The other day I had the privilege of taking care of a couple who was in labor with their first baby. Denise, a G1P0 at 41 weeks and 3 days, broke her water at 1:00am with contraction starting about 8-10 minutes apart at 4:30am. She and her boyfriend, Ralph, labored at home until about 8:00am when the contractions were coming about every 3-5 minutes apart. When she arrived to the hospital at 8:30am, a resident’s vaginal exam revealed that she was 3cm/50%effaced/-3 station!! Since she was a young healthy woman (her health history only comprised of PCOS, or polycystic ovarian syndrome) and had had an uncomplicated, normal, healthy pregnancy, she was “allowed” to ambulate in the halls all morning but required to stay on continuous telemetry monitoring and not allowed to labor in the tub per her physician’s direct order.
(Side Note: This particular physician, Dr. O, is an older physician who is part of a group that is well known for aggressive labor management. They induce almost all of their patients for one reason or another, often once they hit 39 weeks, and if a patient is not already ruptured once they get to the hospital, they will artificially break their patients’ water regardless of dilatation. That’s right, I have personally refused to give them an amniohook when a patient is only 1 or 2 centimeters and they sneak in the room without me and break her water anyway! One time, Dr. U (another doctor in that group) ruptured a patient who was still in triage! They are notorious for setting up “post dates” inductions at 40 weeks and 1 day and although they advertise that they attend VBACs, their statistics show something quite different: Almost NO “successful” VBAC vaginal deliveries and a cesarean rate that is at least 40%. Myself and many other nurses have bombarded them with research and position statements from a variety of sources, including their OWN association (American College of Obstetricians and Gynecologists, or ACOG)) that states intermittent auscultation is the standard of care for low risk, uncomplicated pregnancies, but they refuse to listen. So Denise’s situation is unfortunately not uncommon. To be honest, I am surprised they “let” her get past 41 weeks! I think they view it as a slap in the face to attend any delivery after 40 weeks!)
When I came on at 3:00pm, Denise was in the middle of getting an epidural. Turns out that at 12:30pm, Dr. O’s vaginal exam revealed that the patient was “only” (his words) 4cm/80%/-3 so he ordered pitocin augmentation and the pit was started at 1:00pm. Although the patient had originally told the nurse it was her plan to labor without an epidural, pitocin lead to stronger, longer, and closer contractions which lead to the patient requesting one. And an epidural was granted. For the next 3 hours I was instructed to continue to turn up the pitocin to obtain 5 contractions in 10 minutes. I titrated appropriately until I obtained moderate to strong contractions (per my palpation) every 2-3 minutes, where the baby was still looking good on the monitor. I changed the patient’s position every 30 minutes: right side, sitting up high, left side, sitting up high, etc. in hopes that I would help the baby makes his way down the birth canal and not get “stuck” in any acynclitic position. (According to the patient, she was complaining of severe back pain the last few hours so I was concerned about an occiput posterior baby. So since Denise could no longer move herself to help move the baby, I was doing the moving for her!)
At 7:00pm Denise was feeling a lot of rectal pressure, so much that she was breathing through it (even though the epidural was still effective at taking away her back and abdominal pain). We all were very excited!! Since Denise was only feeling rectal pressure during contractions I told her it would be best to wait until she was feeling rectal pressure at all times, with our without a contraction, before we called the doctor. Well Dr. O must have had ESP because he came into the room to perform a vaginal exam. His exam revealed that Denise was 4cm/100%/ -1 station! The patient was a bit disappointed that she was still only “4cm” but I assured her that he was completely thinned out and that she had brought the baby down a whole bunch! However, Dr. O had a different take on it, “You are still only 4cm, he said, “And if you don’t make any significant progress within the next hour we will have to talk about a change in the plan.” (Could he have BEEN any more vague?!) And then he turned around and walked out. “What does he mean by change of plan?” Denise asked me. “Well I’m not sure,” I said back, “let me go find out.”
