Risks To Baby From Cesarean Section Birth

Originally published Nov 6, 2008 at 12:08 AM on Cafemom

So, I read a surprising comment today--someone believing the risk of amniocentesis outweighs the risk of a cesarean to the baby. She said that a cesarean has its risks, but amnio could be the end of the world.

Do people really think a cesarean is that SAFE? I'm sorry, but it's not. And while, yes, the risks to mom are higher than risks to baby, just because those risks are frightening and include horrific infections, infertility, death, etc. does not make the risks to baby insignificant (and they are still greater than to a baby born vaginally and include a 3x increase in risk in death).

Here's just the short list, so you don't have to drag through all the papers and sources I have.

image courtesy of stockxchng

Risks to baby from cesarean section birth

Breathing problems^[1]

weakened immune system^[2]

digestive problems^[3]

fetal injury^[4]

diabetes (risk is 20% greater for babies born by c-birth)^[5]

asthma (risk is 50% greater)^[6]

neonatal depression (from anesthesia)^[7]

hospital borne infections (rate is higher due to the longer stay after a c-birth)^[8]

neonatal mortality (risk rises from .62 to 1.77)^[9]

and increased risk of SIDS^[10]

Low APGARS^[11]

There's the list of the most common side effects. I know that most people aren't aware of them, so that's why I compiled a list here. I couldn't find a comprehensive list anywhere else. I may expand this journal with a short synopsis of each condition at a later date.

My daughter was born by cesarean, beautifully, APGARS of 9, no side effects that we know of. But that doesn't negate that these risks are real and any baby born by cesarean could be affected in one of the ways above. It's important to be informed about the potential risks in any procedure being performed on you or your baby.

image courtesy of stockxchng

^[8]Pai, Madhukar. 2000. “Medical Interventions: Caesareans Sections as a Case Study.” Economic and Political Weekly 35 (31): 2755-2761.

What You Should Know About Shoulder Dystocia

Photo courtesy of stockxchng

This is something that my doctor loved to threaten me with when I was carrying Lilly. It was ridiculous because 1. my daughter was perfectly normal sized and 2. I had no intention of birthing on my back, which is the primary cause of problems, and my doctor knew this and had agreed to it. She was just angry that I wouldn't consent to an unnecessary induction for her convenience.

What is Shoulder Dystocia? It's a very rare and serious complication in which baby's shoulders get stuck that affects babies of all sizes, though it occurs slightly more frequently in babies that are over 9lbs. It's still rare, however, and not something that you should spend time worrying about. There is no way to accurately predict it ahead of time and any provider talking about it is likely looking for the bigger paycheck that comes with a cesarean birth (the difference? vaginal birth: $10K, cesarean birth: $25K and a VBAC costs more than a regular vaginal birth, thus, it's always in an OBs best financial interest to go for a cesarean--though it's NOT in mom's OR baby's, as mom is 5.5 times more likely to die and baby is 3 times more likely to die and complications of less serious natures are far more frequent as well).

So, doctors love to say, "Your baby is too big," (usually based on faulty ultrasound data, despite the fact that ultrasounds can be wrong by 2lbs or even more and become useless in determining size after week 20). The reason is usually shoulder dystocia. Many techniques have been used over the years, including just killing the baby, though the most success has been found in the easiest technique to date--the Gaskin Maneuver. The Gaskin Maneuver consists of having mom roll onto all fours (or assisting if necessary). During the process, many babies become dislodged and pop right out. If this doesn't happen, then the doctor actually has better access to help wiggle the baby around until the shoulder releases and the rest of baby is born (Woods or Rubin maneuver).

Most obstetricians don't even know that this maneuver exists, though most midwives are trained in it. In one study, it was shown to be effective in 83% of use without any further maneuvers. No maternal or perinatal mortality occurred. Morbidity was noted in only four deliveries: a single case of postpartum hemorrhage that did not require transfusion (maternal morbidity, 1.2%), one infant with a fractured humerus and three with low APGAR scores (neonatal morbidity, 4.9%).

