I wish I was kidding. I’m not. I was insensed to read that a woman in Colorado was denied coverage because of a prior cesarean. I hope you’ll read Navelgazing Midwife’s post. It’s a good summary of the situation.
Ick.
Want Insurance? Get Sterilized
June 4, 2008 at 8:20 pm (awareness, cesarean, childbirth, hooey)
Tags: cesarean risk, denial of coverage, health insurance, sterilization
Choosing cesarean limits future choices
April 27, 2008 at 2:48 pm (ICAN, VBAC, advocacy, awareness, cesarean, childbirth, data, depression, fear, hooey, news)
Tags: birth trauma, choosy moms, March of Dimes, medical use, misperception, over-used procedure, over-used surgery, Time magazine
I was irritated to discover that Time magazine published an article entitled “Choosy Mothers Choose Cesareans” in their special Environmental Issue. Since cesarean surgery is an over-used procedure[1], it is quite inappropriate for this type of article to appear along-side articles dealing with the Presidential candidates’ climate change positions and how the US can be more green. Needlessly consuming medical services is anything but green, and Time magazine should take responsibility for its poor choice in content.
According to the article, more women are choosing cesareans, a trend doctors expect will continue. I do not know nor have heard of anyone actually choosing a cesarean, save the stories I read or hear about through the media. I believe that the media is creating this belief that women choose cesareans, and that this is a trend we should expect to see continue. But perhaps it is true that women are choosing major surgery for reasons cited, such as (1) fear of ripping/tearing the perineum, (2) fear of incontinence, (3) fear of pain, (4) fear of birth, (5) or fear of having a stretched-out vagina. Time’s article feeds into the misperceptions of birth generated by Hollywood blogs and reality shows like A Baby Story.
Fear of ripping/tearing: from what I have learned over the years, women rarely rip or tear during childbirth if they push following their body’s signs, are given appropriate time to labor and birth their babies, and/or have the perineum massaged or supported during pushing. Episiotomies can cause more damage to the perineum, vagina, and anus than a natural tear anyway. I wonder if this fear stems from botched episiotomies?
Fear of incontinence: cesarean delivery does not prevent incontinence. Sorry!
Fear of pain: I wonder why so many women are taught to fear the pain of childbirth. Granted labor was one of the most challenging things I have ever done, but I think my exercise habits and outdoor enthusiasm (road biking, hiking, backpacking, running) had prepared me for childbirth. I don’t look back on my labor and regret the pain - I regret the fact that a cesarean became necessary. Anyone who has done a little bit of study on the purpose of pain in childbirth can tell you that it is actually beneficial - it can indicate problems that need attention as well as provide important feedback to the mother and her careproviders regarding her progress.
Fear of birth: there actually is a term for women who have a fear (phobia) of childbirth - lockiophobia. If a woman is not phobic, then she should work with a psychologist or psychotherapist to determine the root causes of her fear and overcome those. Pregnancy can bring up psychological pains of the past, but they are not avoided through cesarean surgery.
Fear of a stretched-out vagina: do I really need to address this?
The title of my post suggests that cesareans will limit future choices. This is true - women who have had a cesarean are at risk of being pressured into repeating surgery for future births, have a slightly more elevated risk of uterine rupture and other poor birth outcomes, are unable to have normal birth at most birth centers [2], may not be able to have a normal birth at their local hospitals [3], will be pressured to comply with hospital protocols that may lead to interventive birth outcomes for future births, may have difficulty finding providers who will support their choices in future births to name a few limitations.
Other things you may not know about cesarean aftermath [4]
- Risk of post-partum depression and post-traumatic stress disorder
- Negative impact on breastfeeding, bonding, and other key mammalian birth-related processes
- Stillbirth, miscarriage, infertility
- Pain, adhesions, slow recover, unsightly scaring
- Negative impact on relationships with other family members, particularly partners/spouses
- Rejection of birth - some women choose to never have another baby because they don’t want to go through surgery again; some women don’t feel like they gave birth; some women equate cesarean birth with “birth rape“
Thankfully I have come to learn about the viability and appropriateness of vaginal birth after cesarean. I was encouraged to subscribe to the ICAN Yahoo list where I learned much of what I know now about birth that I didn’t know before my daughter was born. I know the dangers of choosing cesarean for the first, second, or fifth time. I have experienced stress, depression, and other tangible and intangible outcomes related to cesarean surgery. I worry that my current trouble with recurrent pregnancy loss is related to the cesarean. I resent that I have to consume more medical services to rule out uterine defects caused by the cesarean. Tomorrow I will have a hysterosalpinogram performed.