The fact of the matter is that I knew exactly what Dr. O meant….he meant that he was going to do a c-section. But I didn’t want to tell her that for two reasons, 1) it is NOT my responsibility to tell a patient that someone else is going to perform a cesarean section on them, it’s the SURGEON’S responsibility, and 2) I hate even talking about the possibility of a cesarean section when someone is in the middle of labor because it is like you are telling the patient you are already “giving up” on them. Of course I understand that some cesareans are necessary, but I know that if I was in her position and someone gave me a “cesarean ultimatum” during labor, I would feel like people were giving up on me! I mean here she is, basically being given a one hour ultimatum, and because of the limitations of the epidural it is not even like she can “do” something to play an active role: she can’t walk around or get in the tub, we’ve already got her hooked up to pitocin and an epidural, we’ve already tried the position changes, her water is already broken, and I am pretty sure she doesn’t know magic. So here I am feeling like my hands are tied, but trying to stay positive and encouraging so that the patient does not feel upset, passive, defeated, or worried. Because those emotions do NOT facilitate labor, and in fact, those emotions can actually release hormones in your body that directly work AGAINST labor.
So I walked out to the desk to find Dr. O but he had already left. (I don’t think he went very far, maybe into another patient’s room, but nonetheless, he was no where to be found.) I felt an obligation to tell Denise something so I went back into to the room and said this:
Me: “Denise, I think Dr. O is with another patient right now but once I find him, if you would like, I can ask him to come back in to answer any questions you might have.”
Denise: “Yeah, I would like him to come back in because I don’t want a c-section.” (starting to get a bit teary eyed) “I mean, is that what he meant by change of plan? Can they give me any other medicine to help with my contractions?”
Me: “Well I don’t know what he meant exactly but he could have meant he would like to try an IUPC which stands for intrauterine pressure catheter. It is a thin tube that lies beside the baby’s face and actually measures in millimeters of mercury how strong your contractions are. If I have an IUPC, I might be able to go up on the pitocin if the contractions aren’t “strong enough.” Right now the external monitor only tells me when they are coming and when I feel your belly it is all subjective. Unfortunately there isn’t any other medicine we can give you to help “speed up” labor besides pitocin. He could also have meant a cesarean. But we won’t know until we talk to him.”
Denise: (almost in a scared tone) “But I don’t want a c-section! I want to push my baby out! Oh I don’t want a c-section!”
Me: (feeling like I wish I could help but don’t know how) “Well let’s talk about what you can do. If Dr. O comes in to check you, you have the right to refuse his vaginal exam and request more time. You also have the right to ask him about all of your options, if there are any, besides a cesarean. You have the right to ask him his reasons for why he thinks a cesarean is necessary. You have the right to hear all that information and then take as much time as you need to decide what you would like to do. If you need some alone time with Ralph or if you need to call your mom or any other family members you have that right. I just want you to know that if you and Dr. O decide together that a cesarean is the best option, it will NOT be an emergency and therefore you can take as much time as you need to prepare. The baby is not in distress and in fact, has looked beautiful on the monitor all day. If you both decide that a cesarean is the right course of action, I promise I will go over everything to expect with you, I will make sure anesthesia sees you before you get to the OR so you can ask them any questions, and barring any other emergency, I will be with you the entire time, from the moment I wheel you in to the OR, to the moment I wheel you out of the recovery room. I’ll help you breastfeed as soon as possible. I will stay with you the whole time…”
At this point I was starting to get a bit emotional and realized I was rambling so I excused myself and went out to the desk. I just knew in my heart what was going to happen and I was deeply saddened by it. And don’t get me wrong, I am not trying to be overly dramatic but I just knew that when she broke her water at 1:00am and came to the hospital at 3cm, she was not expecting to end up with a cesarean.
Well exactly one hour later Dr. O came back into the room to do a vaginal exam. I turned towards Denise and I said, “Is that okay with you, Denise?” and she said “Yes.” According to Dr. O, Denise was still the same and had made no “progress.” Dr. O, while standing at the foot of the bed, looked up at Denise and said “Well Denise, we’ve run out of options here. If we continue to keep you on pitocin eventually the baby is going to run out of gas and crash. Uteruses can only take so much and your uterus is going to get thinner and thinner and will be at risk of rupturing if we continue like this. You have essentially been 4cm for 7 hours and for a primip, you need to progress at least one centimeter an hour. We need to do a cesarean and as soon as I tell the charge nurse we’ll get going on it.”