Many doctors use traction (pulling on baby's head) or fundal pressure (where the nurse climbs on the bed and jumps down onto your stomach) before anything else and these are not only the least effective techniques, but dangerous to mother and baby.

The McRoberts maneuver (where mom's legs are brought up as far back toward her stomach as possible, which realigns the pubic bone and can slip baby's shoulder out) should be tried first and if failing, suprapubic pressure (where the doctor or nurse makes a fist and pushes hard on the baby's shoulder just above the pubic bone) can be applied. Next, the Gaskin maneuver should be performed and if that fails, then Woods and Rubin maneuvers can be tried.

McRoberts is effective in 39.5% of cases and in 58% with the addition of the suprapubic pressure. These methods can cause serious injury to the mother (McRoberts can injure mom's legs, particularly the femur and hips), but are typically safe to the baby. Woods does not have an available statistic for effectiveness and can break the baby's humerus. The Rubin maneuver is the opposite of Woods and requires less traction and causes significantly less injury.

Australia is currently training doctors in fracture of the clavicle, which has been dismissed until now as so dangerous to the baby and difficult to perform that it should not be used. However, it is used in some cases and can be lifesaving for baby. It's a severe emergency procedure that should not be attempted until all others have failed.

The Gaskin maneuver is most criticized due to it requiring the mother to be able to roll over and support herself on her hands and knees--something that is difficult, if not impossible, to do with a normal epidural. That's the only criticism, however, that is keeping it from being more widely studied and implemented.

The evidence from the literature on shoulder dystocia shows clearly that shoulder dystocia cannot be predicted with any degree of accuracy and it cannot be prevented by any specific strategies or maneuvers. Half of the babies in the Gaskin study were not larger than average and many were in the 5lb range. The worst outcomes did occur in the 'macrosomic' (larger than 10lbs) category. However, 'macrosmia' is not a sole cause nor does it always lead to shoulder dystocia. In fact, over 90% of macrosomic babies can be delivered vaginally without incident.

Perhaps in those "birth plan creators" that are available all over the internet that include sections on emergency births, preferences on maneuvers should be included in the event of shoulder dystocia. It's unlikely that doctors would be open to this, however, despite evidence of effectiveness and safety of the procedure, simply because they have no experience with it.

The best thing you can do as a pregnant woman is to be educated and if your doctor brings up the issue, discuss it with him/her. Eve if they don't, it might be useful to know their typical management of shoulder dystocia in case of emergency and their willingness to attempt maneuvers with less risk to mother and baby, even if unconventional, before the more dangerous, riskier maneuvers. It's also important to stay calm and follow your care provider's direction if the complication does arise.

Maneuver illustrations:

Traction:



McRoberts:


suprapubic pressure:


Woods Screw Maneuver:


Rubin Maneuver:

Gaskin Maneuver:

Myths of BabyWise

Myths and Facts about Baby Wise:

#1. BW/GKGW is church approved: Myth! The only church that (consistently) approves of this program is the one the author founded himself. Attempts to use it in other churches have ended in excommunication from most Christian communities the Ezzos have come in contact with. They have been accused of cultish behavior (which is different from being a cult) by respected Christian authorities, from scripture twisting (analysis of scriptures referenced show a lack of context with the situation and other scriptures can actually be found to denounce many claims made within the books) to isolationism, brainwashing (GKGW users are well programed to be angry at negativity surrounding the program, to not process when presented with facts), exclusivity, authoritarianism and physical and emotional endangerment. While the program is taught from many churches nationwide, they are taught by parents, not as a part of church curriculum.

#2. BW is pro-breastfeeding. Myth! In truth, most mothers, no matter how abundant their milk starts out, under the scheduling in BW (which was originally 4 hour intervals until babies started dying under such neglect and has been edited to 2.5-3 hours in current editions) almost all mothers in the program lose supply by 5 months. Typical weaning age of a BW user is 4-6 months. Originally, the Ezzos suggested abandoning breastfeeding at 3 weeks. While there are always exceptions to any rule, the fact remains that the rule in BW is to destroy a mother's supply and starve her baby (BW is linked to FTT from starvation and dehydration).

