Sky-high Caesarian Section Rates in the World

Caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries. Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems. A statement from the World Health Organization (WHO) underscores the importance of focusing on the needs of the patient, on a case by case basis, and discourages the practice of aiming for “target rates.”Caesarean section may be necessary when vaginal delivery might pose a risk to the mother or baby – for example due to prolonged labour, foetal distress, or because the baby is stuck in an abnormal position. However, caesarean sections can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.

Ideal rate for caesarean sections

Since 1985, the international healthcare community has considered the “ideal rate” for caesarean sections to be between 10% and 15%. New studies reveal that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. But when the rate goes above 10%, there is no evidence that mortality rates improve. There are wide variations in Caesarean section rates across the world, indicating a lack of consensus about the best way of delivering babies.

In countries where cesarean deliveries are currently below 15 percent, there is an improvement in infant, neonatal and maternal mortality and low birth rate with increases in the cesarean rate. In countries where cesarean deliveries are greater than 15 percent, the increasing rates are not associated with these health improvements and can be associated with harm. In middle and higher income countries, substantial decreases in health risks and costs can be achieved through reduction of unnecessary cesarean deliveries.

Countries with the highest CS Rates in each Region:
1). Brazil (55.6%) and Dominican Republic (56.4%) in Latin America and the Caribbean
2). Egypt (51.8%) in Africa,
3). Iran and Turkey in Asia (47.9% and 47.5%, respectively),
4). Italy (38.1%) in Europe, 
5). United States (32.8%) in Northern America,
6). New Zealand (33.4%) in Oceania. 

In Egypt, according to the latest data, more than half of all women give birth by CS without much difference between urban and rural areas. In China, choosing the date of the baby’s delivery on the basis of luck and fate for the future of the baby by some people is one of the explanations for scheduling a CS. On the other hand, several European countries have managed to control their CS rates over time. It is noteworthy that Finland has one of the lowest increases not only in Europe but among all countries included in this analysis.Japan (19.8 per cent) among the lowest in Asia.

Around one in four births in the UK is by c/s, while in Cyrus the figure is 52% and in Sweden 17%. The United States has a very high rate of cesarean delivery, one in three births happen by c/s, or 1.3 million babies born via surgery (32.8%). A study in France found more cesarean sections were performed in for-profit hospitals than in public hospitals, which treat more complicated pregnancies, suggesting that financial incentives may also play a role in explaining excess cesarean deliveries.

Betrán, A. P, Ye, J., Moller, A-B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS ONE,11(2):e0148343. doi:10.1371/journal.pone.0148343. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148343

Health at a Glance:  OECD INDICATORS. (2013). Retrieved from website:http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf

Nitrous Oxide

Nitrous oxide (N2O) is routinely used as an analgesic in obstetrics during labour. Nitrous oxide is known by most people as “laughing gas.”Many dentists use it to help with pain during dental care. Nitrous oxide was discovered by the English scientist and clergyman Joseph Priestley in 1772, when he noticed that a candle burned in the air with a remarkably vigorous flame. That was one year after the discovery of oxygen. In 1800 Humphrey Davy of the Pneumatic Institute in Bristol, England, experimented with the physiological properties of the gas, such as its effects upon respiration. He even administered the gas to visitors to the institute, and after watching the amusing effects on people, who inhaled it, coined the term "laughing gas." The date that Davy's experiment with nitrous oxide was on Boxing Day, December 26, 1799. On this day, Davy locked himself into a box and had a physician release 20 quarts of N2O into the box every 5 minutes for as long as he remained conscious. He lasted more than an hour in the box, and happily survived the ordeal.

He described his experience this way:

·         He noticed a sweet taste in his mouth, and a gentle pressure in the head, chest and limbs which spread to his fingers and toes.

·         He experienced vision changes and objects becoming clearer and brighter.

·         His hearing became acute while a distant but not unpleasant.

·         He said that the previously cramped box suddenly felt larger and more spacious.

·         He enjoyed himself immensely and declared the entire experiment a huge success.

