ACOG has issued a new recommendation that, when possible, all women who undergo c-sections should wear inflatable compression devices on their legs during delivery and, in some cases, given medication in order to prevent thromboembolism, a potentially fatal blood blot.
According to ACOG, c-sections double a woman’s risk of developing clots that can lead to pulmonary embolism (when a clot breaks free and travels to the lungs). The recent leading cause of maternal death in New York was pulmonary embolism. Currently about 1 in 3 births is via cesarean section.
Birth activists have been making the point about increased risk of embolism for some time now. Ina May Gaskin, who writes about it in her book Birth Matters, reminds us that a woman giving birth today is twice as likely to die in childbirth than her own mother was. This is an oft-cited reason to try and reduce the number of c-sections by encouraging more VBACs and fewer interventions that can lead to c-sections.
The ACOG release, however, does not mention lowering the c-section rate, rather it focuses on prevention of clots in women who have surgery.
Dr. Andra H. James, who worked on new guidelines, writes, “VTE [venous thromboembolism] is a major contributor to maternal mortality in this country. The risk of VTE is increased during pregnancy and the consequences can be severe….It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.”
From the release:
“Most women who develop clots in the lower extremities will have pain or swelling in the leg. Sometimes, clots travel to the lungs causing a life-threatening condition known as pulmonary embolism. Symptoms include sudden shortness of breath, chest pain, and coughing…. The College recommends preventive treatment with anticoagulant medication for women who have had an acute VTE during pregnancy, a history of thrombosis, or those at significant risk for VTE during pregnancy and postpartum, such as women with high-risk acquired or inherited thrombophilias. Women with a history of thrombosis should be evaluated for underlying causes to determine whether anticoagulation medication is appropriate during pregnancy. Most women who take anticoagulation medications before pregnancy will need to continue during pregnancy and postpartum.”
The compression devices are placed on mom’s legs during surgery and removed once she’s able to walk around. The college noted that in emergency situations it’s not worth postponing the surgery to get the devices on. But when possible this could be a “potentially cost-effective intervention.”
I’m all for cost-effective interventions, but I can’t help but feel a small amount of outrage that the first bullet point in clot prevention isn’t the effort to bring the c-section rates down to a healthy percentage. According to the World Health Organization that would be closer to 1 in 10 births, rather than 1 in 3.
Birthing choices: Do I have to get an epidural if I give birth at a hospital?