term effects of cesareans, the ACNM called for a national databank that would link subsequent complications to the original cesarean birth. Currently, "any conclusions about the risks of cesarean section are mere speculation, and some of those conclusions are potentially life-threatening," Carr said. Women, as represented at the media briefing by Barbara Stratton and Karen Salinetti, shared their concerns. Barbara Stratton believes her cesarean wasn't medically necessary. After an ultrasound just before her due date, Stratton's physician told her that her baby was in the 95th percentile for size and weight and pressured her to start labor. The resulting complications from the interventions to induce labor led to the cesarean delivery of Stratton's 8 ½ lb. baby. For the next year and a half, Stratton experienced extreme pain, problems with breastfeeding and postpartum depression as a result of her surgical birth. "My story is an example of what has become, for many, the typical obstetrical over-management of birth and is why I feel the surgery is very preventable," Stratton said. Karen Salinetti of Falls Church, Virginia underwent several additional surgeries after her cesarean in order to remove adhesions, which may have caused her two miscarriages. "I want women to know all the risks; too often, information about the surgery is glossed over, and in my case, had I been better informed, I might have made different decisions," Salinetti said. Also at the briefing, Peter Bernstein, MD, of Albert Einstein College of Medicine in New York, NY, presented an update of his article 'Complications of Cesarean Delivery,' which was published by Medscape.com in September 2005. Bernstein wrote, "With the increasing rate of cesarean deliveries, providers will see more and more of these complications. It is also critical for the provider and the patient to be aware of the risks for complications so that they can make informed decisions about the best mode of delivery given the individual clinical situation they face." Women who are interested in learning more about cesarean section should be directed to read Childbirth Connection's free booklet "What Every Pregnant Woman Needs to Know About Cesarean Section," available at www.childbirthconnection.org. Learn more about the ACNM REDUCE Campaign - and how you can take action in your local community, online at www.midwife.org. Back to main REDUCE Campaign page |
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