#3. BW is not abuse. Questionable -- BW users are flagged in several CPS divisions as 'potential abusers' and a child abuse prevention council's religious task force (including evangelical Christian pastors) investigating BW programs found that they were not developmentally and age appropriate. It further concluded that the programs did not consider individual temperament, have a balance of loving guidance and discipline, or foster parental discernment.

#4. GKGW creates a harmonious home. Myth! In fact, GKGW creates a permanent struggle between parent and child. Most users describe their relationship with their children as "Adversarial." It's also been commented by many mothers that they feel no bond towards their child(ren) while using the program.

#5. GKGW is the only Christian Parenting style. Myth! Attachment Parenting, which GFI slurs on a constant basis is actually made up majority of Christians and Catholics. Dr. Sears, the original AP author, is a Christian himself and has authored a Christian Parenting book.

#6. GKGW teaches children to respect their parents. Myth! Definition of Respect: the condition of being esteemed or honored: to be held in respect. To show regard or consideration for: to respect someone's rights. To feel or show deferential regard for; esteem. The truth: most children raised under GKGW fear their parents and escape them as soon as they are old enough to go. The Ezzos have no contact with their adult children. Their youngest daughter was last quoted as saying she will not have further contact with her parents and is praying for their souls.

#7. GKGW teaches children to behave properly. Myth! In truth, one of the biggest complaints from users is that they have difficulty controlling their children in public. Anger, emotional and anxiety disorders are prevalent in children in this program as is severe depression and low self-worth, which contributes to episodes of 'acting out'. When tested, they show no ability to differentiate right from wrong without an authority figure to ask and have few to no decision-making skills.

8. Crying it Out is harmless. Myth! CIO has been proven to cause brain damage, is linked to emotional disorders (one of the first questions asked when looking into these is 'If your child was was left to cry, do you believe, that at any point he may have felt abandoned or hopeless?" It is linked to ADHD (which is a brain chemical imbalance), ADD, Attachment Disorder (which there is no cure for and causes lifelong bonding and empathy issues), certain forms of autism, depression and Abandonment complex. Also, babies that are left to CIO tend to grow to be children who cannot self-soothe and are unable to handle any change in their sleeping routine. As toddlers, they often resort to crying faster than babies who are not left to CIO and are typically harder to comfort.

9. BW babies sleep through the night. Impossible to determine. In actuality, no one can be sure. For one, many mothers have mistaken catatonic babies who are weak from hunger and crying as being asleep. For two, since BW parents aren't around their babies at night, they often aren't aware of the babies waking and lying alone in their rooms, wide awake. Also, CIO conditions you to no longer hear your baby's cries, as illustrated in this quote:

I thought T, our second child, had started sleeping through the night early--as Babywise promised and as J had done. It was only because my sister was staying with us for a few months that I found out I had become immune to his nighttime cries. I just didn't hear and register them--she occasionally woke me up to take care of the baby or would ask "Didn't you hear him crying last night?"

#10. Attachment Parenting results in unruly children running the household. Myth! In truth, children who are raised with real AP parents have boundaries and rules and respect for their parents. Ezzo seemed to confuse Attachment Parenting (which is Breastfeeding, Birth Bonding, Baby-wearing--for mother's convenience as well as baby's well-being, Bedding close to baby--again, for mother's convenience and baby's well-being, as it is shown to dramatically reduce the risk of SIDS, Belief in baby's cry as a form of communication, being prepared for birth and Balance--meaning balancing being husband and wife as well as being parents, so that no one's needs are unfulfilled) with permissive parenting (where the parents are basically absent of decision making within the family).

Quotes from GKGW moms who were either separated from their BW communities or accidentally ended up in AP communities:

"For the first time we were separated from our group of close friends who all were pro-Ezzo. We developed other close friends who seemed to be practicing "attachment parenting". At first I thought these families were ruled by their kids, but over time I noticed what trusting relationships they had and how great their kids were, without all the stress we were having, and had been through."