Nitrous oxide remained a novelty until 1844, when Horace Wells had one of his teeth extracted while breathing the “laughing gas.’ In 1868, Andrews advocated the addition of oxygen with nitrous oxide to prevent the hypoxia often associated with its administration, thus permitting gaseous anesthesia with a nitrous oxide-oxygen mixture to become a reality. In 1881, Stanislav Klikovich in Russia introduced the use of nitrous oxide in the treatment of angina pectoris. He was the first physician to make a detailed study of nitrous oxide oxygen mixtures to provide pain relief without loss of consciousness or hypoxia. In 1934, Minnitt was the first to introduce a self-administered apparatus containing nitrous oxide and air for analgesia during childbirth.

Nitrous Oxide and the Brain

Technically nitrous oxide is not a narcotic because it is not processed through the liver. It is however classified as an analgesic because it relieves pain by releasing opioids while simultaneously activating your opioid receptors. It is classified as an anesthetic in its own right although lighter doses are used as an aid to a general anesthetic in applications as an anxiolytic, meaning that it is known to reduce anxiety

Labour and Childbirth

 For labor pain, half nitrous oxide gas is mixed with half oxygen and breathed through a mask or a mouthpiece. Labour is usually painful, yet, each woman’s experience of labor pain is highly individual with respect to both the nature and intensity of the sensations and her ability to cope. Exceptionally, a very few women may not feel pain; others can control their response so as to reduce pain. Most women think that pain is going to be a major part of giving birth. Some women experience a high degree of physical pain without suffering; others suffer greatly from pain that caregivers think is modest.

Many women in Europe and other countries, such as Canada, South Africa, United Kingdom, and Australia, use it to help cope with pain in labor. It is so common that in some countries as many as 8 in 10 women use nitrous oxide to help with labor pain. Women in these countries have been using this method of pain relief in labor safely for many years. Nitrous oxide hasn’t been used as often in the United States, but that is changing. The inhalation administration of nitrous oxide to women during labor could be an alternative to the common interventions used. Many women use nitrous oxide while standing, squatting, sitting in chair, birthing ball or in shower

The full analgesic effect of nitrous oxide is felt 50 seconds after inhalation. A person might feel drowsy, lightheaded, or a little silly while using nitrous oxide. This is why it got the name laughing gas. The dizziness means it is working well and the person should be encouraged to sleep after a contraction. The relaxation helps to speed the labour process. It is failry simple and easy to use. The nitrous oxide mask or mouthpiece is always held by the labouring woman by breathing the gas.

Nitrous Oxide is Safe for Baby

Nitrous oxide is a very safe for babies. Experts dont believe that using N2O presents any dangers to mother and baby because unlike a narcotic, Nitrous oxide is the only pain relief method cleared from your body through your lungs rather than the liver and expelled completely and no evidence of adverse effects to baby. As soon as the mask is pulled away, the effect of breathing the gas is gone within a few breaths. No extra monitoring is needed for mother or baby because of using nitrous oxide. Although metabolized in the lung tissue although some of the gas passes into the blood stream. However, studies have not shown adverse effects on babies of mothers who used nitrous oxide in labour.

Quick Recovery 

There are no long lasting effects when using nitrous oxide, you breathe into the mask, which you hold and control, when you need it for the pain. When the labor pain subsides, pull the mask away from your face, take a couple of breaths and the nitrous oxide is out of your system quickly. It has been reported that the Duchess Kate Middleton used nitrous oxide during labour and from what I see is that she seems to be walking around with all her mental faculties as well as the rest of us

Source

Agency for Healthcare Research and Quality. (2012). Nitrous Oxide for the management of labor pain. Retrieved from website:

http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1230&pageaction=displayproduct

Public Domain Essays: http://publicdomainreview.org/2014/08/06/o-excellent-air-bag-humphry-davy-and-nitrous-oxide/

 McAney, T. M., & Doughty, A. G. (1963). Self-administered nitrous-oxide/oxygen analgesia in obstetrics.  Anesthesia, 18(4). Retrieved from website: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1963.tb13573.x/pdf

Breastmilk Comparision

Breastmilk is the ideal food for infants. Human milk contains all the right ingredients - protein, carbohydrates, fats, vitamins, minerals, and water - in just the right balance. No formula can make that claim. Infant formula manufacturers attempt to artificially duplicate human milk. Formula feeding is a practice that is relatively recent - about 60 years - compared to the beginning of humankind (not to mention all other mammals) relying on breast milk.