At this point Denise burst into tears, “OH GOD, BUT I DON’T WANT TO HAVE A C-SECTION! I WANTED TO PUSH HIM OUT! I WANTED TO PUSH HIM OUT! I REALLY THOUGHT I COULD DO IT! I WANTED TO DO IT! I WANTED TO PUSH MY BABY OUT!” Ralph gave her a big hug and I kept squeezing her hand trying to bit my lip so that I didn’t start to cry myself. She was sobbing. And then Dr. O said “Listen, Denise, there is no reason to get like this. I mean, when you came to the hospital this morning I also had 4 other patients that came in around the same time. Everyone else has already delivered…you’re the only one left. And some women even came in with cervixes more closed than yours. You see, the baby just isn’t coming down enough in the birth canal to dilate your cervix, and it’s just a failure to progress. It’s just failure to progress that’s all.” Then he turned to me and said “As soon as I tell the charge nurse we’re going to go.” So then I said, “Well I am not at all ready to go yet. And I think she deserves a minute to come to terms with all of this, Dr. O. She deserves some time to make her decision and call her family.” And then Dr. O looked straight at me, baffled, said “Whatever” and then stormed out slamming he door behind him.
I threw myself onto Denise and have her the biggest hug I could. I whispered over and over in her ear, “You are NOT a failure Denise, I know you wanted to push him out. I know you did. You have done so much work today and you never gave up. You are a strong woman, Denise, you did not fail and your body did not fail. NOBODY is a failure here. It’s okay to cry. It’s okay to cry, Denise. Please know you did so much for your baby and you never gave up. You are a strong woman…”
I stayed there for about 10 minutes with her and Ralph, letting her cry. When she calmed down a bit I encouraged her to take her time to talk with Ralph and call her mother or family if she needed too. I told her that I needed to get some things ready and that I was going to give them some privacy.
So by this point I was pretty upset. For one, I think the way Dr. O went about the whole thing was so cold and insensitive. Um hello, do you think telling a patient that “everyone else” has already delivered is going to make them feel better!? Because in my opinion, it just stresses the insane notion that her body is in someway a “failure.” I could mull over and over and over again in my head everything that surrounded this whole situation and I have almost made myself sick over wondering if this was really a necessary cesarean for “true” arrest of descent/dilatation. But regardless, I feel like he completely took Denise and Ralph out of the whole process and it should have been handled better. Second, Dr. O did NOT go over the risks and benefits of the cesarean with them, claiming later that the residents “review that” on admission (which, by the way, they don’t…they just have everyone sign a consent for “vaginal delivery possible cesarean section”). Third, Dr. O did not at all go over other options besides cesarean, and even if he thought the safest course of action was a cesarean at that point in time (which I am not disputing), he didn’t even say anything like “and our other options, X, Y, & Z, are not the best course to take because of A, B, C, so it is in my professional opinion that the safest course of action is to perform a cesarean section. But please take your time to talk it over.”). I have seen other doctors do this before. Even in situation where everyone agrees that a cesarean is absolutely necessary, it is still the patients right to make the final decision. And finally, he didn’t even give them a chance to talk it through and when I asked for “some time” he got pissed.
So I walked out to the desk to get my paperwork ready and Dr. O was writing a note in her chart:
Dr. O: (sarcastically and not even looking up from what he was writing) “So when do you think you’ll be ready to go?”
Me: (frustrated) “It’s not about me being ready, it’s about Denise and Ralph being ready! I think it is more than just a courtesy to allow them some time to come to terms with this new development. They have a RIGHT to some time, Dr. O. This isn’t an emergency. The baby has looked great on the monitor all day and I shut the pitocin off.”