It is regrettable that women such as Ms. Chung are led to believe and accept that cesarean birth is risk free, complication free, and consequence free. It is simply not the case, and it does not take more than 30 seconds with an internet search engine to learn that much care should be taken when deciding if cesarean surgery is right for a woman and her baby. The March of Dimes states that cesarean surgery should only be performed when the mother’s life or baby’s life is at risk. Cesarean surgery is a blessing when used appropriately, but its safety is not justification for indiscriminate use.
[I sent a slightly abridged version of this post to Time magazine's Editor.]
[1] The World Health Organization maintains that an acceptable rate of birth via cesarean surgery is 10-15%. When the cesarean rate exceeds this range, the risks outweigh the benefits.
[2] To read the AABC’s recent statement on VBACs at birth centers, click here.
[3] Go to http://www.ican-online.org to see if your hospital allows VBACs.
[4] See also http://www.childbirthconnection.org/article.asp?ck=10166; read ICAN’s book, Cesarean Voices to learn how cesareans have impacted real women and real babies.
ORLive Sensationalizes and Marginalizes Childbirth
March 2, 2008 at 11:10 pm (awareness, cesarean, childbirth, hooey, news, risk)
Tags: cesarean surgery, complicated childbirth, high-risk childbirth, ORLive, surgical birth
This really creeps me out! I’ve known for a while that OR Live will feature a planned cesarean birth at the Shawnee Medical Center. Is this an attempt to further normalize cesarean birth? Is it a response to America’s voyeuristic preoccupation with “reality” shows? Is this yet another way to marginalize and trivialize natural childbirth?
The press release points out that “[a]ccording to the Centers for Disease Control, every year more than 1 million women in the United States deliver by Cesarean Section, commonly known as a C- section.” (See it’s ok. It’s normal. It’s safe because mom and baby are in a hospital.) It’s like watching Little Red Riding Hood. You don’t know if it’s the version where little red gets away or the one where the wolf eats her. This is an apt means for normalizing technologically-manipulated childbirth.
Notice the technorati tags at the bottom of the page: OR-Live surgical video medical video C-Section Cesarean Section fetal distress breech position
There is nothing here that indicates a medical need for a cesarean. Fetal distress (a subjective and often misleading diagnosis) cannot be predicted far in advance. Breech position would not have been determined at the time I first heard about this event. So how did this mother and baby get selected for major abdominal surgery, I wonder? The press release states that cesareans are reserved for babies that cannot be born vaginally. The title claims that cesareans are performed during “complicated” or “high-risk” deliveries. How has that been determined in this case?
Or is it that some lucky gal and her innocent child will be selected sometime during this week preceding or on the day of the big show for a 7:00 pm cesarean?
Ugh, if this don’t make yer skin crawl . . .
Bad news for homebirth in Utah
February 8, 2008 at 5:12 pm (VBAC, awareness, childbirth, fear, hooey, midwifery, news)
Tags: amniocentesis, breech, direct-entry midwives, high risk, low risk, twin birth, twins, Utah
From an article in the Salt Lake Tribune:
The bill would put new limits on direct-entry midwives, who are licensed and attend home births. By defining a “normal” birth, it bans them from administering to women with a host of medical conditions, from diabetes to hypertension.
They also would be stopped from assisting women whose babies are breech or who want a vaginal birth after a previous cesarean section (VBAC).
How is it that people who never see “normal” birth (a term that is easily usurped and unfortunately true of augmented birth in this day and age) are able to determine normalcy. If they can determine “normal”, then perhaps they should start overtly forcing more women into induction, augmentation, and other interventions. Medically-managed labor & delivery is certainly most common in a hospital setting. In fact, why don’t we just get rid of the mother’s (and other vested persons’) desires altogether? Many - if not most - OBs are contemptuous towards mothers with birth plans anyway.
I can tell you that “normal” should equate to “natural”, but it doesn’t any more. And really the only venue for assuring natural birth is home. Sure “natural” might not happen for everyone. I’m not even trying to suggest that all women should give birth at home. But these restrictions . . . why not ensure that direct-entry midwives are well-trained for breech, twin, and VBAC scenarios. How do you ensure this? By keeping it legal and supporting midwives who feel confident in their skill level with breech, twin, and VBAC labor. Just as an OB should know if s/he is the appropriate person to deliver a breech baby or perform an amniocentesis (and lemme tell you, some simply are NOT), so should a CNM or direct-entry midwife.
I’ve written about “normal” and “natural” before - click here to read!