"At that time, I joined a mom's group and met some attachment parents. I had such a negative image of these parents in my mind because of everything Ezzo had said about their parenting philosophy. I expected their children to be holy terrors. What I found astounded me. Their children were so loving and thoughtful without even having to be prompted! They listened to their mothers and did everything that was asked of them. It wasn't a robotic obedience, either. I could tell these kids genuinely wanted to please their mothers. Moreover, their mothers seemed to enjoy them so much! I could tell that the relationship they had with their children was strong and based in trust and love. "

11. People who don't like GKGW have never read or used GKGW. Myth! In actuality, the people who speak out the strongest against BW, TW, GKGW, Prep, etc. are the parents who have used it. Contact moms, ministers, minister's wives, decade-long users, etc. They watched it rip their families apart, had children diagnosed with horrible, life-shattering disabilities, had babies nearly die, put on NG feedings, etc. Some just realized that they were miserable under the program, as much as they professed otherwise--sometimes because they believed they would be bad parents if they were unhappy with it.

12: People who don't like BW are Ezzo-bashers. Myth AND Fact! Many anti-GKGW parents actually met and liked the Ezzos themselves. It's the teachings and methods they don't agree with. While I, personally, have a problem with anyone who would endorse child-abuse and neglect on such a wide-scale as Gary Ezzo has, I am not, by far, the only opinion on this subject.

13. Couples should spend at least 15 minutes together every day conversing with each other and focusing on their relationship. Fact! This is probably the best advice in the whole system. However, it should NOT be at the expense of the children's time. They can converse while the kids are taking a bath (or while giving them the bath), before the kids get up in the morning, after they go to bed, etc. There is no reason to sacrifice your relationship with your children for your relationship with your spouse/significant other. And you don't have to do it sitting on a couch! It can even be in the car, driving to the store! It's good to acknowledge your loved ones--all of them.

So, to wrap it up, Baby Wise, Toddler Wise or Growing Kids God's Way is a dangerous system that is highly-criticized, linked to failure to thrive in infants, abuse in toddlers and children, attachment disorders, emotional disorders, lack of family bonding, resentment and fear in children; is run by a man who publishes himself, writes inaccurate information against medical advice and is probably as far from "What would Jesus do" as one can get, in this author's opinion. I don't see a man who stopped a prostitute from being stoned as being supportive of harming children or who said that the Kingdom of Heaven belonged to infants and children or who said praise could fall from those same lips would advocate someone ignoring the gifts of communication God has bestowed upon infants for a man's schedule or forsaking the instincts God gave us to care for our children.

It is unbelievable to me that there are people who believe they are doing good by their children by torturing them. Sure, they may end up with zealous children suffering from Stockholm syndrome--if they ever manage to get the random acts of kindness in, which would certainly make them feel justified, but they're just as likely raising sociopaths or people who will never be able to care for themselves from the serious trauma they've inflicted. And not realizing that neglect and abuse are neglect (Child Neglect can be defined as “the persistent failure to meet a child’s basic physical and/or psychological needs”) and abuse (Abuse is a pattern of coercive control that one person exercises over another. Battering is a behavior that physically harms, arouses fear, prevents a person from doing what he/she reasonably wishes or forces her to behave in ways he/she does not want) is just something I will never understand.

Disclaimer: This is an opinion piece written using facts taken from multiple sources, stories of current and ex-GKGW/BW users (anecdotal evidence), various medical and theological studies, the Bible and Holy Scripture, Legal Definition sources, Dictionary.com, Wikipedia (only from verified, properly referenced source material), AskDrSears.com, and http://www.ezzo.info/ and is not a substitute for medical advice, psychological evaluation, legal advice or theological counseling and is not endorsed by any entity. Originally published under the title "BabyWise: BabyLies--Proof that if Satan wrote a book and said it was Godly, people would line up to sell their souls." Taken from the quote: "[BW] is proof that if Satan wrote a book and claimed it was church approved, there are plenty of [parents] who would abuse their kids and sell their souls."