U.S. Rate of Cesareans Exceeds WHO Standards

By Terry A Rondberg, DC

Because of increased dangers and risks to the mother and baby, cesarean procedures (C-sections) are supposed to be reserved for cases in which normal births may be impossible or dangerous. Yet, according to a research report published in the British Medical Journal, the United States has seen a steep rise in cesareans to women with no reported medical risk.

Researchers analyzed information on four million births per year between 1991 and 2001, identifying mothers with no medical risk or labor and delivery complications noted on the birth certificate. From this group of
mothers, they examined those cases where mothers had a first-time cesarean.

Results showed that cesarean rates increased by 67% among these mothers. First-time mothers aged 34 and over were the most likely to have a ‘no indicated risk’ cesarean, with almost 1 in 5 giving birth by cesarean in
2001.

Cesarean births also rose steeply for ‘no indicated risk’ mothers under 30, increasing by 58% between 1991 and 2001. For first-time mothers over 40, the odds of having a ‘no indicated risk’ cesarean were over 5 times that for mothers aged 20-24.

In the U.S., 24 % of births are cesarean — double the rate of many European countries. The World Health Organization says no country’s C-section rate should be higher than 10 to 15 percent.

Undergoing cesareans where there is no reported medical indication raises serious questions, say the authors, not least for younger mothers who plan to have further children. Previous research has indicated that women who have vaginal birth after having cesarean deliveries are at increased risk for maternal morbidity and such serious complications as uterine rupture, endometriosis, transfusion or newborns who suffer brain injury from lack of oxygen.

According to the International Cesarean Awareness Network, “a cesarean section is major abdominal surgery with all that entails. The surgery itself, as opposed to medical problems that might lead to a cesarean increases the risk of maternal death, hysterectomy, hemorrhage, infection, blood clots, damage to blood vessels, urinary bladder and other organs, postpartum depression, post traumatic stress syndrome, and rehospitalization for complications. Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs as well as placenta previa, placenta accreta, infertility, ectopic pregnancy, uterine rupture in subsequent pregnancies and the risk of chronic problems from adhesions.

There are also risks to the baby such as respiratory distress syndrome, prematurity, lower birth weights, jaundice, lower APGAR scores (APGAR is the means of assessing the health status of a newborn), and finally in 1 to 9 percent of cases the baby is scarred or even maimed by the scalpel.”

Other studies show that women are 5 to 7 times more likely to die when undergoing a C-section, and are at greater risk for bladder or uterus problems, hemorrhage, infection and hysterectomy. Some mothers experience long-term side effects such as hip pain, bowel problems and pain during sex.

SOURCES: “Rise in ‘no indicated risk’ primary caesareans in the United States,”
1991-2001: cross sectional analysis, British Medical Journal, November 19, 2004

“Caesareans Have Drawbacks for Future Pregnancies,” British Medical Journal / International Cesarean Awareness Network, online FAQ

Tamoxifen linked to 82% increase in strokes

Wellness is a big part of my personal, as well as professional life. I’m going to begin posting lots of articles I’ve authored over the years on the subject of wellness, especially studies and insights that I think my family and friends need to know. Enjoy and be well! -Terry Rondberg

Tamoxifen linked to 82% increase in strokes

By Terry Rondberg, DC
More than 250,000 women in the United States are diagnosed with breast cancer each year and many are given the prescription tamoxifen. Recent studies, however, show that the drug Tamoxifen increases the risk of thromboembolism (a blood clot that has traveled from its site of origin to another vessel and therefore can increase the risk of stroke as much as 82%.

The research was published in Neurology, the scientific journal of the American Academy of Neurology (AAN). Researchers from Duke University Medical Center conducted a systematic review of all clinical trials of tamoxifen published since 1980 using MEDLINE.

Nine trials met their inclusion criteria, with 39,601 total subjects enrolled, 19,954 of whom were randomized to tamoxifen. Six of the trials specifically reported ischemic stroke events. All trials used a standard dose of tamoxifen (20 mg daily).

“With tamoxifen, we found the frequency of all strokes was 1.06% and for ischemic stroke was 0.71%, versus 0.39% with controls,” reported study author Cheryl Bushnell, MD, MHS. The risk of ischemic stroke increased by 82% and risk of all strokes by 29% in women randomized to tamoxifen versus placebo or other therapies.

Despite the uncontestable numbers reported in the study, the AAN distributed a press release saying the increase in risk was “slight,” and listing the supposed benefits of the drug before mentioning the research results.

SOURCE: “Risk of ischemic stroke with tamoxifen treatment for breast cancer: A meta-analysis,” Neurology: 63: 1230-1233