It is certainly interesting to ponder how we as bipedal mammals have
evolved/adapted in birth. It is also interesting to consider whether small
intracranial hemorrhages could be a very normal event occuring in the neonate
travelling through the birth canal or whether intracranial hemorrhage is a side
effect of medicalized hospital birth.
However, I do not think considering the normalcy of intracranial hemorrhage in
vaginal birth is the best response to this study.
I would like to reiterate that the "findings" in this Radiology research study
are "clinically insignificant" according to the study's own authors. We are
talking about a total sample size of 88 babies and only 17 babies were
identified with varying degrees of intracranial hemorrhage. The media is to
blame for taking this small study and reporting it's findings in such an
irresponsible manner.
Unfortunately, some health care practitioners will take this study(and the 2
minute news blip) and say "see, c-sections are better/safer." A great
response would be to direct them to another recently published study which
actually has a huge sample size and dramatic statistically significant findings:
Infant and neonatal mortality for primary cesarean and vaginal births to
women with "no indicated risk," United States, 1998-2001 birth cohorts.
Division of Vital Statistics, National Center for Health Statistics, Centers for
Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
BACKGROUND: The percentage of United States' births delivered by cesarean
section has increased rapidly in recent years, even for women considered to
be at low risk for a cesarean section. The purpose of this paper is to examine
infant and neonatal mortality risks associated with primary cesarean section
compared with vaginal delivery for singleton full-term (37-41 weeks' gestation)
women with no indicated medical risks or complications. METHODS: National
linked birth and infant death data for the 1998-2001 birth cohorts (5,762,037
live births and 11,897 infant deaths) were analyzed to assess the risk of infant
and neonatal mortality for women with no indicated risk by method of delivery
and cause of death. Multivariable logistic regression was used to model
neonatal survival probabilities as a function of delivery method, and
sociodemographic and medical risk factors. RESULTS: Neonatal mortality rates
were higher among infants delivered by cesarean section (1.77 per 1,000 live
births) than for those delivered vaginally (0.62). The magnitude of this
difference was reduced only moderately on statistical adjustment for
demographic and medical factors, and when deaths due to congenital
malformations and events with Apgar scores less than 4 were excluded. The
cesarean/vaginal mortality differential was widespread, and not confined to a
few causes of death. CONCLUSIONS: Understanding the causes of these
differentials is important, given the rapid growth in the number of primary
cesareans without a reported medical indication.
PMID: 16948717 [PubMed - indexed for MEDLINE]
www.lamaze.org/Research/iTheJournalofPerinatalbrEducationi
Someone on this list had a quote near their byline to the effect of "If c-
section is safer than(or as safe as) vaginal birth, just consider how dangerous
vaginal birth in hospital has become"
There is absolutely no question that cesarean section is the more dangerous
delivery for both mother and baby in a normal pregnancy. Study after study
demonstrates that the risks of major surgery:bleeding, infection, embolism,
while reduced over the recent years still pose a significant risk to the mother
when compared with normal birth(3 times the mortality risk and increasing
exponentially with repeat surgeries). Risks for baby include prematurity,
respiratory problems, maternal separation, increased mortality rates, stillbirth
and then, of course, breastfeeding problems.
Mary Herrington, RN, IBCLC
Lactation, Memorial Hermann, Northwest
Labor & Delivery, Memorial Hermann, The Woodlands
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