Post Partum Hemorrhage
Yes, you are reading correctly, I am saying that it’s okay to have a c-section.
I realize that much of my platform here is about normal birth and allowing mamas (and babies) to come into and move into this world naturally.
Yet, I have had 2 C-sections.
Yup, 2 C-sections!
So how come I am such a proponent of “normal birth?”
I’ve often berated myself for not “trying harder” to deliver vaginally. I should have at least tried, shouldn’t I? These feelings welled up once again as I was about to pen another post about the virtues of normal, vaginal birth, this time about how normal birth is now associated with important positive brain proteins in babies. Then just when I was about to get started, I looked over at my 2 sleeping children (I’m writing this in a hotel on my way back to Austin from Summer vacation) when I had to stop myself and ask, “Are my children somehow brain deprived because they were delivered via c-section? Are they in anyway developmentally impaired or otherwise “less than” because they were c-section deliveries?” My children are beautiful and as healthy and cunning as they come!
I also know that without c-sections, neither of my children (or myself for that matter) may be here. My daughter’s birth, my first c-section delivery was emergent, traumatic and both of us are lucky to be alive! I don’t remember all the details of her “coming out” but according to my husband, she was in distress, blue and the neonatologists worked on her for a bit before she cried. I was vomiting profusely from the pregnancy (I had all day sickness all 9 months!) and the anesthesia only made things worse. Added to that, my uterus was lacking in tone, so once my daughter was born, it didn’t contract but was kind of like a stretched out balloon. And I bled. I’m not talking a little sputter, I’m talking this side of hemorrhage! Everything started to move more quickly, there was a lot of clatter as more instruments were opened and soon I was given something in my IV to “calm me down” (translation-make me out of it so that I’d stop trying to see what was going on and getting more agitated in the process.) I watched my OB’s eyes over her mask; they were set, focused and soon you could hear a pin drop in that OR suite. I knew that things were not good.
But I lived to tell about it and I am thankful that I and my almost 10 year old sassy girl are just fine. And I can tell you, there is no brain deficit in this one! In fact, that smart mouth is about to drive me crazy!
Same with my son. My darling boy was born at 39 weeks via c-section. While his birth was much calmer, my uterus was again an overused balloon, lacking in tone and contractility. This time, my baby was put to my breast and with a bit of pitocin, I was stitched up, good as new (sort of!).
I know that I may not be here to write this blog or to critique and share the various articles that I read had I not had 2 c-sections. I would not have the 2 children that I adore beyond words without my 2 c-sections.
”So how are my words affecting mamas who may have had a C-section or are about to have, a truly medically necessary, a C-section?”
I hope that my words will give you some solace. Sometimes you have to do what is right for you, and if a C-section is what is needed for you to have a healthy baby-and to survive yourself, then by all means, go for it! Yes, C-section rates in the United States have reached unacceptable rate. They are also often performed for “unnecessary” reasons. And there is no denying that c-sections carry with them risk. So if you can avoid having one, I prayerfully ask that you do. There really are benefits to having a normal vaginal birth for both mamas and babies. I look at it this way: If this is the way in which Mother Nature designed us to have our young, it must be good because she’s not been wrong so far!
But I am also very thankful for medical science and technology for evolving and developing such that I was able to have my children and live to tell about it! Without seeming mellow dramatic, I am quite convinced that I would be dead otherwise.
We do need to curtail the number of c-sections performed in the United States. I do believe that health care providers need to meticulously scrutinize each situation to evaluate if a proposed c-section is truly necessary. But if a health care provider, after careful analysis of the situation deems it in you and your baby’s best health interest to have a c-section, it (you) will be okay!
At least that is what statistics released by the US Centers for Disease Control and prevention indicate. According to a recent report, minority women in the United States are more likely to die during and immediately after childbirth than Caucasian women. According to their report,
“Black, Hispanic and Asian women – and a handful of white women not born in the U.S. – accounted for 41% of all births nationwide between 1993 and 2006, but for 62% of pregnancy-related deaths.”
