Marion’s Message

Editor’s note: This article first appeared in Midwifery Today, Issue 82, Summer 2007. Join Midwifery Today Online Membership What is the ideal cesarean section rate? That rate associated with the least possible morbidity and mortality for mother/baby. This is the suggestion of Fernando Althabe of the Perinatal Research Unit, Montevideo, Uruguay, and Jose Belizan of the Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, in their recent article in The Lancet.(1) They acknowledge that the appropriate rate is debatable. One to five percent is a range for the minimum. Fifteen percent, as suggested by WHO (2), is a commonly accepted goal for a maximum rate. Althabe and Belizan are commenting on a study of cesarean rates in developing countries, reported in the same issue of The Lancet.(3) One way to determine whether 1% or more is really a minimum safe cesarean rate, look at three conditions that can be fatal without surgical intervention. The rates of these conditions are variable, depending on the population and other factors. Placenta previa at term occurs in about one in 200 births. However, it is more common in multipara and in older women, occurring in more than 1% of the time, even more frequently if the woman has had a previous cesarean. In primipara the rate may be one in 400 or less. Abruptio placenta occurrence varies between 0.5% and 1.5%. It is more frequent in women who have high blood pressure, smoke cigarettes, or are carrying a multiple pregnancy. Cocaine or methamphetamine use raises the rate dramatically. Finally, transverse lie in labor occurs about one time in three hundred and is more frequent in multipara, multiple births, and with prematurity. With these three conditions, we have a 1% or 2% population-wide rate of potentially necessary cesarean deliveries, without even considering disproportion,… Read more…. Marion’s Message: Too Many or Not Enough Cesarean Sections?

 Read more…. Marion’s Message: Too Many or Not Enough Cesarean Sections?

With maternity mortality in childbirth so high around the world, Millenium Development Goal 5, maternal health, is something that we all can work toward.

 Read more…. MDG 5: Something We Can Work With

Associate Editor Marion McLean shares stories of the interconnectedness and complexities of dealing with birthing women and their mothers and mothers-in-law.

 Read more…. Marion’s Message: Midwives, Mothers and Mothers-in-law

At the March 2005 Midwifery Today Conference in Eugene, we sat in a circle discussing third and fourth stage problems. A young midwife with a hospital background raised a question. “When do you push the panic button?” People looked at her with interest and she continued, “What I mean is, in the hospital, they always stress that over twenty minutes from the time the baby is born to placental delivery is high risk. But people here are talking about much longer times. How do you know when you are in trouble?”

 Read more…. Marion’s Message: When Do You Push the Panic Button?

My first day at the conference, I noticed a number of Native American participants. I felt gratitude and joy at their presence. Our lives are enriched when we are able to interact with people of different cultural backgrounds. Further, the roots of indigenous cultures that have lived on the same land over centuries connect us through time to the ancient ways in a unique manner.

 Read more…. Marion’s Message: Gratitude to the Cultures

In 2004 I served as midwife for a dear family. I thought a lot about the time to be born, as the due date came and went. Is there a time designated for us to come into the world? “For everything there is a season, and a time for every purpose under heaven,” says the Holy Bible. “A time to be born and a time to die.”

 Read more…. Marion’s Message: A Time to Be Born

Disturbing reports about the risks of cesarean delivery have been issued for years. Recently yet another has been suggested: an increased risk of unexplained stillbirth late in pregnancies that follow a pregnancy ending in cesarean delivery.

 Read more…. Marion’s Message: Another Good Reason to Prevent Cesarean Section

A very small percentage of babies are at risk of developing cerebral palsy in the perinatal period. But these are our most vulnerable of charges. If there is already some neurological damage, spare these babies hypoxic stress, if need be, by surgical intervention.

 Read more…. Marion’s Message: Cerebral Palsy Again