A few 2007 birth statistics

I’m not bored, but I did wake up at 4am which led me to the CDC.  Under “What’s New” at the NCHS page I read, “Twin Births Remain Stable, New Report Shows”.  Ok, so I was a bit disappointed that it wasn’t an entire report about multiple birth, but since I still hadn’t actually read the 2007 birth report, I suppose it was good that I took a peak.  If you’re interested to see what I posted about multiple gestation and birth as well as a collection of other data points that I found interesting, have a look here.

I browsed the site further and found some interesting statistics.  I was particularly looking for information on multiple gestation, of course, and was disappointed not to find method of delivery stats readily available for multiple gestation sets.  I did create a little spreadsheet though for 2007 births by gestational age and method of delivery.

I only looked at 34+ weeks gestation.  Information from 20-33 weeks gestation is available, but since I know less about those groups, I didn’t include it.  It is possible that premature babies are more at risk of dying during vaginal delivery than cesarean, I don’t know for certain, and I’m sure that parents need to consider their options carefully, if options are given.

ATTENTION!  Notice that the nation 2007 cesarean rate was 31.8% in 2007, another all-time high.  The World Health Organization suggests that a cesarean rate of 10-15% is indicative of a birth reality that is consistent with science and good practice as measured by healthy birth outcomes for mom and child(ren).  Get above that 15% range, and THE RISKS BEGIN TO OUTWEIGH THE BENEFITS.  I repeat . . the risks outweigh the benefits outside of the cesarean rate range of 10-15%.

So let’s extrapolate a bit . . .
You’re the MOST likely to birth vaginally if you make it to 40 weeks.  Problem is that most OBs do not encourage women to gestate to 40 weeks and a high number of elective cesareans take place in the 39th week.  If your baby comes before 37 weeks, look out . . . 41% of all live US births between 34 and 36 weeks gestation happened via cesarean surgery.  We need to be asking . . . WHY.  And why are nearly 1/3 of all babies being born via major surgery.  Why are so many women having their babies surgically extracted from their bodies, especially when subsequent pregnancies will even more likely end with a repeat cesarean?  WHY WHY WHY!!!!!

ASK SOMEONE WHY!

WHY 32% . . .

Cesarean Recovery, v.1

I am annoyed by my cesarean recovery.  I am more than 5 months post partum and still have pain and tenderness on the left side of my abdomen.  I’m sure I must have a number of adhesions that need to be broken down.  I did attend ICAN’s webinar about scar care and have been doing some massage.  I use a few drops of Young Living’s lavender oil – I recommend a therapeutic/medicinal grade essential oil – and massage it into my skin.  I have to massage all along the left side of the top layer of abdominal muscles (rectus abdominus), and it’s tender from pelvis to ribs.  Not good.

I am also annoyed that so many people are resigned to putting themselves, their babies, and their patients through this major abdominal surgery without a really really good reason.  Fetal distress, small pelvis, cephalo-pelvic disproportion, maternal demand, and previous cesarean are the usual suspects and are not necessarily indication for a cesarean.  <sigh>  I recovered easily enough from my first cesarean, but this time around it’s a different story.

I’ll end v.1 here.  To recap, I am not pleased with my recovery because I still have significant tenderness and pain more than 5 months after my surgery.  Does that sound like fun to you?

Positive Thoughts On the Cesarean Section

One of my ICAN friends posted this on Facebook today:

BirthCut Calling all C/S mothers! I am looking for positive cesarean birth stories! I am also looking for any tips about the actual surgery and/or recovery you may have for cesarean mothers. And, well, anything else you may have — art, videos, etc etc. Thanks!

Interesting thought.  Do I have anything positive to say about my cesareans?  Actually, I think I do:

DECEMBER 2004

I was exhausted from the flu – vomiting and pooping everywhere.  The illness forced my body into labor before we were ready.  Although I arrived at the hospital at 9cm dilated, my baby quickly got stuck.  I don’t know if I could have pushed her out.  I was so utterly exhausted.  I pushed with everything I had and it still wasn’t enough.  By the time I had the cesarean I was incredibly thankful for the “convenience” of modern medicine.