Formula does not contain the disease-fighting factors or the digestive enzymes that breast milk has. The nutrients in formula are more difficult for a baby to digest and absorb than the nutrients in human milk, requiring the baby to handle excess waste. Some formulas may have a less than optimal composition by containing too much salt and/or not enough cholesterol, fats, lactose, zinc, and iron, among other nutrients. Did you know…

Formula-fed babies have a greater risk of:

Ear Infections

Diarrhoea/constipation

Pheumonia

SIDS (Sudden Infant Death Syndrome)

Children who were formula-fed have a greater risk of

Obesity

Diabetes

Astma and allergies

Cancer

Increasing awareness that feeding baby's breast milk is beneficial and is an important promotion goal

 

 

 

 

 

 

 

Galatagogues

List of Galactagogues - Herbs that Increase Breastmilk Production

A galactagogue is an herb that is used to help increase breastmilk production in nursing mothers.

Lactogenic foods

- Carrot seeds, beet and yam.

- Beet leaves, spinach, chicory and other dark green leafy vegetables.

- Plain Oats and oat straw capsules or liquid extract.

  Below is a list of some of the more effective and popular ones and some important information about each:

Fenugreek - one of the best and strongest herbs for increasing milk production. When taken in very large amounts, Fenugreek is also used for lowering blood sugar levels, and is, therefore, not recommended for use by diabetics or those who are on strict insulin regimens to regulate their blood sugar levels. It also works on the digestive system, and in a small percentage of people, it may cause gas in either the mother or baby. Many mothers of adopted babies have successfully used this herb to help establish a breastmilk supply to feed their adopted babies. Fenugreek is not recommended for use during pregnancy as it can cause uterine activity.  Fenugreek must be used with consistency for best results, otherwise it can negatively affect or decrease milk production.

Goat’s Rue - Goat's Rue is a powerful herb for stimulating milk production and increasing the flow of breastmilk. It has been shown to increase milk production by 50% in many cases, and may also stimulate the development of the mammary glands themselves. This herb is safe for use during pregnancy. This herb is one of the main ingredients of the Nursing Tea/Nursing Tincture. It can be used as a single herb by itself, or to use along with or to add to the Nursing Tea/Tincture when something a little stronger is needed.

Fennel - this herb is great for increasing breastmilk production, and at the same time is also extremely helpful in relieving symptoms of gas or upset stomach. It is the perfect herb to take in conjunction with Fenugreek, when gas is a problem. This is also one of the main ingredients of the Nursing Tea/Nursing Tincture, as well as the Tummy Tea/Tummy Tincture which is specifically formulated for gas, colic, reflux and indigestion.

Red Raspberry Leaf - also one of the ingredients of the Nursing Tea/Nursing Tincture. It not only helps to increase breastmilk production, but it also will help the uterus recover after birth, as it is a uterine toner. Red Raspberry Leaf is incredibly high in vitamins and minerals, including  Niacin (a B vitamin), which has been said to be helpful in relieving symptoms of Reynaud's Syndrome.

Vitex - although this herb is a prolactin-inhibitor, it has traditionally been used, and is proven in case studies, to actually increase breastmilk production in nursing mothers. Its main function is that of balancing hormones, therefore, this herb is very helpful for women who are experiencing hormonal imbalances, such as PMS symptoms, while breastfeeding.  Note:  Vitex use may re-start the menses in nursing women.

Alfalfa - a great herb for increasing breastmilk production while providing the body with lots of good vitamins and minerals. It is very high in Vitamin K in particular, which helps to staunch bleeding. Many midwives encourage all their clients to take Alfalfa for at least six weeks before birth, and for several months afterwards, to help avoid hemorrhage at the birth, and to help the body recover and make plentiful breastmilk afterwards. (Alfalfa is also an ingredient in the Nursing Tea/Nursing Tincture. Note: This herb is not recommended for use by those on blood-thinning medications due to its high levels of Vitamin K.

Nettle - a similar herb to Alfalfa. Helps to enrich the milk.
(Also a Nursing Tea/Nursing Tincture ingredient.)