Dr. O: (frustrated) “I don’t know why you are fighting me on this!”
Me: (increasingly frustrated) “I’m not fighting you on ANYTHING Dr. O, but you have to understand, she is devastated that she is going to have a cesarean. We owe it to her to let her calm down and not wheel her down the hall as a sobbing mess! Her whole family lives in a different state, including her mother, and I think that it isn’t too much for her to ask for some time to call her family before she goes in for MAJOR ABDOMINAL SURGERY!”
And then he said it….he said that phrase that breaks my heart every time I hear it…
Dr. O: “She’ll forget all about it when she is holding a baby in her arms.”
This phrase comes in many forms but every one says the same thing, “All that matters is that you get a baby out of this deal… and your experience, your experience doesn’t matter.”
Kristen, a doula, graduate student, mom, and author of the blog Birthing Beautiful Ideas wrote an amazingly insightful and moving must read post entitled, “Scars That Run Deep: ‘All That Matters’ After A Cesarean” that explores this very topic.
Kristen writes:
“You have a healthy baby. That’s what matters.”
Mothers who express sadness, anger, or disappointment after undergoing a cesarean section often hear these words uttered by (presumably) well-meaning family, friends, and health care workers. In fact, these words seem to be one of the most common responses that people give upon hearing that a mother has had a cesarean. I presume this is because it can be jarring to witness the juxtaposition of the joy and wonder of a newborn life and the mother’s grief over her baby’s entrance into the world. And so, particularly in a culture that does not have a well-developed ritual for expressing and experiencing grief, people try to fill up the mother’s “empty grief jar” with an elixir of “healthy baby joy.” But, as we all know, grief and joy don’t work like that.
Kristen goes on to write about why having a healthy baby isn’t “all that matters” after a cesarean, the concept of mourning the loss of a vaginal birth, and why a mother’s birth experience IS part of “what matters” regarding the entire childbirth experience. Kristen also outlines step by step details about what a mother experiences when she undergoes a cesarean, from the minute the wheel her into the operating room to the first time she gets to hold her baby to caring for a newborn after major surgery. Kristen writes,
In addition, the de-valuing of the mother’s birth experience–a de-valuing implied by the “healthy baby line”–undermines the significance of one of the most transformative days of a mother’s life. For on the same day that her baby is born, she is “born” as a mother. And if this dual-birth is marked by passivity and separation, then it is no wonder that the mother grieves her birth experience. That having her healthy, miraculous, wonderful baby is not all that matters to her.
In fact, her sadness is partially a result of being separated from her healthy, miraculous, wonderful baby during the first few moments and even hours of that baby’s life. And it can be the result of a feeling that her body is “broken,” “unable” to bring her child into the world on its own. And it can be the result of a feeling that her body might not even “know” how to work properly to bring a child into the world. And it can be the result of feeling as if she has disappointed not only herself but also her partner and/or other friends and family. And it can be the result of the sheer difficulty of recovering from major abdominal surgery and simultaneously caring for a newborn baby, two of the most physically and emotionally demanding experiences that any person will ever undergo.
In other words, her sadness and her grief are understandable. They are normal.
Please check out Kristen’s post in it’s entirety on her blog. The excerpts I have provided here are only a small piece of this very eye opening composition.
In the end Denise gave birth to her 9lb 8oz baby boy, Rayne Nicolais, by cesarean section at 9:01pm. Baby Rayne was found to be in an occiput posterior position and still very high in the pelvis when he was born. I had the opportunity to stay with Denise, Ralph, and Baby Rayne for the entire experience and with the help of a ton of pillows, Denise breastfeed Rayne skin to skin in a football hold for an entire hour and 15 minutes in the recovery room. And boy was he a vigorous breast feeder!!
Although all in all, there was a positive outcome to Denise’s birth experience, I do wish that for Denise and Ralph, things could have turned out differently. I wish that Denise could have PUSHED her baby out like she so desired and worked so hard for. And of course I am grateful that at the end of the day Baby Rayne was a happy, healthy, chubby, bouncing baby boy. In the recovery room where Denise really held her baby boy for the first time, she welled up, looked at her boyfriend and said, “I think I am falling in love all over again!” It was so beautiful! As a nurse, experiences like this solidify what I feel in my whole being is true about pregnancy and childbirth; That the journey is as important as the destination.
