My reading list for this “vacation” also includes some journal articles. Sometimes when I search for an article by author, I find that the author has written many interesting articles. That happened today when I was juggling multiple portals to find a link for a long reply turned post in progress. I entered the author SL Clark in the search for the American Journal of Obstetrics and Gynecology, and got a list of gems.
One on the use of oxytocin made me sigh as I saved a copy. We are visiting with my in laws right now. My sister in law was given oxytocin for what ended up being a three hour active labor and delivery. I try not to second guess treatments of my family and friends once they have occurred, but this surprised me so much that I stammered “Why??!!”
She, like her mother, has incredibly quick labors, and we were all concerned whether she would make it to the hospital in time. Unfortunately for her, her epidural didn’t “take”. She thought the augmented contractions were unbearable. I had augmented contractions without an epidural my first labor, and they aren’t any fun, even if it is your plan to tough it out pain-wise. I wish I had known to refuse it or at least challenge its use. Like her, I was in active labor with intact membranes, I was low risk, and the fetus wasn’t in any distress. We were both given oxytocin upon admission. She told me she wasn’t going to take any childbirthing classes before her first delivery because her physician told her she “didn’t deserve to feel any pain.” I found that statement infuriating and misleading, but I kept my mouth shut. Unfortunately, by his logic, she was less deserving this time around.
Another article of his is what led to the title of this post. The results of his group’s review of maternal mortality since 2000 concludes that mortality during cesarean section is eleven times that of a vaginal delivery.
RESULTS: Ninety-five maternal deaths occurred in 1,461,270 pregnancies
(6.5 per 100,000 pregnancies.) Leading causes of death were
complications of preeclampsia, pulmonary thromboembolism, amniotic
fluid embolism, obstetric hemorrhage, and cardiac disease. Only 1
death was seen from placenta accreta. Twenty-seven deaths (28%)
were deemed preventable (17 by actions of health care personnel and
10 by actions of non-health care personnel). The rate of maternal death
causally related to mode of delivery was 0.2 per 100,000 for vaginal
birth and 2.2 per 100,0000 for cesarean delivery, suggesting that the
number of annual deaths resulting causally from cesarean delivery in
the United States is about 20.