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Doctors’ Notes: Navigating C-section delivery by maternal request

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For many first time mothers, pregnancy is an exciting time, with promises of tiny onesies, beautiful safari-themed nurseries, and of course, the birth of their first-born child.

That last birth part, however, can be tricky. Barring any medical or obstetrical contraindications, a vaginal birth is the ideal mode of delivery for both the mother and her newborn. Some women, however, envision a vaginal delivery to be a painful, traumatic, and a possibly inelegant process they would rather avoid.

Physicians facing a CDMR request must navigate the delicate balance between empowering women to advocate for their health and “doing no harm”, one of the core ethical principles rooted in the Hippocratic oath.
Physicians facing a CDMR request must navigate the delicate balance between empowering women to advocate for their health and “doing no harm”, one of the core ethical principles rooted in the Hippocratic oath.  (dreamstime)

A planned Caesarean section (C-section) may seem like the more controlled way to welcome their baby into the world. These C-sections, performed without any medical or surgical reasons, are referred to as a Caesarean delivery on maternal request (CDMR).

Physicians facing a CDMR request must navigate the delicate balance between empowering women to advocate for their health and “doing no harm”, one of the core ethical principles rooted in our Hippocratic oath. So challenging are these discussions that the Society of Obstetricians and Gynaecologists (SOGC) recently published guidelines to help clinicians navigate these layered conversations.

There is surprisingly little data on the numbers of CDMRs performed yearly, but what is well-established is that the overall rate of C-sections in Canada is on the rise, now at a staggering 28 per cent. The majority of these surgeries are obstetrically necessary, with the benefits to the mother and baby’s health far outweighing the surgical risks of infection, bleeding, bowel or bladder injury, or blood clots in the lungs.

If you asked women recovering from their first C-section, most will not have suffered any of these complications. What these women might have experienced, however, is a delay in starting skin-to-skin contact with their newborn, a lengthy hospital stay, and a painful surgical recovery requiring prescription pain medications and lasting for up to 6 weeks’ postpartum.

While women who are still pregnant with their first child may not be prepared to think of their potential next pregnancies, maternity care providers are — primarily because the impact of one C-section on subsequent deliveries is so significant.

Most women will expect a surgical scar to form on their skin, but they might not be aware that the same scar tissue can form around their major abdominal organs. This increases the rates of all the surgical risks mentioned earlier in future C-sections.

Some women may also not recognize that, like the wound on their skin, the opening that was made in their uterus to deliver the baby must also heal after surgery. Rarely, that scar on the uterus has trouble withstanding the pressure of another pregnancy and may break down during the next delivery. This is an obstetrical emergency called a “uterine rupture,” which can be very dangerous for the health of both the baby and her mother.

In pregnancies that follow a C-section, the placenta (the organ that allows your baby to grow) may attach in an unhealthy manner to the uterus, and may invade through the previous C-section scar and the uterus into the bladder and the bowels. This condition, called an “invasive placenta” is directly related to the number of C-sections a woman has experienced and increases a woman’s risk of premature labour, bleeding, and the permanent removal of her uterus (a hysterectomy) during her delivery.

With all this in mind, you can see why it’s uncomfortable for maternity care providers to recommend CDMRs. What we must do, however, is explore deeply and repeatedly the worries and experiences that have led a woman to request a CDMR in the first place.

Some may fear pain, and reviewing the spectrum of available pain management options in labour may alleviate these anxieties.

Others may worry about developing a “leaky bladder” after a vaginal delivery, and reviewing that a C-section is only protective against urinary incontinence after a woman’s first delivery, but that the protective benefit is lost, irrespective of which way a woman delivers, after her second baby, may be important.

Some women may point out that any woman attempting a vaginal delivery may ultimately be recommended a C-section, and that planned C-sections are far safer than those performed in an urgent manner. We would have to agree and reassure them that protocols are in place in every obstetrical hospital to ensure that both planned and unplanned vaginal and Caesarean deliveries are held to the highest standards of obstetrical care.

