Prot ecting the Mother and Baby Continuum
Impact if Birthing
Practices on Breastfeeding
Pro tecting the Mother and Baby Continuum
Mary Kroeger
with
Linda J. Smith
Episiotomy and Surgical Delivery and Breastfeeding
153
rience. Ln a decade of work with over J 4,000 deliveries by "civilized women" in the squatting position, he has learned that episiotomy is never indicated. 16 The majority (70%) of the women he
obselVed/attended sustained no laceration or very small tears. He
argues that in the upright squat position, all the anatomic and
physiologic forces work optimally and, with the mother herself in
control of the delivery (as the film depictsl, large tears are uncommon. He also reinforces the empowerment a mother apparently
feels in this position, and he reinforces the connection between
the peace and control th is position imparts to the mother and her
readiness to touch, cuddle, and breastfeed her infant.
Cesarean Section: Background Information
A cesarean section (e5). or su rgical delivery of a baby through the
mother'S abdomen, can be a life-saving intelVention for mother,
fetus, or both. Based on global data, WHO estimates that the CS
rate should not exceed 10- 15%, even in a high-risk referral facility. 17.18 Cesarean rates are on the rise in many parts of the world
and have reached shocking numbers in some countries. In the last
thirty years, CS rates in the United States rose sharply. climb ing
from 4.5% of all births in 1965 to 16.5% in 1980, and jumping
again to 24.7% in 1988. The rates dedined slightly in the early
1990s as more women sought vaginal birth after a primary C-section (VBAC), but the rates began to climb again, and in 2001 the
rate was back to 24. 5% of all births (Figure 8-3). One explanation
for the e5 rate turning upwards again is that fewer VBACs are
being attempted. VBAC has long been com mon in Europe (where
it is termed Mtrial of scar"), in Africa, and in most resource-poor
countries. 19
Box 8-1 CS and VBAC Rates: A Marker of the Move
away from Vaginal Delivery?
In ihe United States, the practice of VBAC bega n to increase
when a national effort to reduce the CS rate was undertaken. 20
Between 1990 and 2000, the VBAC rates increased and peaked
at 36% of all mothers with previous CS, and then began to
drop again because of limited evidence that there is additio nal
risk of complications {See Figure 8_3}.22 The ACOG Bullet;"
continued
154
Vaginal Birth After Cesarean Dell vtrlOl In lilt!! USA. 1990- 200 1
30
,r-'r-
25
ۥ
r
20
r
iii
S0
...
,...
r
15
10
5
o 1990 199119921993 19941995199619971998199920002001
Year
FIGURE 8·3
US VBA( R
Practices on Breastfeeding
Pro tecting the Mother and Baby Continuum
Mary Kroeger
with
Linda J. Smith
Episiotomy and Surgical Delivery and Breastfeeding
153
rience. Ln a decade of work with over J 4,000 deliveries by "civilized women" in the squatting position, he has learned that episiotomy is never indicated. 16 The majority (70%) of the women he
obselVed/attended sustained no laceration or very small tears. He
argues that in the upright squat position, all the anatomic and
physiologic forces work optimally and, with the mother herself in
control of the delivery (as the film depictsl, large tears are uncommon. He also reinforces the empowerment a mother apparently
feels in this position, and he reinforces the connection between
the peace and control th is position imparts to the mother and her
readiness to touch, cuddle, and breastfeed her infant.
Cesarean Section: Background Information
A cesarean section (e5). or su rgical delivery of a baby through the
mother'S abdomen, can be a life-saving intelVention for mother,
fetus, or both. Based on global data, WHO estimates that the CS
rate should not exceed 10- 15%, even in a high-risk referral facility. 17.18 Cesarean rates are on the rise in many parts of the world
and have reached shocking numbers in some countries. In the last
thirty years, CS rates in the United States rose sharply. climb ing
from 4.5% of all births in 1965 to 16.5% in 1980, and jumping
again to 24.7% in 1988. The rates dedined slightly in the early
1990s as more women sought vaginal birth after a primary C-section (VBAC), but the rates began to climb again, and in 2001 the
rate was back to 24. 5% of all births (Figure 8-3). One explanation
for the e5 rate turning upwards again is that fewer VBACs are
being attempted. VBAC has long been com mon in Europe (where
it is termed Mtrial of scar"), in Africa, and in most resource-poor
countries. 19
Box 8-1 CS and VBAC Rates: A Marker of the Move
away from Vaginal Delivery?
In ihe United States, the practice of VBAC bega n to increase
when a national effort to reduce the CS rate was undertaken. 20
Between 1990 and 2000, the VBAC rates increased and peaked
at 36% of all mothers with previous CS, and then began to
drop again because of limited evidence that there is additio nal
risk of complications {See Figure 8_3}.22 The ACOG Bullet;"
continued
154
Vaginal Birth After Cesarean Dell vtrlOl In lilt!! USA. 1990- 200 1
30
,r-'r-
25
ۥ
r
20
r
iii
S0
...
,...
r
15
10
5
o 1990 199119921993 19941995199619971998199920002001
Year
FIGURE 8·3
US VBA( R