In closing I would like to leave you with one of my favorite quotes…
“It’s not just the making of babies, but the making of mothers that midwives see as the miracle of birth.” ~ Barbara Katz Rothman.
Super Comment!: Maternal Death in the U.S., or TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth May 27, 2009
Tags: childbirth, delivery, hospital birth, labor, labor induction, labour, maternal death rate, maternal death rate world rankings, maternal mortality, midwife, obstetrician, pregnancy, risks, unnecessary cesarean section, Vaginal Birth After Cesarean, VBAC, World Health Organization
Dear NursingBirth,
I’m a huge fan of your blog! Please keep the awesome entries coming! I am learning so much. I am just a novice birth-junkie rather than a birth professional and so am anxious to eat up all the great information you’re giving out here.
Anyhow…. Our state treasurer’s wife (that’s here in Arizona) died today in childbirth, and their baby is said to be in grave condition. They’re not giving causes or reasons. Here’s the link:
http://www.azcentral.com/news/articles/2009/05/26/20090526treasurers-wife0526-ON.html
Can you think of occurrences in hospital-birth that would end up with a dead mother and a baby in really bad condition? I’d love to hear from someone who knows her stuff. The things that came to mind for me were amniotic fluid embolism, severe uterine rupture, and cesarean gone really wrong.
Keep up the amazing work!!!
Diana
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Dear Diana J.,
I just read the story you linked to and my heart goes out to that family. Unfortunately the story you linked to did not go into any details, including the most important detail which is: Did the treasurer’s wife have a vaginal birth or a cesarean section, as the risks are significantly higher with a cesarean section. I think your question is a good one and since this story has the potential to make national headlines, I think that it is an important enough question to put as its own post on my site. I hope, however in posting about your question that moms out there who read my blog are not unnecessarily worried or upset that we are talking about maternal death as it is still a relatively RARE occurrence when you think about all the other causes of death in childbearing women.
Let’s put it into perspective. As the Arizona Central story stated, “In late 2007, the National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention, released a report showing that there were 13 maternal deaths per 100,000 live births in 2004 in the United States.” And since in 2004 there were 4.1 million births in the United States, if you do the math that would make about 533 maternal deaths in 2004. And don’t get me wrong…that’s 533 deaths to many for sure! However take a look at this chart published by the Center for Disease Control (CDC) entitled: Leading Causes of Death by Age Group, All Females- United States, 2004. It shows the following:
Leading Causes of Death for 15-19 year old Females, 2004:
1) Unintentional Injury (51.7%), 2) Suicide (8.8%), 3) Homicide (7.5%), 4) Cancer (7.3%), 5) Heart Disease (3.1%), 6) Birth Defects (2.8%), 7) Pregnancy Complications (0.9%)
Leading Causes of Death for 20-24 year old Females, 2004:
1) Unintentional Injuries (40.5%), 2) Homicide (8.4%), 3) Cancer (8.0%), 4) Suicide (7.6%), 5) Heart Disease (4.6%), 5) Pregnancy Complications (2.7%), 6) Birth Defects (1.9%), 7) HIV disease/Stroke (1.4%).
Leading Causes of Death for 25-34 year old Females, 2004:
1) Unintentional Injuries (25.3%), 2) Cancer (15.1%), 3) Heart Disease (8.2%), 4) Suicide (7.5%), 5) Homicide (5.8%), 6) HIV disease (4.4%), 7) Pregnancy Complications (2.3%).
And for women ages 35-44 years old, pregnancy complications don’t even crack the top 10.
Okay so if you are a pregnant mom please know that dying of pregnancy/childbirth related complications is rare and I don’t want to completely freak you out. But there is something very disturbing about the United States maternal mortality statistics which shocks most people when they hear it….