Trust Birth or Don’t?
January 29, 2008 at 10:02 pm (VBAC, advocacy, awareness, cesarean, childbirth, empowerment, fear, homebirth, hooey, midwifery, risk, spirituality)
Tags: birth experience, birth outcome, natural birth, normal birth, polemic, trust birth
I can’t resist. You would think that since I am new to homebirth and haven’t had a VBAC yet that I wouldn’t bother myself with polemics regarding homebirth. I’m obviously not that bright. My homebirth google alert today included a post about the power of positive thinking and the homebirth movement. I had to check it out.
I won’t link to this weblog out of principle, but if you search for the quote using your favorite search engine, you’ll find it easily enough . . .
“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”
I’d like to play with the words a bit:
“If you refuse to trust birth and insist that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”
Some people, practitioners and women, simply refuse to trust birth. Some will insist that birth is inherently dangerous. They will likely achieve the birth experience that they desire, and it will likely be overly-managed, overly-medicated, potentially surgical, and definitely exorbitantly expensive.
“If you don’t trust birth and accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”
And somewhat similarly:
“If you don’t trust birth even though you don’t believe that birth is inherently dangerous, you will likely have trouble achieving the birth experience that you desire.”
Some people don’t trust birth and have accepted the “fact” that birth is inherently dangerous. They will likely create that reality in their birth experiences. If women engage practitioners with this guiding philosophy, they will likely lose faith in the natural processes of life and end up dissatisfied with their birth experience even if the outcome is positive.
Some women know that birth isn’t dangerous most of the time but lack the trust needed to achieve particular outcomes. Perhaps this was me once upon a time. I never really considered that birth might be dangerous. Why would I be created for a particular skill if it were inherently dangerous to me or my offspring? However, I’m not sure that I trusted myself enough last time. I didn’t trust my body. I didn’t trust my instincts. That’s probably the worst part of it . . . I didn’t listen to my inner voice.
“If you trust birth and acknowledge that birth is inherently natural to our species, you will likely achieve the birth experience that you desire.”
If you trust birth you are fortunate enough to understand that certain life events are natural and far less risky than some of the every day activities in which we engage. Things like riding in cars. That single activity is far more risky (statistically speaking) than giving birth. If you trust birth you may not be “rewarded” with a particular birth outcome but understand that complications and poor outcomes are possible. Trusting birth is not about sticking your head in the sand. It’s about understanding that most of the time women can achieve normal birth when given appropriate support, time, and space.
Going back to the original quote:
“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”
“Trust” - in the original text, the blogger puts the word “trust” in quotes; this diminishes the validity of “trust” in relation to childbirth
“Refuse to accept” - ultimatum . . . polemic
“Inherently dangerous” - emotional scare tactic
“Reward” - as if there’s a prize involved???
“Desire” - as if all that matters for homebirthers is what the woman desires
Do you see yourself anywhere in my “play on words” section? Where do you want to be? Do you want to be afraid to be pregnant? Do you really want to go into labor and delivery afraid? Do you really want to go into labor and delivery lacking trust? What is positive and proactive about being fearful and lacking trust? What do you as a pregnant and/or laboring woman gain from that perspective? I would say nothing. You have lost your power and are no longer an active participant in your care when you are afraid and can’t trust. Perhaps you (and your birth experience) are more manageable that way. How do you feel about that? Do you want to be managed?
I can’t really define homebirth for you. Everyone comes to homebirth from different paths. Some women always know that they’ll have their babies at home. Some women are involved in social structures that are more inclined to promote homebirth, homeschool, extended breastfeeding, attachment parenting, and the like. Some women are disgruntled consumers. Some women aren’t given the choice to have a vaginal hospital birth and turn to homebirth as their only choice. Some women who give birth at home don’t fall into any of these generalized categories.
For me homebirth is about safety, sanctity, Faith, Trust, natural life processes, achieving physiologic birth, what’s best for me and baby, avoiding an unnecessary cut, vaginal birth after cesarean, comfort, family, community, and a whole host of other things that I haven’t even discovered yet!
Musings on Birth Safety
January 11, 2008 at 9:41 am (ICAN, VBAC, advocacy, awareness, childbirth, empowerment, fear, homebirth, hooey, midwifery, risk)
Which is it - childbirth is safe, normal, natural or dangerous, wild, and unpredictable? Do we really need to draw a line in the sand like that? Isn’t childbirth all of that - normal, natural, wild, unpredictable, sometimes just fine, sometimes not?
