Statement from ICAN Regarding the Deaths of Two New Jersey Women

The women of the International Cesarean Awareness Network offer their deepest sympathies to the families of Melissa Farah and Valerie Scythes, two New Jersey women who died after undergoing cesarean surgery.* This tragedy affects not just these new families; it is a tremendous loss to the community.

While any birth poses small but measurable risks to mothers and babies, it is well-established that cesareans increase the risk of a mother dying by 3-4 times. Common causes of maternal death by cesarean include: hemorrhage, infection, post-operative blood clots, and adverse reactions to anesthesia.

The World Health Organization states that a cesarean rate of above 10-15% cannot be justified and rates higher than that pose a health risk to mothers and babies. In the United States, the cesarean rate is 30.2% and in New Jersey it is 37%, the highest in the country. These rates suggest gross overuse of the surgery. Medically valid reasons for a cesarean section include:

• Complete placenta previa at term
• Transverse lie at time of labor
• Prolapsed cord
• Abrupted placenta
• Eclampsia or severe preeclampsia with failed induction of labor
• Large uterine tumor which blocks the cervix
• True fetal distress confirmed with a fetal scalp sampling or biophysical profile
• True cephalopelvic disproportion
• Initial outbreak of active herpes at the onset of labor
• Uterine rupture
• Failed induction with fetal distress

Women who are advised cesarean sections because of the following reasons should explore all their options since medical opinions differ in these areas:

• Macrosomia (large baby)
• Maternal age
• Assisted reproductive technology
• Cephalopelvic disproportion (CPD)
• Dystocia • Failure to progress
• Breech
• Fetal distress
• Prolonged pushing stage

When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. When the surgery is overused without sound medical justification, however, it puts mothers and babies in harms way. Because of the increased risk associated with surgical delivery, ICAN works to reduce the number of cesareans that are medically unnecessary. Women can help reduce their risk of a cesarean section by following these tips:

• Choose a care provider with a low cesarean rate. Midwives can safely care for healthy low-risk women and have very low cesarean rates.

• Educate yourself on your birth options and your rights

• Hire a doula or labor assistant

• Avoid induction except for clear medical reasons

• Avoid common medical procedures which increase your chance of a cesarean

• Ask questions and explore all your options if you're told you need a cesarean because your baby is too big, you've gone "overdue," or your labor is moving slowly.