IS THERE ANY BENEFIT TO LOW CSECTION RATES

1
IS THERE ANY BENEFIT TO LOW C-SECTION RATES?
BIRTH PLAN VERSUS BIRTH OUTCOME

• COMPARED WITH A PLANNED CESAREAN, A PLANNED
  VAGINAL DELIVERY IS MORE LIKELY TO RESULT IN THE
  TWO BIRTH OUTCOMES THAT HAVE THE MOST SEVERE
  RISKS OVERALL
• ONLY WITH GREATER TRANSPARENCY OF THE RISKS AND
  BENEFITS OF ALL BIRTH PLANS AS THEY RELATE TO
  ALL CORRESPONDING BIRTH OUTCOMES CAN WE TRULY
  INFORM WOMEN

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2
IS THERE ANY BENEFIT TO LOW C-SECTION RATES?
PVD RISKS INCLUDE

• Intrauterine fetal demise at late gestational
  age, intracranial hemorrhage, cephalhematoma,
  fetal trauma, neonatal encephalopathy, shoulder
  dystocia, brachial plexus injury
• Pelvic floor disorders, pelvic organ prolapse,
  urinary and fecal incontinence, sexual health
  problems, perineal lacerations, episiotomy,
  perineal pain

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3
IS THERE ANY BENEFIT TO LOW C-SECTION RATES?
THE REALITY

• AN 85-90 SAFE VAGINAL DELIVERY RATE IS
  UNACHIEVABLE BY MODERN HEALTHCARE STANDARDS, AND
  A 10-15 NATIONAL CESAREAN RATE WILL NOT BE
  ACHIEVED IN THE U.S.
• THE 1985 W.H.O. RECOMMENDATION IS OUTDATED, AND
  CONTRADICTS COMMENTS MADE IN 2008 BY THE W.H.O.S
  OWN DIRECTOR OF ITS MAKING PREGNANCY SAFER
  PROGRAM

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4
IS THERE ANY BENEFIT TO LOW C-SECTION RATES?
RISKS WITH REDUCING RATES

• INFANT, FETAL, NEONATAL AND LATE PERINATAL
  MORTALITY RATES ARE ALL LOWER TODAY THAN THEY
  WERE IN 1980 AND 1985 WHEN THE CESAREAN RATE WAS
  LOWER (16.5 AND 22.7 RESPECTIVELY)
• RESEARCH HAS SHOWN DECREASED INFANT AND MATERNAL
  MORTALITY AND MORBIDITY WHERE CESAREAN RATES ARE
  NOT LIMITED TO 10-15

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5
IS THERE ANY BENEFIT TO LOW C-SECTION RATES?
FINANCIAL COST

• THE FULL SPECTRUM OF SHORT- AND LONG-TERM
  FINANCIAL, PSYCHOLOGICAL AND HEALTH COSTS MUST BE
  APPLIED TO ALL PLANNED VAGINAL DELIVERY OUTCOMES,
  AND THEN COMPARED WITH ALL PLANNED CESAREAN
  DELIVERY OUTCOMES
• STRONG OPPOSITION TO UNCOVERING THE TRUTH EXISTS

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6
IS THERE ANY BENEFIT TO LOW C-SECTION RATES?
CESAREANS ARE NOT ALL EQUAL

• A PLANNED CS HAS LOWER RISKS THAN AN EMERGENCY
  CS
• A PLANNED CS AT 39 WEEKS HAS LOWER RISKS THAN AT
  lt39 WEEKS
• A CS CAN BE WANTED OR UNWANTED
• A REPEAT CS HAS GREATER RISKS THAN A PRIMARY CS
• A CS MAY BE DEEMED MEDICALLY NECESSARY OR
  UNECESSARY

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7
IS THERE ANY BENEFIT TO LOW C-SECTION RATES?
GENUINE CHILDBIRTH AUTONOMY

• TRUE ADVOCATES OF BIRTH AUTONOMY SUPPORT ALL
  WOMEN AND ALL BIRTH PLANS, REGARDLESS OF WHERE
  THAT LEAVES NATIONAL CESAREAN AND VAGINAL
  DELIVERY RATES
• AND REGARDLESS OF WHETHER IT REFLECTS THEIR OWN
  PERSONAL BIRTH PLAN PREFERENCES

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