Blessed Thistle - also known as "Our Lady's Milk Thistle". It increases breastmilk while helping to alleviate mild forms of postpartum depression. It is a bitter herb (known as a digestive bitter), which is healthful for the liver and digestion. Although it is an effective herb for increasing milk production, it is no longer included in the Nursing Tea. Many customers found it to be too bitter and did not like the taste, therefore hesitated to use the tea. We do have Blessed Thistle available as a single herb in the tincture form.

Borage - traditionally used to help balance the adrenals as well as increase breastmilk production. It is not for use on a long-term basis, and because it contains an alkaloid that can be hard on the liver, it is not one of the herbs that is recommended for nursing mothers/babies.

Hops - used in many cultures for years to help with breastmilk production. You've heard women say that they "breastfed their babies on beer"? The Hops is why. Beer from other countries has Hops that are helpful, but our beer here in this country is not as effective. It is the dark German beers that tend to have the right ingredients or the right quality of Hops. Hops is not on the list of favorite herbs recommended for increasing breastmilk production, however, because it can be quite sedating and it can cause depression with prolonged use

Oxytocin

Oxytocin is a powerful mammal hormone. When we hug or kiss a loved one, oxytocin levels drive up. It also acts as a neurotransmitter in the brain. In fact, the hormone plays a huge role in pair bonding. Prairie voles, one of nature's most monogamous species, produce oxytocin in spades. This hormone is also greatly stimulated during sex, birth, breast feeding.

In women, it is released mainly after distension of the cervix and vagina during labour, and after stimulation of the nipples, facilitating birth and breastfeeding, respectively. Oxytocin is released during orgasm in both sexes. In the brain, oxytocin is involved in social recognition and bonding, and might be involved in the formation of trust between people. Virtually all vertebrates have an oxytocin-like nonapeptide hormone that supports reproductive functions and a vasopressin-like nonapeptide hormone involved in water regulation.

Oxytocin is also released during the physical stimulation of a woman’s nipples. The release of oxytocin creates feelings of contentment, reduces anxiety and increases feelings of security and calm.
Naturally, due to these factors, there is much evidence that the oxytocin is important to mother-baby bonding as it enables an increase trust and decrease in fear.

Skin-to-Skin

Skin -to-skin contact  is a method of caring for newborn babies that involves putting the newborn on the mothers' chest skin-to-skin. Skin-to-skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their needs for oxygen, and keeps them more stable in other ways as well.

Your bare chect is the best place for your baby to adjust to life outside the womb. Your baby smells you, hears you, feels you and gets to know you.

When babies are held skin-to-skin after birth, data shows that they are:

• Hap­pier. A baby fusses less and is less agi­tated when placed naked (not wrapped in a blan­ket) on the mother’s chest imme­di­ately after birth, as well as later in the recov­ery room. (If the room is chilly, a blan­ket can be draped over both mother and baby.)
• More sta­ble. A mother’s body helps to reg­u­late her baby’s tem­per­a­ture, heart and breath­ing rate, and blood sugar level.
• More likely to breast­feed. The first hour or two after birth is usu­ally a quiet but alert time for a new­born, and many babies intu­itively “crawl” to their mother’s nip­ple and latch on with lit­tle or no help. This laid-back posi­tion allows you to use your hands to guide your baby, sup­port him, or express a few drops of colostrum to draw his atten­tion to the breast.

100 Reasons to Breastfeed

 

 

1. The World Health organization and UNICEF recommend it!
2. The South African Paediatric Association promotes breastfeeding

