For those of you who do not know, April is Cesarean Awareness Month. Did you know that our national cesarean rate continues to increase every year? Over 31% of births take place surgically via cesarean section. Consumer Reports has named cesarean surgery one of the top overused procedures in the United States. Even though the US tends to deal with pregnancy and childbirth from a medical perspective, our country’s maternal/fetal outcomes are among the WORST in the industrialized world. I hope you will take some time this month to learn about cesarean surgery, why women in your communities may not consider cesarean-born babies to have been birthed, why women are having more trouble post-cesarean with becoming or staying pregnant, why women may have less access to birthing options following a cesarean, and why women should be searching for less medically-interventive options for pregnancy and childbirth. Talk to people in your community about preventing unnecessary cesareans (keeping in mind that cesareans are appropriate for some emergent situations and in case of emergency), midwifery care (nurse-midwifery and professional midwifery), birth venue choices, and how to help someone recover from a cesarean. For more information on Cesarean Awareness Month, visit http://www.ican-online.org and also search for a local chapter. Together we can make a difference, one birth at a time.
I received an excellent question from a Facebook friend the other day. And even though my response is brief, I suppose this might be a question that a lot of folks have for people like me!
“So I’m curious… What led you to become involved with ICAN? Personal experience or passionate commitment to natural childbirth? Or both?” ”I am always interested in how people come to be involved in this kind of advocacy.”
My brief response:
I had a cesarean in 2004 and didn’t fully understand the impact of it until much later. I joined ICAN when it was time to try for another baby and have been involved ever since. So, now it’s personal experience as well as passionate commitment to evidence-based practices in obstetrics as well as spreading the word about the benefits of natural childbirth, VBAC, homebirth, birth plans, doulas, midwives, whatever! Also, I’m very concerned about the national cesarean rate and our local rate in Missoula. That’s it in a nutshell!!
And of course I suggested that she have a look at my blog!
Phew, 7pm and I’m exhausted. Here’s a summary of my activities today:
The twins – yes, I said twins, look good. I’m not quite as far along (only by a couple of days) as I would have thought, and this is an agonizing alteration to my pregnancy “schedule.” What I mean is that as a loss momma, that last thing I want to be doing is backing up in time… adding MORE time into the 1st trimester.
Both babies are measuring about the same size. Both babies’ heartbeats were easily detected and measured right around 130 which is good for 6 weeks 4 days or so. We were so thankful to see those sweet flickers again.
My husband and I found out definitively about the twins about a week ago. A nurse at the RE’s office recommended a scan because my HCG numbers doubled too quickly. At about 5-1/2 or 6 weeks we were able to see two sacs and even visualize the heartbeats for both babies. I call them my little flickers.
Health Reform: I was thrilled to have been invited to attend a local health reform meeting to represent consumer concerns. I introduced myself as an University professor and a professional opera singer which of course got a couple of laughs. Then, I continued by saying that I’m a consumer advocate and come to this gathering as a woman with a scarred uterus. The main concerns I articulated as a cesarean mom were:
- A high local cesarean rate (around 31%); a low VBAC rate (about 1%) at the hospital
- A lack of support for the local birth center
- Decrease in numbers of CNMs locally
- Insurance and health care costs
- Insurance company driven health “care”
Additionally, it alarms me that even with my supposed “good” health coverage, I am struggling to pay last year’s medical bills. The bills are overwhelming, so they pile up, and my credit score is suffering as well.
Arts Advocacy: I am one of the educations outreach directors for a new opera company. We had a meeting today to help prepare for the next board meeting and our upcoming educational outreach program.
I even managed to mop the floors. I’d say it was a pretty darned productive day.
I’ve been looking through stock and Creative Commons Licensed photos tonight that deal with pregnancy. I figured that while I’m in the mood I’d look for some photos that we could possibly use for the upcoming ICAN Conference in April in Atlanta.
I find this a particularly interesting portrayal of Venus, the goddess of fertility among others. Notice that in this piece of artwork, she is missing her lower abdomen. There is a hole there. This is how I feel – like a goddess (albeit worldly, a woman who is quite fertile) whose corrupted uterus has been excised from her body. It is so hard not to point at the cesarean as the root of my current woes.
I am so sorry that so many of you know how I feel. No one deserves it.