The United States ranks 42nd in the WORLD for maternal mortality rates, with 1 in 4,800 women dying from pregnancy complications in the U.S. in 2007. That means that 41 countries other countries in the world have BETTER maternal mortality rates than the United States!
Many of our practices and current situations in this country, including our obsession with medically unnecessary labor induction, our over-medicalized maternity care system, the practice of defensive as opposed to evidenced-based medicine, the lack of a universal health care system, large differences in health disparities among different racial/socioeconomic groups, the obesity epidemic, and our skyrocketing cesarean section rate greatly contribute to our country’s maternal death rate.
So what exactly is defined as “maternal death.” According to the World Health Organization, “A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” Therefore a death of a woman that died from complications arising from a cesarean section a month after she had the baby would be counted in the maternal death statistics where a pregnant woman who died in a car accident or murdered during a domestic violence dispute would not.
Okay, but you are probably thinking Why? Why are so many women dying in childbirth in an industrialized, developed country like the United States at a much higher rate than other industrialized, developed countries like Japan, many countries in Europe, or Australia?
Ina May Gaskin, midwife and founder of the Safe Motherhood Quilt Project, gives us some insight into the situation in her book Spiritual Midwifery, page 455, written in 2002:
“According to the CDC, there has been no improvement in the U.S. death rate (which is nearly twice as high as Canada’s) since 1982. Sadly, the CDC estimates that the true death rate is as much as three times higher than that which is reported and that half of all the reported deaths could have been prevented through early diagnosis and good care. Given the situation it makes sense for women to avoid unnecessary surgery while pregnant or in labor. Women double or triple their risk of dying when they have an unnecessary cesarean. Medical mistakes do happen, even to people who are well informed about their possibility.”
Also Ina May’s Safe Motherhood Quilt Project website also links to a Maternal Mortality in the USA Fact Sheet that is worth checking out!
The 2008 documentary Orgasmic Birth (which I highly recommend renting) has a 20- minute movie clip as part of the “special features” section of the DVD that provides some eye opening statistics about maternal and infant mortality rates in the United States as compared to other industrialized countries around the world. In this short movie clip, entitled Birth By The Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today. It is a MUST WATCH CLIP for anyone who is or cares about a mother.
Also, here are some articles from mainstream news sources published in response to the 2007 maternal mortality rankings that provide some insight:
1) More U.S. women dying in childbirth: Death rate highest in decades; obesity and C-sections may be the cause Associated Press, August 24, 2007
2) Maternal Mortality Shames Superpower U.S. Inter Press Service, October 13, 2007
3) U.S. ranks 41st in maternal mortality Seattle Post-Intelligencer, October 12, 2007
A flyer published by the medical journal The Lancet in 2006 entitled Causes of Maternal Death: A Systematic Review ranks the top 9 causes of maternal death related to pregnancy/childbirth complications in DEVELOPED countries as the following:
1) Other Direct Causes (21.3%), complication of the pregnancy, delivery, or their management which includes (among other things):
-Anesthesia Complications* (responsible for about 3% of all maternal deaths by itself and includes: management of the difficult airway in obstetric patient, aspiration of gastric contents under general anesthesia, local anesthetic toxicity, and high spinal or epidural block which paralyzes the breathing muscles of mother).
2) Hypertensive Disorders (16.1%), includes (among other things):
-Preeclampsia
-Eclampsia*
-HELLP Syndrome*
3) Embolism (14.9%), includes (among other things):
-Pulmonary Embolism (typically a complication seen post-op surgery)
-Deep Vein Thrombosis (DVT) (more likely to develop for women on bed rest or post-op surgery
- Amniotic Fluid Embolism (rare and more appropriately known as Anaphylactic Syndrome of Pregnancy)*
4) Other Indirect Causes of Death (14.4%), pregnancy-related death in a patient with a preexisting or newly developed health problem like cardiovascular disease, seizure disorder, respiratory disorder, diabetes, kidney disorder, liver disorder, obesity, etc.
