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ABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Alternative Health News
What They Don't Say Could Hurt You
I have written previously regarding the difficulties of drawing information from patients who are poor historians, forgetful or just plain uncooperative. The thought to revisit the topic occurred recently during preparation for an upcoming seminar.
Herbal Medicine: Go Mainstream
When it comes to practicing herbal medicine in a mainstream setting, there are a number of important points to understand when it comes to prescribing formulas. Some important questions to ask are - what method of prescribing and dispensing is most effective in this setting?
You are What You Eat Part II: Integrative Protocols
In the previous installment of this article I discussed important ideas concerning gastrointestinal health and foundational ideas from TCM, which can provide key insights into creating effective protocols for healing the gut.
There Are No Secrets: Treating Complicated Conditions with TCM
Including standardized extra points, there are just over 400 acupuncture points on the body. You get 400 and I get 400 - same. Yet, time and time again treatment protocols are coveted as if they were some secret formula only intended for the right and privileged.
We Get Letters & E-Mail
Patient Perception and the Farce of "Fast Relief"; A Fly in the Ointment; Persecuted for Choosing to Practice Chiropractic.
Healing Leaders

Energy is a hot commodity. Society pays dearly for it and for the expertise of those who know how to cultivate it.


The Potter's Wheel: Reflections on Practicing in a Technology-Driven World
In my very early years of practice, an older patient named Cora would call me at home, usually late Sunday night after she had consumed an unknown quantity of beer.
Medicine Presents: A Great Opportunity
The changing nature of health care presents both opportunities and challenges. While we tend to focus on our profession, we can sometimes forget the impact other health care professions can have on us.
What the Science Says About Magnesium Stearate
It's often been said that scientific studies can be used to support just about anything. But discoveries are never made one study at a time.
Are They Finally Fixing Medicare Reimbursement?
Even with federal sequestration cuts taking effect in March, including a 2 percent reduction in Medicare reimbursement to health care providers, hope may be on the horizon in the form of a much-anticipated, perpetually suggested overhaul of Medicare's Sustainable Growth Rate formula, which serves as the basis for determining physician reimbursement.
SOAP Notes: It's Time for a Cleaning
I have been planning for some time to write an article about how traditional SOAP notes do not fit chiropractic practice, and the unfairness of holding DCs to a model clearly created for and primarily applicable to medical physicians.
Happenings in Our Evolving Profession
Good things seem to be happening for our profession and recent developments show we are all on board. Talking about being on board, this September The Veterans Express-Purple Heart Tour is expected to make its way out of the station.
Going Shoeless: The Pros & Cons of Barefoot Running
With the subculture of barefoot runners and the products catering to them growing daily, just about every chiropractor has been asked at one point or another about their opinion regarding barefoot running.
Chiropractic: The Right Choice for Relieving LBP
"Low back pain (LBP) is a common threat to medicine and a reasonable threat to all national health care systems. ... Reducing ineffective treatments is necessary to decrease the LBP associated costs."
Helping Infertility Patients with the Spirit Essence
As many of you know, when it comes to treating infertility, we are dealing with a patient population that is, generally speaking, in emotional turmoil. These patients often experience fear, anxiety, despair, hopelessness, grief and anger.
Remembering Joe Weider (1920-2013)
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Why You Should Get to Know the National Vaccine Information Center
Barbara Loe Fisher has been a diligent advocate for providing parents with the information necessary to make informed decisions regarding the usage of vaccinations for their children.
The Spirits of the Points: The Gall Bladder Official
The Gall Bladder is known as The Official of Decision Making and Judgment. In any given day, this Official makes countless decisions – conscious and unconscious, which influence every aspect of our being.
Have a Heart: Say No to Soda
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Peer Points: Stories of Practice Success
When patients go see Arizona-based acupuncturist Jing Liu, it is to get top care from an practitioner well versed in all aspects of Traditional Chinese Medicine.
Correcting Kid Logic in Health Care and Research Design
A recent broadcast on public radio described a fascinating phenomenon known as kid logic.
Research Abstracts From the Journal of Manipulative & Physiological Therapeutics
Effect of Pain Relief on Lumbar Muscle Function and Activation; Effects of Thrust Amplitude and Duration of HVLA Spinal Manipulation; Immediate Effects of Upper Thoracic Manipulation on Cardiovascular Response.
Some Thoughts on the TMJ
The temporomandibular joint is an interesting and dynamic articulation that can cause a lot of problems.

