Elective Caesarean Births : Issues And Implications

Within Victoria there are multiple models of maternity care available to women. An initial discussion with the woman’s treating GP during the early stages of her pregnancy is critical in her decision-making about which model of care she will choose and this key discussion is essential in allowing a woman to make the first of many informed decisions throughout her pregnancy. According to a survey conducted by Stevens et al. (2010) only 43% of women felt ‘they were not supported to maintain up-to-date knowledge on models of care, and most reported that model of care referrals were influenced by whether women had private health insurance coverage.’ Many elements of these models of care differ: from location of care, degree of caregiver continuity, rates of intervention and maternal and infant health, outcomes access to medical procedure, and philosophical orientation such as natural or medical (Stevens, Thompson, Kruske, Watson, & Miller, 2014). According to the World Health Organization (1985) and Commonwealth of Australia (2008) there is a recognition that ‘85% of pregnant women are capable of giving birth safely with minimal intervention with the remaining 15% at potential risk of medical complications’ (McIntyre & Francis, 2012).

Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).

Maternal mortality represents more than the loss of lives for individual women, as it also reflects the larger value and prioritization of women 's health and threatens the health and survival of families, young children, and even the communities in which they live (Royston and Armstrong, 1989). Maternal mortality is unacceptably high (WHO, 2015b). Globally, approximately 830 women die every day from pregnancy- or childbirth-related complications (ibid.). The causes of maternal mortality are predominately preventable and can be classified into three fundamental causes: (1) medical - consisting of direct medical problems and pre-existent/coexistent medical problems that are aggravated by pregnancy, (2) underlying - social and legal conditions, and (3) health systems laws and policies that address availability, accessibility, and quality of reproductive health services (PHP et al, 2011).

Carla Keirns dwells upon a problem of unnecessary cesarean deliveries performed only for urgent clinical reasons. As a diabetic expectant mother, she was going to deliver her first

The conclusion was ultimately reached that medical or elective induction of term women was associated with an increased risk of cesarean delivery and that estimate was determined heavily based on the Bishop Scores attained The study closes by advising that induction of labor, whether it is medical or electively induced, should be avoided because a low Bishop score means that the cervix is unripe and even with cervical ripening agents, the study showed that the risk of cesarean delivery for nulliparous women remained unchanged. Their advice is to allow the mothers to spontaneously go into labor if they have an unfavorable Bishop score because it will lower cesarean delivery rates (Vrouenraets et al. 2005). This rationale directly correlates

The author is a nurse in a level two trauma facility in a community of approximately fifty thousand people in Oregon. The community is a college-town surrounded by a large agricultural area. There is a minimal ethnic diversity within the community. The diversity present occurs mainly from internationally students and faculty from the college. There is a growing population of women who desire low interventional births in the community. The author has worked on the labor and delivery unit of the hospital for the last 14 years. The hospital is the only one in the area to offer trial of labor services to women who have previously undergone a cesarean section. The unit on average experiences around 1000 deliveries annually.

Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally

According to “Human Sexuality: Diversity in Contemporary America,” women and couples planning the birth of a child have decisions to make in variety of areas: place of birth, birth attendant(s), medication, preparedness classes, circumcision, breast feeding, etc. The “childbirth market” has responded to consumer concerns, so its’ important for prospective consumers to fully understand their options. With that being said, a woman has the choice to birth her child either at a hospital or at home. There are several differences when it comes to hospital births and non-hospital births.

The National Guideline Clearinghouse, a division of the Agency for Healthcare Research and Quality (AHRQ), has complied the following recommendations that are evidence-based for considerations for those parturient desiring a vaginal birth after a previous cesarean delivery.

Increasing cesarean rates have led to another observation, evolutionary changes. The increase of c-sections have lead to an increase in women with narrower hips. Since women are no longer restricted by delivering babies vaginally, natural selection cannot eliminate the gene for narrow hips, something that may have resulted in maternal mortality. The increase of women with narrow hips may result in an increase in women whose bodies cannot not deliver babies without assistance, thus resulting in more c-sections.[16] Eventually, if c-sections are not regulated, a vaginal delivery could become a rare

Also, Jeffrey Ecker suggests that mothers in this day and age have become less tolerant of birth risks and complications than mothers in years past. Mothers, he finds, repeatedly choose cesarean births because they are associated with less major complications, despite the fact that only about 5 percent of vaginal births experience such problems.20 Whereas a 5 percent rate of complications was simply accepted as a natural peril of life, today mothers find such perils

Compared with hospital births, home births are associated with less adverse perinatal outcomes at the expense of precipitous and prolonged labors (1). Up to 20% of all planned home births and 25% of planned home births among nulliparous women require unplanned intrapartum transfer to hospital for delivery (1). Of the 15,524 courses of care, 84% of women gave birth at the birth center. Four percent were transferred to the hospital prior to labor and 12% were transferred while in labor. The intrapartum fetal mortality rate for women admitted to the birth center in labor was 0.47/1000. The neonatal mortality rate was 0.40/1000 (4). From 2004 to 2009 MANA Stats 2.0 dataset includes 24,848 courses of care. 3,343 were transferred care, prior to the onset of labor, for either medical reasons (complication requiring specialty care) or nonmedical (moved during pregnancy). 655 (12.1%) were transferred to the hospital intrapartum or postpartum, 5 out of 6 women transferred (83.44%) were transferred

Recently, there have been many women opting to be induced rather than going through a natural onset of labor. In 2008 23.1% of live births were induced in the United States, which was a doubled amount from the 1990s (Cheng, Kaimal, Snowden, Nicholson, & Caughey, 2012). However, it seems as if the negative and positive effects of being induced are rarely highlighted. It is important though that patients receive correct evidence based research about induction compared to the natural onset of labor before making a decision. Medical professionals will be able to educate patients by answering this research question: In women who are experiencing a full term/ post term low risk pregnancy, what is the effect of being medically induced before the natural onset of labor on maternal, fetal, or neonatal mortality and morbidity compared with natural onset of labor? The databases CINAHL and MEDLINE were used along with the search words of “induction of labor” AND “expectant management”/ “induction of labor” AND “spontaneous labor” to find articles related to the specific research question about induction and natural labor. These articles will provide conclusions that will help deliver education to pregnant women and health care professionals.

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.

The very first question that I had when I began this paper was why are so many women opting to receive a cesarean section when a vaginal birth has many more favorable outcomes, so after doing some research I came across an article entitled “Cesarean section or vaginal birth- What difference does it make,” this article talks about the differences between a cesarean section and a vaginal birth and within the article a definite line is drawn between a safer choice of delivering naturally and the more burdensome surgery of having a cesarean section. I was astonished to read that “ Despite all this, the vast majority of women would still prefer to have a normal, straightforward