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Pregnant? Watch out for unnecessary c-sections and other questionable medical procedures

Consumer Reports News: May 08, 2013 09:38 AM

Pregnant women often undergo medical procedures and invasive interventions, including induced labors and cesarean sections, without fully understanding the risks or being involved in making decisions about their care. Those are some of the findings of a major new survey to be released on Thursday of 2,400 women who recently had babies.

The survey, conducted by Childbirth Connection, a nonprofit organization that focuses on maternity care, identified numerous areas where care for pregnant women often fails to follow established guidelines. Many of the concerns mirror those we previously reported on in our story What To Reject When You're Expecting.

"Our survey suggests that pregnant women need to take a more active role to make sure they get the the care that is best for themselves and their babies," says Maureen Corry, M.P.H., executive director of Childbirth Connection. "They need access to trustworthy information about the benefits and harms of interventions, to educate themselves, and be their own advocate."

For example, 41 percent of women in the survey had their labor induced, usually with a drug called oxytocin (Pitocin). Among the reasons given for the induction were that the baby might be getting large or that the mother had reached her due date. But research suggests that neither of those reasons by themselves typically warrants induction. Moreover, about a quarter of women who were induced said they felt pressured by their health care provider to undergo the procedure.

The survey also illustrated how one intervention often leads to others. For example, about three-quarters of first-time mothers who entered labor had their labor induced and were given epidural analgesia, and a third of those women wound up having an unplanned c-section. In contrast, only 5 percent of women who were neither medically induced nor given an epidural ended up with a c-section. "That six-fold increased risk for surgery shows the cascade of intervention that often begins with labor induction," said Carol Sakala, Ph.D,, Childbirth Connection's director of programs.

Another major area of concern involved pregnant women who had previously delivered a baby by c-section. Nearly half of those women said they would have liked to try to deliver their next baby vaginally, but many were denied that possibility either because their doctor (24 percent) or their hospital (15 percent) refused to give them that option. Yet guidelines from the American College of Obstetricians and Gynecologists now encourage vaginal births after c-sections, or VBACs, and growing research highlights the potential risks of multiple cesarean births.

The survey revealed several other troublesome trends:

  • About 40 percent of mothers did not hold their naked babies against their skin soon after birth, though research suggests that strengthens mother-baby bonding and breastfeeding. One quarter of healthy babies spent the first hour of their lives with hospital staff for routine care, not with their mothers.

  • While breastfeeding offers numerous benefits for the baby and mother, about half of women who said they wanted to exclusively breastfeed experienced ill-advised hospital practices that can undermine the process, like being offered free formula. And six months after giving birth, less than a third of women were exclusively breastfeeding their babies.

  • Many women reported that they held back from asking questions because they were concerned about being perceived as difficult, they wanted maternity care that differed from what their health care provider wanted, or their provider seemed rushed.

  • Few women used simple, low-risk, drug-free measures to ease labor pain, like taking hot showers or baths. Women who had taken childbirth education classes were more likely to try such measures.

  • Most women who had an episiotomy, an incision in the skin around the vagina made during delivery, were not included in the decision to undergo the procedure.

Read more about out coverage of babies and kids products and services, including Ratings and buying guides for car seats, cribs, high chairs, and breast pumps.


Transforming maternity Care: Listening to mothers [Childbirth Connection]

Joel Keehn

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