Being Seduced to Induce: What Women Should Know
About Their OBs
The following was excerpted from the MIDWIFERY
TODAY E-NEWS a publication of Midwifery Today,
Inc. Volume 3 Issue 25 June 20, 2001 Vaginal vs.
Cesarean Birth - Part 2 Code 940 To subscribe,
go
here.
The following is from a Lecture by Marsden Wagner
M.D. in New York City, April 2001.
"Women will only agree to cesarean section
if they are convinced it is safe for them and
their baby. One of the first efforts of obstetricians
promoting cesarean section has been to take the
scientific evidence on risks of cesarean section
and torture the data until it confesses to what
they want it to say.
One example: Obstetric hype in popular and professional
magazines says research shows 60% of women who
have vaginal birth have urinary and fecal incontinence.
But a careful reading of the research papers they
refer to reveals something very different. The
hype lumps all women with vaginal birth together
instead of doing what the researchers did- dividing
them into risk groups. When analysis of risk was
done, they found that women at high risk for urinary
and fecal incontinence have had large numbers
of births; have had babies weighing over ten pounds
at birth; and most importantly, have been the
victims of unnecessary, aggressive obstetric interventions
during their labor and birth.
What are these aggressive, invasive obstetric
interventions that have been proven scientifically
to cause permanent damage to the pelvic floor
and urinary tract and also lead to more otherwise
unnecessary cesarean section? One example is the
use of powerful and dangerous drugs to start or
accelerate labor, a practice that has doubled
during the past 10 years. These drugs make labor
abnormal with violent contractions that can damage
the uterus and pelvic floor. The only reason women
agree to such induction is because they are not
told the truth about the drugs, for example that
Pitocin (oxytocin), a drug used for decades to
induce labor, doubles the chance the woman will
have urinary incontinence in the future. By withholding
such facts doctors seduce to induce.
Induction with drugs is not the only aggressive,
invasive intervention that is frequently used
in vaginal birth and is associated with damage
to the urinary system, pelvic floor and rectal
areas. Episiotomy has been scientifically shown
to result in more pelvic floor damage than a natural
tear. When an effort was made in the 1980s to
reduce cesarean section in the United States,
the rate of using forceps or vacuum extractor
to pull the baby out went up--some doctors just
can't stop doing invasive interventions. And there
is good data that using forceps or vacuum to pull
the baby out has more risk of pelvic floor damage
than any other form of birth
Obstetricians have turned birth into a surgical
procedure and done damage to women's bodies and
now suggest the solution is to promote yet even
more radical and aggressive surgery, cesarean
section. The solution is less unnecessary invasive
surgical procedures during birth, not more.
[Re: the Midwifery Today E-News article, Issue
3:23]: The two obstetricians tried to say that
vaginal birth can damage a woman, but they never
pointed out the ways in which cesarean section
can do harm not only to the woman but to the baby
as well. The following excerpt from my article
"Choosing Cesarean Section" in The Lancet
of November 11, 2000 reviews some of the dangers
associated with cesarean section, the alternative
to vaginal birth that some doctors are trying
to promote:
'In addition to the increased risk the woman
will die with an elective cesarean section, there
are other risks for the woman including the usual
morbidity associated with any major abdominal
surgical procedure--anesthesia accidents, damage
to blood vessels, accidental extension of the
uterine incision, damage to the urinary bladder
and other abdominal organs. (1) Some of these
risks are common: 20% of women develop fever after
cesarean section, most due to iatrogenic infections
requiring diagnostic fever evaluation for both
woman and baby. (1)
There are also risks women carry to subsequent
pregnancies due to scarring of the uterus including
decreased fertility, increased miscarriage, increased
ectopic pregnancy, increased placenta abruptio,
increased placenta previa (1,2,3). Recently in
the United States the widespread use of the unapproved
drug misoprostol (Cytotec) for labor induction
has created a new risk of cesarean section in
subsequent pregnancies. Women attempting VBAC
who are given misoprostol have a rate of uterine
rupture of 5.6% compared with a rupture rate of
0.2% for women attempting VBAC not given misoprostol,
a 28-fold increase in risk of uterine rupture.
(4) For women choosing cesarean section, all of
these risks exist in all of their subsequent pregnancies
even if the original cesarean section was not
an emergency. The increased risks of ectopic pregnancy,
abruptio placenta, placenta previa and ruptured
uterus are all life-threatening to both woman
and baby.
For whatever reasons women choose cesarean section,
very few are clearly informed about fetal risks.
In an emergency cesarean section where the baby
has developed a problem during the labor, the
risks to the baby of doing the cesarean section
will likely be outweighed by the risks to the
baby of not doing it. In an elective cesarean
section where the baby is not in trouble, the
risks to the baby from doing a cesarean section
still exist, meaning the woman who chooses cesarean
section puts her baby in unnecessary danger. That
some women are choosing cesarean section strongly
suggests women are not told this scientific facts.
The first danger to the baby during cesarean
section is the 1.9% chance the surgeon's knife
will accidentally lacerate the fetus (6.0% when
there is a non-vertex fetal position). (5) Obstetricians
may be less aware of this risk--in one study only
one of the 17 documented fetal lacerations was
recorded by the obstetrician doing the surgery.
(5) A much more serious risk to babies born by
cesarean section is respiratory distress. Many
reports in the scientific literature document
the cesarean section procedure per se is a potent
risk factor for respiratory distress syndrome
(RDS) in preterm infants and for other forms of
respiratory distress in mature infants. (1) RDS
is a major cause of neonatal mortality. The risk
of newborn RDS is greatly reduced if the woman
is allowed to go into labor prior to the cesarean
section. Another serious risk to the baby born
by cesarean section is iatrogenic prematurity
(the baby is premature because the cesarean section
was performed too early). Even with repeated ultrasound
scans, the standard deviation for estimating gestational
age is large, creating errors in judging when
to do an elective cesarean section. Doing the
elective cesarean section after the woman goes
into spontaneous labor would markedly reduce this
risk as well. A vast literature documents the
increased mortality and morbidity, including neurological
disability, associated with premature birth.'
So beware. Surgeons try to sell surgery. Never
forget that obstetricians are, after all, surgeons.
Women must be extremely cautious in the face of
this hard sell and get the facts from those who
do not have a vested interest in surgery."
-Marsden Wagner M.D., M.S.P.H. For more about
Dr. Wagner, go
here.
1. Wagner M, 1994. Pursuing the Birth Machine:
The Search for Appropriate Birth Technology, Sydney,
Australia: ACE Graphics.
2. Enkin M, Keirse M, Renfrew M, Neilson J, 1995.
A Guide to Effective Care in Pregnancy and Childbirth,
2nd ed, Oxford University Press.
3.Goer, H, 1999. The Thinking Woman's Guide to
a Better Birth. Putnam, New York: Penguin.
4.Plaut M, Schwartz M, Lubarsky S, 1999. "Uterine
rupture associated with the use of misoprostol
in the gravid patient with a previous cesarean
section," Am J Obstet Gyn 180:1535-42.
5. Smith J, Hernandez C, Wax J, 1997. "Fetal
laceration injury at cesarean delivery,"
Obstet & Gynecol 90:344-6.
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