Today I was in class trying to follow along in a fast-paced discussion of voice pathologies. One such pathology discussed was the Human Papilloma Virus which can attack the vocal folds. Colds and other viral infections can manifest as papillomas (small harmless epithelial tumors) on or near the vocal folds (membranes of the voice box). This is called Recurrent Respiratory Paillomatosis (RRP).
RRP shows up in children, and the suspected cause is a HPV-infected mother. When a baby descends through his/her mother’s birth canal, the baby can contract HPV if the mother carries the virus. Adult onset RRP evidently is becoming more prevalent, possibly due to changing sexual practices.
In the course of teaching us about HPV and the respiratory equivalent, RRP, the instructor stated that pregnant women with HPV have have their babies “delivered” via cesarean section. The instructor was given this information by . . . you guessed it . . . a DOCTOR! I couldn’t hold my tongue. I wanted my colleagues to be sure to know that although a doctor may suggest that a pregnant woman with HPV should have a cesarean, that it’s not a mandate.
I wish I had told my colleagues that uniformly recommending cesarean delivery due to HPV is not an evidence-based practice. Why is this important? What if a pregnant woman enters this practitioner’s speech & hearing clinic complaining that her voice is hoarse and weak, and upon further investigation, it is discovered that she has RRP. This practitioner may tell her that she’ll have to have a cesarean because she has RRP. That may be one more woman who, heeding the advice of her care providers, would be cut.
Let’s look at some of the literature on the net about both HPV and RRP. (See sources at the bottom of this post.)
Frequency: According to the RRP Foundation, there are maybe 20,000 active cases of RRP in the U.S., and the CDC estimates that less than 2,000 children contract RRP in a year. HPV is quite prevalent – approximately 20 million Americans are infected.
Transmission. Active condyloma during pregnancy or HPV can cause a baby to become infected, but occurrence is deemed RARE. As stated previously, RRP is becoming more prevalent in the adult population possibly due to changing sexual practices, and HPV has a strong connection to sexual practice.
Childbirth recommendations: Cesarean delivery is not completely protective from RRP though recommended for consideration when visible condyloma is present in a primaparous pregnant patient. Cesarean delivery is not protective against RRP in mothers with genital warts.
Well-meaning practitioners from other unrelated fields can and do contribute to the cesarean problem. However uncomplicated a cesarean may seem when presented antiseptically from a medical provider or behavioral clinician, important questions are not being asked:
- How likely is transfer of the presumed pathogen
- How is cesarean delivery protective against the transfer of specific STDs and other viral infections
- What physical complications can arise for the mother with a cesarean
- What physical complications can arise for the baby due to a cesarean
- How does cesarean delivery affect the mother-baby dyad
- What psychophysical or emotional complications can arise after cesarean delivery (or after traumatic birth experiences); how and when do they manifest
- What complications may arise (at birth, in childhood, during puberty, in adulthood) from possible RRP transfer
- How should the patient/client prioritize the risks/benefits of vaginal or cesarean birth
- What does the mother (and her support team – partner, family members, close friends, etc.) desire
- Who is more important – the mother or the baby
This last question is the most perplexing, it seems, for the medical community. Babies are born innocent and vulnerable. They are unable to advocate for themselves. In protecting the rights of the unborn or barely-born (not that I oppose that ultimately, I might add), care providers knowingly and unknowingly subvert the rights of the mother. The mother is here right now. She is hopefully a positive contributor to her community. She may already care for other children. She may have a life partner. When her health and happiness is compromised for the well-being of her innocent child, is our society really any better for it? Which is more important – kinetic energy, a life in process, a current contribution . . . or potential energy, a life about to begin, a possible contribution.
I hope readers will take to heart the broadest implications of this post. First, medical doctors and insurance companies are not the only ones adding to the increasing cesarean rate. We find well-meaning contributors in some of the most unlikely places. Second, questions beyond “how easy is it to fix” must be asked when the life and well-being of the mother-baby dyad is at risk.
CDC information on HPV – http://www.cdc.gov/STD/HPV/STDFact-HPV.htm
Condyloma in Pregnancy Is Strongly Predictive of Juvenile-Onset RRP – http://www.greenjournal.org/cgi/content/full/101/4/645
eMedicine – http://www.emedicine.com/med/topic2535.htm
Genital HPV Infection Learning Module – http://depts.washington.edu/nnptc/core_training/clinical/PDF/HPV2008.pdf
RRP Foundation – http://www.rrpf.org/
Women’s Health, HPV and Genital Warts – http://www.womenshealth.gov/faq/stdhpv.htm