3. Breast milk is more digestible than formula

4. Breastfeeding reduces a mother's risk of breast cancer

5. Baby's suckling helps shrink mother's uterus after childbirth

6. Formula feeding increases baby girls' risk of developing breast cancer in later life

7. Formula Feeding is associated with lower I.Q.

8. Breast milk is always ready and comes in a nicer package than formula does

9. Breast milk helps pass meconium

10. Breast milk contains immunities to diseases and aids in the development of baby's immune system.

11. Breastfeeding satisfies baby's emotional needs and increases bonding between mother and baby

12. Breast milk provides perfect infant nutrition

13. Breastfeeding reduces a mother's risk of developing ovarian cancer

14. Nursing helps mom lose weight after baby is born

15. Pre-term milk is specially designed for premature infants

16. Breastfeeding protects against Crohn's disease (intestinal disorder)

17. Formula feeding increases risk of children developing diabetes

18. Breastfeeding baby helps decrease insulin requirements in diabetic mothers

19. Breastfeeding may help stabilize progress of maternal endometriosis

20. Baby's suckling helps prevent post-partum haemorrhage in mother

21. Breastfeeding reduces a mother's risk of developing endometrial cancer

22. Formula feeding increases chances of baby developing allergies

23. Breast milk lowers risk of baby developing asthma

24. Formula feeding increases baby's risk of otitis media (ear infections)

25. Formula feeding may increase risk of sudden infant death syndrome (SIDS)

26. Breastfeeding protects baby against diarrheal infections

27. Breastfeeding protects baby against bacterial meningitis

28. Breastfeeding protects baby against respiratory infections

29. Formula fed babies have a higher risk of developing certain childhood cancers

30. Breastfeeding decreases chances of developing rheumatoid arthritis

31. Breastfeeding decreases child's chances of contracting Hodgkin’s disease

32. Breastfeeding protects baby against some vision defects

33. Breastfeeding decreases chances of osteoporosis  

34. Breast milk aids in proper intestinal development

35. Cow's milk is an intestinal irritant

36. Formula-fed babies are more at risk for obesity in later life

37. Breastfed babies have less chance of cardiopulmonary distress while feeding

38. Breastfed babies have less chance of developing ulcerative colitis

39. Breast milk protects against haemophilus b. bacteria

40. Breastfed babies require shorter pre- and post-surgical fasting

41. Breastfeeding results in less sick days for parents

42. Breastfeeding enhances vaccine effectiveness

43. Breastfed babies have less chance of developing necrotizing enterocolitis

44. Breastfeeding contributes to optimal child spacing

45. Breastfeeding is easier than using formula

46. Breast milk is free

47. Formula is expensive

48. Formula costs the government (and taxpayers) millions of  rands

49. Breastfed babies require fewer doctor visits

50. Breast milk always has the right proportions of fat, carbohydrates and protein

51. Breast milk acts like a natural tranquilizer for baby

52. Breastfeeding acts like a natural tranquilizer for mom

53. Breast milk tastes better than formula

54. Breastfed babies are healthier over-all

55. Breastfed babies are less likely to die before their third birthday

56. Breast milk is always the right temperature

57. Breastfeeding mothers spend less time and money on doctor visits

58. Fewer waste packaging products

59. No bottles to tote

60. Breastfeeding may lower the risk of developing high cholesterol

61. No need to refrigerate

62. Cow's milk is designed for baby cows, while human milk is designed for human babies

63. Breast milk aids in the proper development of a baby's gastrointestinal tract

64. Breast milk provides natural pain relief for baby

65. Human milk is the perfect food for a sick infant

66. A breastfeeding mom gets more sleep

67. Babies that nurse are happier at night

68. More sleep for dad

69. Less equipment to maintain and store

70. Less equipment to buy  

71. Breast milk has never been recalled due to manufacturing problems

72. Fresh breast milk is never contaminated with bacteria

73. No need to worry about which brand is better

74. No need to worry about adding contaminated water

75. Breastfed babies get fewer stomach infections

76. Facilitates proper dental and jaw development

77. Breastfed babies have less tooth decay

78. Less money spent on corrective orthodontia

79. Better speech development

80. Less chance of baby getting eczema

81. Breastfed babies have great skin

82. Less spit-up

83. Breastfeeding is better for premature infants

84. Breast milk contains no genetically engineered materials

85. Breast milk contains no synthetic growth hormones

86. Lack of breastfeeding associated with multiple sclerosis in later life

87. Less chance of inguinal hernia

88. Better cognitive development for low birth weight babies

89. Better social development

90. Decreased risk of baby developing urinary tract infections

91. Suckling optimizes hand-to-eye coordination

92. Breastfeeding protects mothers against anemia (iron deficiency)

93. Breastfeeding mothers spend less money on menstrual supplies

94. Breastfeeding is a self confidence booster for mom

95. Breast milk may help combat eye infections

96. Breastfeeding may lower blood pressure in childhood

97. No worry about latest ingredient discovered to be missing from formula

98. Much nicer diaper changes

99. Breastfed babies smell fantastic

100. It's what breasts were designed for!