I did recover quickly physically.  I don’t recall feeling poorly for long.  And I still felt like superwoman . . . for a while, anyway.

AUGUST 2009

Pregnant with twins which meant that I was “risked out” of homebirth and birth center birth.  By 37 weeks both twins were breech.  When my Baby A broke her water in the middle of the night, I knew she did it with her feet.  I was so disappointed because the LAST THING I WANTED was to go through major abdominal surgery again.  I had learned so much about my body . . . I learned that my miscarriages were likely influenced by the presence of adenomyosis (caused by the first cesarean in 2004) . . . I knew that if I were to get pregnant again that a VBAC after 2 cesareans would be nearly impossible unless I wanted to try it alone . . . I know that these abdominal surgeries are risky in my line of work (I’m an opera singer).

I had considered bucking the system since breech is a variation of normal, depending on who you ask.  I thank God for guiding me elsewhere, because my precious Baby A would not have likely survived a vaginal birth.  She was entangled in her cord, and the cord was wrapped around her legs.  Both girls presented double footling breech.

Although I am still in pain 5 months later, and have yet another scar, and have yet another saggy somewhat sensation-less flap of skin above my scar, and have found my singing to be anything but stellar due to my weakened core, I am thankful that a cesarean was available to me.

I don’t recommend a cesarean unless it is really REALLY necessary . . . sad that probably half of the cesareans that are performed in the United States are likely not necessary.  A cesarean is considered a morbidity because of its seriousness – it’s a MAJOR abdominal surgery.  However, there are situations where a cesarean may be prudent or necessary.  When the technology is used appropriately, it is indeed a blessing.  To learn more about c-sections, visit Childbirth Connection and ICAN.

Cesarean Scar Care Webinar

I just attended the Cesarean Scar Care Webinar with Isa Herrera via the International Cesarean Awareness Network (ICAN).  What a terrific benefit for subscribers (it was free), a great introduction to ICAN for folks who aren’t subs, and a great cost ($15) for non subscribers.

Herrera is the author of Ending Female Pain and performs physical therapy in New York City.  I was excited to attend this webinar because 5 months post cesarean, I still have a LOT of pain and tenderness, especially on the left side.  I imagine this has a lot to do with E’s position in utero.  Herrera said that an uncomfortable lie can cause more adhesions, so obviously I have a lot of work to do to break up those adhesions and get to healing!

Herrera states:

“Women coming to me are often not getting the tools and advice they need . . .” to recover from cesareans.

Sad but not surprising.

Something I previously misunderstood:  according to Herrera the abdominal muscles (the recti) are not cut during surgery.  Instead, they are pushed to the side.

Something else I didn’t know:  during a cesarean 8 layers of fascia and connective tissue are cut.  From what I previously learned, it’s the damage to the fascia and connective tissues that compromise the uterus the most.

Something of which I am skeptical:  Herrera hypothesizes that regularizing and rehabilitating the scar tissue and adhesions may reduce the risk of uterine rupture in future pregnancies and labors.  The reason that I am skeptical is that from what I know about scar formation and healing, scar tissue NEVER approximates undamaged tissue.  Scar tissue organizes differently from undamaged tissue.  On the other hand, it is possible that with Body Talk or acupuncture or other healing modalities that damaged tissue can be restored.  And it’s not like my arm splits open every time I use it, and I have a large gnarly scar on it!

Herrera talked us through a number of exercises and stretches that should help break up adhesions and encourage healing.  The ones that I plan to start using immediately are “long strokes,” “longitudinal stretches,” and kegels while drawing in my abs.  I’ve also started using my Wii Fit and have found that the exercises there have woken up my core a bit.  I am also massaging lavender oil, purchased from Young Living because of the medicinal-grade quality, into the “damaged” areas.

