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Safety of Caesarean sections is questioned - Jump in procedure rate give some in Brooklyn reason to pause

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Could mothers be endangering their babies by undergoing Caesarean sections? The answer to that is being debated by Brooklyn’s health specialists in response to a new report questioning the safety of the procedure. “I personally don’t think it should be avoided…[but] we shouldn’t take it cavalierly,” said Dr. Iffath Hoskins, chair of Lutheran Medical Center’s obstetrics and gynecology department and assistant secretary of the American College of Obstetrics and Gynecology (ACOG). According to Public Advocate Betsy Gotbaum’s latest report, the percentage of Brooklyn women having C-sections increased from 2003 to 2004 at all but two of the borough’s hospitals. Coney Island Hospital at 2601 Ocean Parkway and Maimonides Medical Center at 4802 Tenth Avenue saw their figures decrease. The highest increase in Caesareans sections was recorded by Victory Memorial Hospital, 699 92nd Street. Hospital spokesman Gerald McKelvey presented another figure – of first-time mothers, “the number of C-sections per 100 births is nine. So that’s nine percent.” Women who have already had Caesareans generally undergo the procedure again if they have more children. There are two reasons why women have C-sections – they request the procedure or the health of the baby or mother is in danger. In the latter case, the woman is generally enduring a high-risk pregnancy. She could have “high blood pressure problems and she needs to be delivered for her own safety,” Hoskins explained. In other cases, the baby may be too big for a vaginal birth, the baby’s shoulder and not the head enters the birth canal first, the baby’s heart rate drops during labor, or labor is too slow or stops. These scenarios may be partially responsible for Brooklyn Hospital Center’s high rate of C-sections. Gotbaum’s report notes that the hospital, located at 121 DeKalb Avenue, had the highest percentage of C-sections performed at any Brooklyn hospital in 2003 and 2004. Asked about the figures, Robert Cooper, a spokesman for the Brooklyn Hospital Center, said, “We’re in a high-risk area.” But for many women, it’s not a difficult pregnancy that leads them to Caesarean sections – they opt for the invasive surgery. “There are patients who are asking for elective Caesarean sections. They feel that,” Hoskins said, “this works best for me. I want to time my delivery.” Age is also a factor. Women over 40 who had in vitro fertilization and, as a result, are carrying twins or triplets “may be more likely to have Caesarean sections,” Hoskins said. Although many women choose to deliver via C-section – “It is the most common operation in the United States today,” Hoskins explained – it is still a risky method of childbirth. “It’s major surgery,” Hoskins said. “What happens is people tend to think that because it’s done so often, it must be okay.” “I tell all my patients it’s just like driving on the highway,” she continued. “Every now and then bad things happen.” Explaining the risks, Hoskins noted, “Because we are operating in an area near the bladder and the gut, sometimes there’s injury to those structures.” “The patient can have extra bleeding,” she added. “The patient can have an infection.” There can also be adverse reactions to anesthesia. “I’ve been practicing for 30 years. I still worry when I do a Caesarean because I’m so close to the bladder,” Hoskins said. There are also dangers to the baby. Although doctors must perform tests to make sure the baby’s lungs and brain, which mature during the final stages of pregnancy, are fully developed, the baby could be removed from the womb too early. March of Dimes, a research organization striving to prevent birth defects, premature birth, and infant mortality, weighed in on requested C-sections on its website. The organization notes, “With any Caesarean, it’s important that the surgery be done when the baby is full term – born after 37 completed weeks of pregnancy. C-sections may contribute to the growing number of babies who are born ‘late preterm,’ between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term.” These problems could include breathing, feeding, maintaining a healthy body temperature, or jaundice. Lutheran Medical Center, 150 55th Street, is taking steps to decrease the number of Caesarean sections performed each year. The hospital has piloted a program offering acupuncture to women in labor to help them deal with the pain of childbirth. Hospital reps say the alternative medical practice has been proven to “significantly reduce pain, shorten time of labor, and reduce the amount of anesthesia used, particularly during the epidural.” At Lutheran, patients who received acupuncture treatments had fewer Caesarean sections. “If successfully incorporated into normal hospital practice, acupuncture has the potential to drastically change the way women give birth in the United States,” according to the hospital. Lutheran is now hoping to receive a grant to fund an expansion of the program. But in the meantime, there are many things expectant mothers can do to avoid unplanned Caesarean sections and ensure that their babies are born healthy. City Health Department officials advise women to plan all pregnancies and “Always use birth control until you’re ready to get pregnant.” For information about free medical care offered to pregnant women lacking health insurance, contact the Women’s Healthline via 311 or log onto the Health Department’s website, www.nyc.gov/health.

Posted 7:03 pm, October 10, 2011
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