No, childbirth is not always safe. I work with a gal who has nearly died in childbirth several times. She lost one child along the way. She birthed at hospitals under the care of a high-risk obstetrician, and that was a necessary reality for her. A friend of mine recently birthed a baby still. They don’t know why the baby died during birth. Another friend of mine suffered an uterine rupture. Her smart baby was blocking the artery that was compromised, and that is why she is still alive today.
But often pregnancy and childbirth is normal and uneventful. (Well, it’s always a big life event, but it’s not nearly as dramatic as Baby Story would have you believe.) It seems like it is more fun for people - some natural birthers and some who want all of the technological bells and whistles - to hype up childbirth. “Ugh, it was SO PAINFUL I just HAD to have my epidural.” “No one is going to take away my VBAC.” “Oh my gosh if I hadn’t had that c-section, I’d have died in childbirth.” “I’ll have to be dying before I let anyone take me to the hospital again.” (For what it’s worth, I said that last statement following my October miscarriage.) Drama drama drama. Me me me. I want I want I want. I’m being a bit extreme here, but I read so much selfishness and self-indulgence and self-glorification on both sides of the proverbial childbirth fence. Does this help women? Does this empower women to make informed choices that “make” childbirth safe?
Let’s come back to that term “safe” as it applies to childbirth venue. If you don’t believe homebirth is a safe choice, then it’s not . . . for you. If you don’t believe that you can have a natural non-interventive birth in the hospital, and that’s important to you, then you probably won’t have a good experience in the hospital. If you don’t trust anyone but your self and perhaps your partner in childbirth, you will probably prefer unassisted childbirth. We’re only “safe” when we believe we’re safe. I honestly don’t believe that MOST women are safer in the hospital or safer at home or safer at a birth center. They perceive a level of safety and psychologically, and even physiologically, respond to that way of thinking. Certainly there are plenty of “yeah, but” scenarios out there, but I very clearly wrote “MOST women” above.
Be afraid to birth at home. That’s fine. But don’t call a woman crazy for choosing to feel safe at home, especially if she is surrounded by well-trained and caring support. You can be afraid even when someone else isn’t. Be afraid to birth at the hospital. That’s fine. But don’t criticize the woman who chooses to deliver at a hospital, especially if she is surrounded by well-trained and caring support.
It is an unfortunate reality that babies die in childbirth . . . that women die in childbirth. I think doctors, midwives, and other childbirth support providers are all interested in reducing negative outcomes in childbirth. I just wish, hope, and pray for the day when these parties can meet and work from a point of mutual respect. That’s when we’ll have a maternal-child healthcare system that is woman-baby centered and certainly safer for all involved.
We can’t make changes if we don’t talk. Debate is not talk. People who debate don’t listen. I think people who get caught up in debating issues without stopping to listen and learn are afraid. They are frightened sad unhappy people. I have my own set of fears just like anyone else, but I strive to run my life from a place of power and trust. I don’t want to pass fear along to my children. I don’t want to be remembered that way. I don’t want to approach God that way.
May you find power, faith, and love, now and forever.
Gloria Lemay Responds to ABC Segment on Unassisted Birth
January 9, 2008 at 3:34 pm (ICAN, VBAC, awareness, childbirth, empowerment, fear, homebirth, hooey, midwifery, news, risk)
Tags: ABC News, breech, breech birth, breech presentation, cord, cord prolapse, DIY, fetal cord, Gloria Lemay, Good Morning America, hemorrhage, Holland, Kloosterman, unassisted birth, unassisted childbirth, vaginal tear
“The baby could be born in a breach [sic] position, or with the umbilical cord
wrapped around its neck. The mother could suffer from significant tearing or
from a maternal hemorrhage and bleed to death in as little as five
minutes.”
Dear Women,
The above quote is by a physician who was interviewed by Good Morning America for a program about Unassisted Birth on Jan 8, 2008.
I think it’s very important to address the statement that a woman can hemorrhage and bleed to death in as little as five minutes. This is a very horrifying comment for a doctor to make and, for anyone who doesn’t really know birth, it could be enough to send them running for the hospital.
First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING. Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough I.V. fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could. I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting.
Think about it - would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes? I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up. I have had 10 transports for hemorrhage in the many homebirths that I have attended (over 1000). Two women have required transfusions. The other 8 recovered with I. V. fluids, rest and iron supplements. Of course, no one wants to see blood transfusions in this day and age. We also don’t like to see a woman anemic after having a baby because it makes the postpartum time very difficult. The most important action after having a baby is to keep the mother and baby skin to skin continuously for at least the first 4 hours.