For more information on cesarean scar care, purchase Herrera’s book.  Also, check out the websites http://www.apta.org and http://www.pelvicrehab.com.

Hospital VBAC: The Don’t Forget List

[NB: Most of what I've written below applies specifically to the hospital venue.]

We all know the books to read when preparing for a VBAC or the videos that will help us gain confidence in our ability to give birth vaginally.  We all know to pack our hospital bags, including our mental focus recordings, and bring a copy of our birth plans.  We all know that we need a doula with us, one who is experienced supporting VBACing women. 

Many of us even know that we need to talk powerfully about our upcoming VBACs.  “I’m trying for a VBAC” is not nearly strong enough.  Replace that with “I’m planning a VBAC.”  Did you birth the first time with “I’m gonna try to give birth vaginally” going through your brains?  Probably not.  I myself never doubted my ability to give birth naturally.

Anyway, I digress.  In addition to constructing a clear but concise birth plan, you need to also do the following:

  1. obtain a copy of the hospital’s VBAC consent form; review it and make changes as you see fit; give a copy to your care provider and bring a copy with you to the hospital
  2. obtain a copy of the hospital’s cesarean consent form; review it and make changes as you see fit; give a copy to your care provider and bring a copy with you to the hospital.  My hospital doesn’t have a cesarean consent form.  They have you sign their generic “invasive procedure” form which I find unacceptable.
  3. discuss the modifications you’ve made to the above forms with your care provider(s)
  4. especially if you’re NOT married, make sure your will is in order
  5. make sure you bring a medical power of attorney in case medical decisions need to be made and you are incapacitated

Bruce Flamm’s VBAC consent form appears everywhere on the internet.  I personally didn’t find it sufficient, but it is a place to start.  Here’s a great post - an actual cesarean consent form with some added commentary from the blogger.  I’ve taken this form and modified it so that (1) consent is not given for elective cesarean; (2) consent is withheld until the situation would arise for an emergent cesarean; (3) my husband is named as having power of attorney in the case of an emergency where I was unable to make my wishes known.  I also added some things that were missed on the form.

Please ask questions or offer your own suggestions!

NJ Rules That Mothers Have No Rights in Childbirth

This is too complicated and extensive to reproduce here, but essentially a NJ mother’s refusal of diagnostics and “treatments” in childbirth (practices that aren’t evidence based) as well as her refusal to allow a cesarean resulted in her newborn baby being taken from her.

Interestingly enough, the initial reason for her losing her baby (refusing an unnecessarian – the baby was born vaginally without incident) was thrown out of court.  However, this woman has a history of mental illness, and evidently the court found this history compelling enough to take her baby away for neglect and abuse.  However, she never had a chance to neglect or abuse her newborn since she was taken away immediately following birth.

From what I can tell, she ended up in this horrific situation because:

  1. history of mental illness (this is terrifying; I’m currently medicated for depression and was advised to stay on my meds during pregnancy – do I risk losing my babies at birth if I go AMA?)
  2. refusal of standard procedures in this hospital such as epidural and continuous electronic fetal monitoring
  3. squirming around as hospital personnel tried to MAKE her get an epidural
  4. refusing a cesarean
  5. kicking the OB out of her L&D room

To read more about this case as well as interesting comments from the peanut gallery, see Wise Law Blog’s post and the Volokh Conspiracy’s post.  (Unfortunately the commentary at VC’s site turned into a big abortion and feminism flame war between Dillan, Theo, and later John.)

I will say that this family took their chances going to a hospital (St. Barnabas was featured in Jennifer Block’s Pushed) with a 50% cesarean rate.  Additionally, I’m not sure if they had a clearly outlined birth plan (possible protection in court?) or cesarean “consent” form which would indicate under which, if any, circumstances she would agree to a cesarean.  She also should have had a doula.  This family really did go to McDonalds assuming they could get steak anyway.  Not good.

Tragic.  Terrifying.