Finally, some women may listen to all our concerns about CDMRs, but may, after all, still request this as their mode of delivery. To these women, we promise to respect your decision. After all, our only goal is to get you and your healthy, onesie-clad baby home to your beautiful safari-themed nursery as safely and happily as possible.

Dr. Julia Kfouri is an assistant professor in the Department of Obstetrics and Gynaecology at the University of Toronto’s Faculty of Medicine. She is also a Maternal Fetal Medicine Specialist at Sinai Health System. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine.

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Post-vaccine surge? Michigan’s spring coronavirus case spike close to previous year’s autumn high

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(Natural News) The spike in new Wuhan coronavirus infections recorded in Michigan over the spring is similar to a spike seen during the 2020 fall season. According to a Wall Street Journal analysis, the state’s daily coronavirus case count averaged more than 7,000 for almost two weeks – before taking a slight dip to 6,891 on April 20. This echoed similar figures back in November and December 2020, which saw sharp rises in infections for those two months before plunging.

Back in autumn of last year, Michigan averaged more than 7,000 cases per day for a span of 10 days. New infections dropped slightly, then briefly spiked as the December holidays approached. It then fell to the low 1,000s for the succeeding two months – until ascending again in March.

According to University of Michigan internal medicine professor Dr. Vikas Parekh, the sudden increase in new infections could be attributed to several factors. Among the factors he cited was re-openings, which increased people’s interactions and mobility. Parekh said the loosened restrictions contributed to the spread of the highly contagious U.K. B117 variant.

“As the B117 variant spreads nationally, we will likely see other stats [with] their own surges – although I hope none are as bad as Michigan,” the professor remarked. He continued: “The milestone just tells us we are not yet in the clear, especially as we still have large portions of our population who are not vaccinated yet.”

Parekh also expressed optimism over the lower daily caseloads the Great Lakes State reported. He said he believes both cases and hospitalizations have plateaued and will likely decline soon. The professor commented: “[COVID-19] positivity has been declining now for one week, which is usually a leading indicator of case decline.”

Meanwhile, the state cited younger populations and youth sports, such as basketball, wrestling and hockey, to increase new COVID-19 infections. Because of this, Gov. Gretchen Whitmer called to suspend youth sports and indoor dining in the state. She also exhorted high schools to conduct remote class sessions for two weeks to curb the spread of the pathogen.

Michigan still experienced the spike in cases despite having one of the highest vaccination rates in the country

During the opening stages of the U.S.’s immunization drive against COVID-19, Michigan boasted of having one of the highest vaccination rates nationwide. A report by Bridge Michigan even noted the initial “frenzy for vaccines” that “far exceeded the state’s limited supply.” But things have appeared to turn around for Michigan, as it now struggles to reach the 70 percent vaccination rate needed for herd immunity.

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Scottish mom’s legs turn into a pair of “giant blisters” after first dose of AstraZeneca’s coronavirus vaccine

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(Natural News) Sarah Beuckmann of Glasgow, Scotland, felt a tingling sensation in her legs and noticed a rash flaring up around her ankles a week after getting her first dose of AstraZeneca’s coronavirus (COVID-19) vaccine on March 18.

She also had flu-like symptoms right after the vaccination.

Beuckmann called her doctor to arrange an appointment the morning she noticed the rash, but by the afternoon her skin was already breaking out into blood-filled blisters. Blisters also appeared on her legs, hands, face, arms and bottom.

“I ended up asking my husband to take me to A&E,” said Beuckmann, referring to “accident and emergency,” the equivalent of an emergency room (ER). “When I got there, my heart rate was sitting at 160bpm, which they were very concerned about. I got put on an ECG machine.”

Doctors determine AstraZeneca’s COVID-19 vaccine triggers the rash

Medics carried out tests for HIV, herpes and other skin conditions to work out what triggered the rash, but all results came back negative. Doctors finally determined that the vaccine caused her rare reaction after carrying out two biopsies.