What doctors won’t tell you is that the most severe cases of postpartum anemia are in women who have had cesareans. Major abdominal surgery results in anemia. I have a friend who is a pharmacist in a hospital. He spends most of his days trying to figure out individual plans to help cesarean moms get their hemoglobin counts up. He finds these cases of severe anemia in post operative mothers very distressing.
I hope this information is helpful to you.
As far as the other nonsense this person is trying to frighten you with:
1. Significant tearing—if you look with a mirror at your vulva after birth and there seems to be skin that “flaps” away from the rest of the vulva structures, you can always go into the emergency ward and have someone suture the wound. Tears do not bleed like cuts do. This should not dissuade anyone from staying away from the place where the scalpels reside.
2. Breech position—you’ll know if your baby is breech. When the membranes release, you will see black meconium coming out the consistency of toothpaste. With a head first baby, the meconium colours the water green or brown but with a breech, the meconium is being squeezed directly out without mixing with water. The other way that you should suspect a breech presentation is if you have a feeling from about 34 weeks of pregnancy on that you have “a hard ball stuck in your ribs”. Breech presentations are about 3 percent of births.
3. Cord wrapped around the neck—the smart babies put their cords around their necks to keep them out of trouble. If you have a baby with the cord around the neck, it can be unwrapped very easily either during or right after the birth. The most important thing is to keep the cord intact.
Gloria Lemay, Vancouver BC Canada
Advisory Board Member, ICAN
Contributing Ed. Midwifery Today Magazine
Teaching midwifery on the internet at www.consciouswoman.org
Speaking at the Trust Birth Conference, Redondo Beach, CA in March 2008
www.trustbirthconference.com
It’s a New Year Rife with Cesarean Birth!
January 2, 2008 at 10:15 am (ICAN, VBAC, awareness, cesarean, childbirth, hooey, news)
Tags: 2008, autmentation, first baby, first birth, induction, medicalized birth, medicalized childbirth, New Year
I don’t understand why hospital birth pushers (as in ALL women should have their babies “delivered” at hospitals) generally don’t understand or respect natural birth advocates’ (unhindered/non-interventive birth regardless of location) concerns over the growing number of complicated births and cesareans performed in this country!
Look at these media google alerts from today!
‘A’ first baby in Capital Region
Albany Times Union - Albany,NY,USA
The doctor performed a cesarean section. Kin filled the waiting room. Avery is their first baby, but they hope to have more children who will also have …
Twins, baby girl are first births of 2008 for Las Cruces area
Las Cruces Sun-News - Las Cruces,NM,USA
She was delivered via Cesarean section. Quintana said the child is her second, but the birth was more difficult than her first because of Brenda’s large …
Region’s first 2008 baby born in Saratoga Springs
Albany Times Union - Albany,NY,USA
The doctor performed a cesarean section. As Avery arrived in the world, family members filled the waiting room. Avery is their first baby, but they hope to …
Boy, did he arrive early!
The Standard - Hong Kong
The 3.46kg boy, who still hasnt been named, arrived at the stroke of midnight by cesarean section. His mother Chan Ha-ling, 32, had suffered from labor …
Savannah’s New Year’s Baby Born at 4:40am
WTOC - Savannah,GA,USA
Dr. Gregory Whitaker got the page and said he was glad to help out in the Cesarean birth. “First baby I delivered in 1977,” he told us. …
[Not a cesarean birth!]
New Year’s baby born at Overlake
Seattle Times - United States
By Seattle Times staff Puget Sound’s first baby of the New Year was born at Overlake Hospital Childbirth Center in Bellevue, a hospital official said. …
One in six reported first births of the year was NOT a cesarean. Can someone explain this to me?!?!?!!! I don’t want to speculate here though plenty of thoughts are going through my head, I must admit.
If only more people were aware of the serious implications and complications of cesarean birth. I am not talking about emergency cesarean or even emergent cesarean . . . sometimes babies have to be born this way. But I know from my research and interactions with birth professionals that cesarean surgery is way over-used. That augmentation is way over-used. That induction is way over-used. That many women are not allowed to gestate to term (term being 38-42 weeks, generally). That women with cesarean scars are finding it incredibly difficult to have vaginal births. That women who desire to VBAC are being told “no” without good justification, and that these women accept that response. That women are socialized to fear childbirth, to fear their bodies, to fear their power.
Thanks to the International Cesearean Awareness Network (ICAN), I have learned differently. I hope someone will read this post and find their needs attended to through this organization.
I will continue scouring the internet for more “first birth” information.