5) Hemorrhage (13.4%), includes (among other things):
– Obstetrical Hemorrhage (most common causes being uterine atony, trauma, retained placenta, and coagulopathy)
– Placenta Previa*
– Placenta Accreta, Increta & Percreta
– Placental Abruption*
– True Uterine Rupture*
6) Abortion (8.2%)
7) Ectopic Pregnancy (4.9%)
8.) Unclassified Death (4.8%)
9) Sepsis Infection* (2.1%) (most likely to occur post-operatively but can occur post-partum or antepartum)
*Comes to mind for me as having the potential to cause a critical illness or death for baby as well.
**Please note mothers undergoing cesarean surgery, especially repeat caesarean surgery are MORE at risk for anesthesia complications, pulmonary embolism, obstetrical hemorrhage, placenta previa, placenta accreta, and sepsis/infection than moms undergoing a vaginal birth.**
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You are probably thinking, “So what does all of this mean for me?” “How can I reduce my risk?” Both are GREAT questions. It is important to remember that I am not claiming that 100% of maternal deaths are preventable or even foreseeable. No one is. I also do not want anyone to get the impression that I am blaming mothers or putting unrealistic pressures on mothers to control things that are sometimes just happenings that are an unfortunate and very sad part of life. For example, who could have predicted a fatal postpartum hemorrhage for a healthy mom after a normal uncomplicated unmedicated singleton vaginal birth? No one could! But what about a mom who experienced a fatal postpartum hemorrhage after elective cesarean surgery….well that one doesn’t sit so well with me! And which do you think is more likely? If you guessed the latter you are correct…by at least 4 times as much!
So how does a mother reduce her risk of maternal morbidity and mortality related to pregnancy and childbirth complications? The following is a short list you might want to keep in mind. (Not surprisingly, many relate back to avoiding unnecessary surgery.)
TOP TEN Ways to Reduce Your Risk For Complications in Pregnancy and Childbirth:
1) Obtain good and thorough prenatal care, keeping all of your appointments, preferably beginning in your first trimester.
2) Make a conscious effort to eat a well balanced diet during conception and pregnancy that includes adequate amounts of fresh fruits and vegetables, healthy fats, and protein. There are a variety of prenatal nutrition books out there as well as many childbirth books that have a section on prenatal nutrition. If you don’t have one buy one or borrow one from the library!!
3) If you don’t exercise, start! Many gyms, community centers, and YMCAs offer low-impact, pregnancy-friendly classes for expectant moms. Even a 30 minute walk three times a week will do!
4) If you suffer from a chronic disease or illness or are obese, it is important to know that making appointments with health care providers and specialists that can help you to manage your disease and lose weight in a healthy way before and during pregnancy can ultimately help you to reduce your risk of life threatening complications during pregnancy and childbirth.
5) Consider hiring a birth attendant that practices a midwifery model of care.
6) Do NOT agree to a medically unnecessary labor induction.
7) Do NOT agree to a medically unnecessary or elective cesarean section.
8) If you have a history of a cesarean section, seriously consider a vaginal birth after cesarean section (VBAC) if you have no reoccurring or new reasons or medical indications for a repeat cesarean. If necessary switch to a birth attendant that supports VBAC and has the cesarean statistics to prove it.
9) Seriously consider avoiding interventions in labor that evidenced-based research have shown could increase your risk of a cesarean section, fetal distress, and infection including early amniotomy (breaking of waters), accepting pitocin to stimulate or augment contractions without trying other more natural methods for augmenting labor first, going to the hospital during very early labor, accepting continuous external fetal monitoring as opposed to intermittent auscultation for a normal healthy labor and a normal, reactive, and reassuring fetal heart rate pattern, and requesting an epidural or narcotic pain medication (especially in early labor) before trying all methods of non-pharmacological pain management techniques first. (Check out my post: Top 8 Ways to Have an Unnecessary Cesarean Section)
10) Empower yourself to make safe, healthy decisions regarding your pregnancy, your labor, your birth, and your baby by doing your own research!! (Check out my post: Birth Resources EVERY Woman Should Know About).