“Once they found that it was a reaction to the vaccine, they put me on steroids and that really seems to be helping my progress,” said Beuckmann. She had been advised by her doctor not to get the second dose of AstraZeneca’s COVID-19 vaccine because of her reaction.

Beuckmann spent 16 days at Queen Elizabeth University Hospital. She was discharged to recover at home. The 34-year-old mother of one is currently wheelchair-bound due to the bandages on her legs and blisters on the soles of her feet. She may need physiotherapy to help strengthen her leg muscles.

“They are starting to heal and they’re looking a lot better than they were but as the blisters started to get worse, they all sort of merged together,” she said. “I didn’t know what was going on.”

With the blisters merging, her legs have looked like a pair of “giant blisters.” Beuckmann admitted that at one point she feared her legs might have to be amputated.

Dermatologist agrees COVID-19 vaccine causes the blisters

Dr. Emma Wedgeworth, a consultant dermatologist and spokeswoman at the British Skin Foundation, agreed that Beuckmann had likely suffered a reaction to the vaccine.

“Vaccines are designed to activate the immune system. Occasionally people will have quite dramatic activation of their immune systems which, as happened in this case, can manifest in their skin” Wedgeworth told MailOnline. “This poor lady had a very severe reaction, which thankfully is extremely rare.”

It is not clear why Beuckmann, who works in retail, was invited for a vaccine. Scotland’s vaccine rollout was focused on people over the age of 50 when she got vaccinated, although vaccines are available to those who are considered at risk from the virus, or live with someone considered vulnerable.

At least 20 million Briton have had AstraZeneca’s COVID-19 vaccine, which drug regulators say causes a rash in one percent of cases. They say rashes caused by the jab tend to go away within a week.

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Trojan labs? Chinese biotech company offers to build COVID testing labs in six states

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In 2012, BGI acquired Complete Genomics, a DNA sequencing company and equipment maker. The funds for the $117.6 million purchase were raised from Chinese venture capitals. The company has expanded its footprint globally. According to its website, BGI conducts business in more than 100 countries and areas and has 11 offices and labs in the U.S.

People are concerned about China’s access to American DNA data

Some said that with Complete Genomics providing an American base, BGI would have access to more DNA samples from Americans, helping it compile a huge database of genetic information. Some also worried about the protection of the genetic information’s privacy.

According to a 2019 report from the U.S.–China Economic and Security Review Commission (USCC), BGI “has formed numerous partnerships with U.S. healthcare providers and research organizations to provide large-scale genetic sequencing to support medical research efforts,”

There are three main reasons why many people in the biotech community and government have expressed concerns about China’s access to American DNA data.

In the “60 Minutes” interview, Evanina discussed the very likely scenario in which Chinese companies would be able to micro-target American individuals and offer customized preventative solutions based on their DNA.

Evanina asked: “Do we want to have another nation systematically eliminate our healthcare services? Are we okay with that as a nation?”

The second concern is that China may use DNA to track and attack American individuals. As the USCC report states: “China could target vulnerabilities in specific individuals brought to light by genomic data or health records. Individuals targeted in such attacks would likely be strategically identified persons, such as diplomats, politicians, high-ranking federal officials or military leadership.”

The third concern is that China may devise bioweapons to target non-Asians. Steven Mosher, president of the Population Research Institute, discussed it in his article “What Will China Do With Your DNA?” published by The Epoch Times in March 2019.

He wrote: “We know that the Asian genome is genetically distinct from the Caucasian and African in many ways. … Would it be possible to bioengineer a very virulent version of, say, smallpox, that was easily transmitted, fatal to other races, but to which the Chinese enjoyed a natural immunity? … Given our present ability to manipulate genomes, if such a bio-weapon can be imagined, it can probably – given enough time and resources – be realized.”

An article from Technocracy said: “China’s aggressive collection of American DNA should be doubly alarming because it can only spell one ultimate outcome: biowarfare. That is, genetically engineering viruses or other diseases that will be selectively harmful to U.S. populations.”

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