C-sections increasing infant mortality

In the June entry, we examined how c-sections could be increasing maternal mortality in the United States. Now let’s examine the other half of the equation – the baby. As of 2006 our infant mortality rates fall all the way to the second worst in the modern world, according to reports published in an article by CNN (www.cnn.co m/2006/HEALTH/parenting/05/08/mothers.index./). Most of the European nations rank better, and several studies and reports have noted that the United States offers inferior health care regardless seemingly better supply of medical resources. It is also noted that those same countries regularly employ midwives as care providers while our society seems to shun these women – treating them as nothing more than relics. However, midwives are excellent assets to good prenatal care and have lower rates of c-sections.

Studies have shown that c-section babies have poorer outcomes than their vaginally born peers. One such study published in Birth looked at a group of babies born in uncomplicated vaginal births and a group of babies born by planned, uncomplicated c-section births (www3.interscience.wiley.com/cgi-bin/fulltext/118622106/HTMLSTART). When the two groups were compared, it was found that babies born via c-section had higher mortality rates. Another such study published in BMJ also concluded that infants in the occipital anterior position faired better during vaginal delivery than a c-section – either planned or not (www.reuters.com/article/healthNews/idUSSAT17412420071031). Why would this be? As previously discussed, there are risks involved with a c-section, such as a potential for injury to the baby during the incision process. Also, babies born via c-section do not have the benefit of passing through the birth canal where some of the fluid in their lungs is pushed out, leading to higher rates of respiratory distress. Of course, there are many more risks involved, but these are just two examples of what could go wrong during a c-section.

Another factor in this epidemic would be the number of elective c-sections being performed prior to 40 weeks. Because each baby is different, we run the risk of extracting a baby from=2 0the womb before s/he is fully developed and ready to be born. The March of Dimes discusses the risks associated with being born prematurely as difficulties in breathing, feeding, temperature regulation, and jaundice (www.marchofdimes.com/pnhec/240_19673.asp). With the increase of non-medically needed, elective c-sections comes the increase of babies being born prematurely. Prematurity increases mortality. The CDC lists prematurity as being the second leading cause of death in infants (www.cdc.gov/MMWR/preview/mmwrhtml/mm5642a8.htm). A study published in Pediatrics also found that preterm births account for a little over one third of infant deaths. This is alarming in a country where we seem to have so many neonatal intensive care units.

So what should we do to decrease the infant mortality rate? First of all, we should look to our peers in Europe and Japan to see what type of care they provide. As previously stated, those countries tend to treat midwives more like competent care providers and trust the thousands of years of collective experience midwives have accumulated throughout the history of humankind. Secondly, we should seek to increase educational outlets for women aspiring to become midwives and teach our doctors, doctoral students, patients, and others involved in patient care about the risks involved with ro utine medical interventions. We want healthy families – that means both healthy mothers AND healthy babies!

Florida Friends of Midwives Responds to the Closure of Miami Dade College's Midwifery Program

Despite strong opposition from the community, Miami Dade College's Midwifery Program to close indefinitely

MIAMI, FL (August 14, 2008) – Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida is disappointed and concerned with the indefinite closure of Miami Dade College's Midwifery Program, a vital program to the local community and to communities statewide. Despite strong opposition expressed by students, mothers, midwives and concerned members of the community, the College cited tough economic times as the reason for their decision.

On Friday August 8, 2008, the College held a meeting at the Medical Campus to formally announce the closure of the program and return prepaid tuition to currently enrolled students. At that meeting, members of the public showed up to express their disappointment and dissatisfaction with the closure of the program. The College claims tough economic times have caused them to close programs with low enrollment and high costs. However, Midwifery is the first and only one out of over 200 degree-granting programs offered at Miami-Dade College to be eliminated as a result of those cuts.

Students, who had already completed all course requirements to be admitted into the program, were devastated. Some students had relocated to South Florida, and many had already taken out loans to cover tuition costs. "Miami Dade College doesn't understand that we didn't choose to be in this career program just to have any degree – this is our passion," said Melissa Chin Casey, who was set to start the Midwifery Program in the Fall 2008 semester. "It's insulting and cruel for the administrators to say the program was cut because of low enrollment, when we are practically beating down the door for them to let us in. As a public education institution, they have failed this community."

MDC's accredited Direct-Entry Midwifery Program was the first in the country to be offered at a public institution, offering students a more affordable option compared to the programs offered at private colleges and universities. Since it's inception in 1994, over 80 midwives have been trained and graduated the program.

"This community has endured a great loss with the closing of this program," said Tamara Taitt, president for Florida Friends of Midwives. "Many of the women who have graduated from this program have become indispensable to our community by providing quality and personalized pre- and post-natal care."

Obstetrical care in South Florida has come under scrutiny in recent years as the rate of caesarean sections in the state of Florida has increased to an all-time high of 36.6% in 2006 which is well above the World Health Organization and Healthy People 2010's recommendations of 15%. Specifically, Palm Beach County had a cesarean section rate of 39.3%, Broward was 41.2%, and Miami-Dade was 45.5%. According to the Florida Council of Licensed Midwives, Florida Licensed Midwives had a cesarean section rate of 6.3% in 2006. There is also expected to be a significant shortage of Obstetricians in the tri-county area within the next three years.

Miami Dade College is a public institution and has an obligation to the public it serves. FFOM believes it is unjust to close a program that is crucial on a number of levels. To take away this program is to take away one of the only affordable opportunities in this country for women to become Licensed Midwives through an accredited program.

FFOM urges the College to reconsider the closure of the Midwifery Program and also ask for continued support from the community in our efforts to keep this program open.

About Florida Friends of Midwives
Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's families. For more information, please visit www.flmidwifery.org.

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