New Jersey has been criticized for performing too many low-risk cesareans. The state currently has a low-risk cesarean rate which is 5% above the national rate. Thankfully, between 60 and 80% of women who previously had a cesarean wish to have a subsequent vaginal birth, so this number could soon drop. But new research shows that this increases the risk of a serious perineal tear by 21%. So, how can New Jersey protect the health of mothers while reducing their cesarean rate?
Serious birth trauma
The study in the British Journal of Obstetrics and Gynaecology found that mothers who opted for a vaginal birth after cesarean (VBAC) had a high chance of experiencing a third-degree tear of the perineal. This is the area between the vagina and the rectum. Most women will go on to heal within three months. But, mothers can have life-long problems. If the tear isn’t treated properly, urine incontinence and fecal incontinence can occur. Intercourse may be painful and women will feel a constant dragging in their pelvic area due to a lack of support from the pelvic muscles. This type of birth trauma can lead to serious problems, including post-traumatic stress disorder (PTSD). It’s estimated that one-third of mothers who go through a traumatic birth develop this condition.
There are things women can do to reduce the risk of their perineum tearing during childbirth. It’s not known whether these help for VBACs, though. One study found that maternal birth position could play a role in perineal tears. Kneeling down, being on all fours, or lying on your side may lower the risk. Perineal massage in the lead-up and during birth may also help. The study also found that a vacuum-assisted birth can lead to tears. But, this comes with additional problems. When New Jersey births were reviewed, vacuum extraction was found to increase the risk of postpartum hemorrhage and shoulder dystocia. This type of birth can cause life-long problems for the baby, too. The pressure put on the baby’s brain during the procedure can lead to cerebral palsy. Typical cerebral palsy symptoms include muscle tone impairment, involuntary reflexes, poor balance, and asymmetrical posture. Motor skills are also commonly affected and cause feeding, talking, grasping, and mobility problems.
Improved maternal care
On February 14, 2022, it was announced that the New Jersey Assembly Women and Children Committee had given a maternity bill the green light. Bill 804 aims to make maternal healthcare fairer and more transparent. It means medical professionals involved in the care of pregnant women must give them written information on all their birthing options. This should make it clearer for mothers who have previously had a cesarean to make an informed decision on which is best for them and their unborn baby.
There is clearly a risk to women’s health if they have a VBAC. But that doesn’t mean it’s the wrong thing to do as cesareans naturally come with a risk, too. So, it’s crucial mothers are well informed and have access to all the tools and information necessary to make a choice that’s right for them.