The actual numbers are really quite eye opening. For every 100,000 babies born to white women, between 7 and 9 mothers died from complications related to pregnancy. Yet, in comparison, 32 to 35 black women died for every 100,000 live babies, while deaths among Hispanic and Asian women (born in the US and elsewhere) were closer to rates for white women, at around 10 per 100,000. Older mothers were also more likely to die during and just after childbirth in all groups, eighteen white mothers ages 35 and up died for every 100,000 babies born, while 99 older black women died for every 100,000 births - almost one for every 1,000 babies.
In a country as rich as the United States and with exceptional health care resources, it seems unfathomable that women, particularly women of color, should have such a high rate of perinatal death. These numbers beg the question, is access to care the issue? We know that if women don’t have acces to quality health care, they are more likely to suffer complications. But the numbers seem to transcend economic status. So what else can be contributing to these large disparities?
Researchers found that heart problems, general cardiovascular disease and hypertension were the most common causes of death in childbirth for both white and black women during the latter half of the study period. The researchers wondered if genetic disorders or other unknown health related issues could also account for the disparities. To date, they are unable to explain the disparities.
While similar disparities have been noted in other countries, the fact of the matter is that it is unacceptable for a segment of the population to be at increased risk for death by what should be a natural act-childbearing. Sure, childbearing has risks. But when ethnic and genetic differences have been taken into account, women should have the same opportunity-and risk-to have a healthy baby and the data to date is saying otherwise.
If there are differences in access to care, we should correct those differences. Complications such as post partum hemorrhage, which is a huge cause of perinatal death worldwide, should be appropriately managed.With the barrage of medical treatments and technologies available, most pregnancy complications, especially those that occur in the US should be quickly and thoroughly managed.
The researchers are not able to explain the disparities and are calling for and carrying out further research. As a Black mama, very thankful for her babies, I certainly hope that they are able to find the cause (s) of the disparities and narrow and/or eliminate the gap.
Race, Ethnicity and Nativity Differentials in Pregnancy-Related Mortality in the United States: 1993-2006.
Creanga, Anndrea A. MD, PhD; Berg, Cynthia J. MD, MPH; Syverson, Carla, RN, MPH; Seed, Kristi; Bruce, F. Carol RN, MPH; Callaghan, William M. MD, MPH
The LifeWrap (generic name: Non-pneumatic Anti-shock Garment or NASG) is a first-aid device used to stabilize women who are suffering from obstetric hemorrhage and shock. According to the LifeWrap website,
“The leading cause of maternal mortality (deaths from pregnancy and childbirth related complications) is obstetric hemorrhage in which a woman bleeds heavily, most often immediately after giving birth. A woman somewhere in the world dies every 4 minutes from this kind of complication.”
LifeWrap has been studied extensively by SuEllen Miller, CNM, Ph.D, professor at UCSF and the director of the Safe Motherhood Project at UCSF. As Miller shares with KGO TV in San Francisco,
“If they (women) bleed they’re (often) very far from skilled care. They need something to buy them time so they can get to the kind of facility where they can get a blood transfusion or get surgery and that’s what the anti-shock garment does. It (LifeWrap) buys time.”
The LifeWrap is made of neoprene and VelcroTM and looks like the lower half of a wetsuit cut into segments. The LifeWrap reverses shock by returning blood to the heart, lungs and brain. This restores the woman’s consciousness, pulse and blood pressure. Additionally, the LifeWrap decreases bleeding from the parts of the body compressed under it. Recent research has identified that the pressure applied by the LifeWrap serves to significantly increase the resistive index (i. e. increase the tone and help reduce free flow of blood) of the internal iliac artery (which is responsible for supplying the majority of blood ﬂow to the uterus via the uterine arteries). Best of all, LifeWrap is a very low-tech device and can be applied by anyone after a short, simple training. It is very low cost, approximately $300 per suit, so it can be readily accessible by purchase or donation to countries and practices in need.
According to the Interview with KGO TV in San Francisco,
“The UCSF team is hoping to present results from its current clinical trial to the World Health Organization (WHO). If the LifeWrap is added to the organization’s approved medical device list, it would clear the way for donors to provide it to poorer countries, potentially saving thousands of lives.”
This is truly ground breaking news and research! It will be wonderful to live in a world where all mamas can safely give birth and actually live to see their babies.
An actual LifeWrap being used in Zambia. This image comes from the LifeWrap website.