A Building Block of Healthy Aging
Coenzyme Q10 has gained enormous attention in recent years, and with good reason —it's the Energizer Bunny of the cellular world.
A Freebie
Let's face it – patient evaluation takes time. Unless you are really into the diagnostic evaluation game, you probably have found the formal exam protocol tedious if not downright annoying.
News in Brief
Controversial Florida PIP Law Under Review; D'Youville Chiro. Students Learning Art of Co-Managing; And the Award Goes To...; F4CP Recognizes Major Contribution by ChiroTouch.
Side Effects From Big Pharma: Wellbutrin – Dangerous for You and Your Baby
Are some of your pregnant patients taking Wellbutrin? If so, it could be a danger to them and their baby. This drug is extremely popular, but it has a serious history.
Economics of Complementary/Integrative Care
Although this column doesn't usually feature a book review, we're going outside of our usual public health format to discuss a new book written by Patricia Herman ND, PhD.
Helping Patients Through Pregnancy Loss
There is a lot of focus in the acupuncture world on fertility and helping women get pregnant. It's exhilarating to hear the news that a patient is expecting a baby. The other side of that is pregnancy loss. That includes abortion, miscarriage or stillbirth.

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Massage Today
May, 2006, Vol. 06, Issue 05

To C or not to C? That Is the Question

By Elaine Stillerman, LMT

Part of the work of a prenatal massage practitioner is to support your clients' decisions about their pregnancies and birthing preferences in a nonjudgmental environment. Hopefully, we also can educate them about the ramifications, benefits and potential risks associated with their decisions.

In other words, make sure they are making informed decisions based on all the facts (without imposing our own will on them.)

However, I find it rather upsetting to watch the elective C-section rate escalate (it's up 36 percent in the past five years),1 simply because women don't want to go through labor. When asked if they are aware of the risk factors involved in major abdominal surgery, the reply often is, "What risks? My doctor never said anything about risks."

There are a number of medical situations and emergencies that account for approximately 70 percent of all Cesareans. They might include failure of labor to progress, questionable fetal health, prior Cesarean, and fetal malpresentation or breech presentation. In other and less frequent instances, abnormal placentation, obstruction of the birth canal, maternal illnesses and infections and cervical cancer might be indicators of a surgical delivery.23,4

However, even in some of these medical cases, the diagnosis of a C-section might be based on false or incorrect interpretations of instrumentation, and many surgeries are performed when there is little or no risk to the fetus or laboring woman.

There is no question about the safety and benefits of a Cesarean section when the medical need is compelling. However, as with any surgery, a Cesarean section is not without its risks. Whether it is performed out of medical necessity or as an elective decision, women need to be informed about the potential dangers. Dr. Peter Bernstein, MD, the author of "Complications of Cesarean Deliveries," divides the risk of surgical deliveries into three categories: short term, longer term, and those that present risks to future pregnancies. He also recognizes that risk factors are heightened when the surgery is not planned or in an emergency, compared to when it is a planned surgical delivery. Dr. Bernstein's article features the work and research of the Maternity Center Association, New York City.

Some of the short-term risk factors involving a C-section include maternal death (although low),5,6,7 thromboembolism and stroke (deep-vein thrombosis resulting in pulmonary embolism is one of the leading causes of maternal mortality after a C-section),8 excessive bleeding and hemorrhage,9,10 infection,11,12,13 rare accidental surgical injuries, particularly bladder or to a lesser degree, intestinal injuries,14 longer hospitalization,1516 pain,17 and an unhappy birth experience with a longer period of time needed to bond with the baby.18 In the long run, complications from a Cesarean might include additional hospitalization or readmission after discharge,19 incision pain,20 scar and adhesion formation,2122 emergency hysterectomy, or difficulty conceiving another pregnancy.

