Deaths and severe complications in pregnancy and childbirth are increasing in the United States, according to an article, "Rising Maternal Mortality Rate Cases Alarm, Calls for Action," published Sunday in the Los Angeles Times. Experts on maternal health think there are several reasons for this trend: More pregnant women today are older and obese, and childbirth practices have changed greatly over the past two decades with more cesarean sections and induction of labor. The death of a new mother at what should be a joyous time is unspeakably sad. We profiled a Los Angeles man, Matt Logelin, whose wife died unexpectedly a day after giving birth to their daughter.
Why is having a baby today less safe than it was two decades ago? Two studies published Monday in the journal Obstetrics & Gynecology, one on vaginal birth after C-section and one on childbirth-related hysterectomy, make suggestions for addressing the crisis in obstetrics.
The first paper summarizes the findings of a government consensus conference that took place in March at the National Institutes of Health. Researchers concluded that vaginal birth after cesarean is "a reasonable choice for the majority of women." The paper is based on a large database of births and finds that although both elective repeat cesarean section and VBAC are highly safe, maternal death was higher for elective repeat Cesarean sections (0.013% versus 0.004% for a trial of labor). The rates of hysterectomy, hemorrhage and transfusions did not differ between the two groups. Uterine rupture -- the complication that is usually given for discouraging VBACs -- was rare but higher in the trial of labor group (0.47% compared with 0.03% in the repeat C-section group). Infant death was higher in the trial of labor group (0.13% compared with 0.05% in the repeat C-section group).
About one-third of all births today in the U.S. are cesareans, and the most common reason for needing a C-section is that the mother has already had one. But recent studies show that two or more cesareans increase the risk of dangerous complications of the placenta that may be contributing to the increase in maternal deaths in recent years. That complication may prove to be more significant than the risk of uterine rupture in a woman attempting a VBAC, said Dr. James R. Scott, the editor in chief of Obstetrics & Gynecology, in an editorial accompanying the study.
It's time to start reversing C-section rates in part by allowing VBACs in carefully selected patients, Scott wrote. For that to happen, he said, hospitals and insurance companies need to lift their flat-out bans on VBACs. "Instead, the patient should be allowed to make that choice after she has been informed of the facts and has been counseled by her physician thoroughly," Scott said.
Tuesday in Booster Shots: A bad combination -- childbirth and hysterectomy.
-- Shari Roan
Photo: Matt Logelin and daughter Madeline. Logelin's wife, Liz, died of a blood clot one day after giving birth in March 2008. Credit: Allen Brisson-Smith / For The Times