Although most surgical deliveries are safe for the newborn, there still are some risks that must be explored. C-section newborns are four times as likely to die than vaginally delivered babies,23 experience a higher incidence of asthma and respiratory problems,24,25 the birth is more traumatic,26 and these babies often fail to breastfeed.27 In addition, future pregnancies might be affected, with such complications as uterine rupture at the site of the initial incision,28 abnormal attachment of the placenta,29 and the need for a hysterectomy.30

While it's true that modern sanitary conditions and surgical competence reduce the chances of many of these complications, clients should be advised about the risk factors when electing to have a Cesarean. While we can't make up their minds, we can offer documentation to give them a clear picture of what their choice could mean.

References

  1. Eyewitness News, WABC-TV, Dec. 26, 2005.
  2. Bernstein, Peters S, MD, MPH. "Complications of Cesarean Deliveries." Medscape, Sept.15, 2005. www.medscape.com/viewprogram/4546_pnt.
  3. Nelson KB, Dambrosia JM, Ting TY, Grether JK. Uncertain value of electronic fetal monitoring in predicting cerebral palsy. N Engl J Med 1996:334:613-618.
  4. Jibodu, OA, Arulkumaran S. Intrapartum fetal surveillance. Curr Opin Obstet Gynecol 2000;12:123-127.
  5. Wen SW, Rusen ID, Walker M, et al. Maternal Health Study Group, Canadian Perinatal Surveillance System. Comparison of maternal mortality and morbidity between trial of labor and election Cesarean section among primiparas in Washington State. Am J Obstet Gynecol 2004;191:1263-1269.
  6. Schuitemaker N, van Roosman J, Dekker G, et al. Maternal mortality after Cesarean section in the Netherlands. Acta Obstet Gynecol Scand 1997;76:332-334.
  7. Harper MA, Bington RP, Espeland MA, et al. Pregnancy-related death and health care services. Obstet Gynecol 2003;102:273-278.
  8. Ros HS, Lichtenstein P, Belloco R, Petersson G, Cnattingiuis S. Pulmonary embolism and stroke in relation to pregnancy: how can high risk women be identified? Am J Obstet Gynecol 2002;186:198-203.
  9. Hebert PR, Reed G, Entman SS, Mitchel EF Jr., Berg C, Griffin MR. Serious maternal morbidity after childbirth: prolonged hospital stays and readmissions. Obstet Gynecol 1999;94:942-947.
  10. Sherman SJ, Greenspoon JS, Nelson JM, Paul RH, Obstetric hemorrhage and blood utililzation. J Reprod Med 1993;38:929-934.
  11. Allen, VM, O'Connell CM, Liston RM, Baskett TF. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol 2003;102:477-482.
  12. Chaim W, Bashiri A, Bar-David J, Shoham-Vardi I, Mazor M. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol 2000;8:77-82.
  13. Fisher J, Astbury J, Smith A. Adverse psychological impact of operative obstetric interventions: a prospective longitudinal study. Aust NZ J Psychiatry 1997;31:728-738.
  14. Phipps MG, Watabe B, Clemons JL, et al. Risk factors for bladder injury during Cesarean delivery. Obstet Gynecol 2005;105:156.
  15. Thompson JF, Roberts, CL, Currie M, Ellwood DA. Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth 2002;29:83-94.
  16. Kacmar J, Bhimani L, Boyd M. et al. Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study. Arch Gynecol Obstet 2005;271:154-9.
  17. Almeida EC, Nogueira AA, Candido dos Reis FJ, Rosa e Silva JC. Cesarean section as a cause of chronic pelvic pain. Int J Gynaecol Obstet 2002;79:101-104.
  18. Di Matteo MR, Morton SC, Lepper HS, et al. Cesarean childbirth and psychological outcomes: a meta-analysis. Health Psychol 1966;15:303-314.
  19. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. JAMA 2000;283:2411-2416.
  20. Declerq ER, Sakala C, Corry MP, Applebaum S, et al. Listening to Mothers: Report of the First National U.S. Survey of Women's Childbearing Experiences. New York: Maternity Center Association, Oct. 2002.
  21. Al-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction.
Click here for previous articles by Elaine Stillerman, LMT.

 

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