Recent Interesting Reads

Not that I’m voting Republican, but I am curious to know anything about Sarah Palin.  Who is this woman and how did she secure the VP slot on the Republican ticket?  Here are my guesses: (1) She’s such a nobody that when McCain loses, no Republican with a political future would be sacrificed and (2) Should McCain/Palin pull out a win, they have Alaskan Oil in their pockets.  But I digress – read this post at Jezebel about Sarah Palin’s brand of feminism.  I don’t mean to be polemic, and well, when you hear it enough times, it ceases to be polemic and looks more like the down-low on shadiness.

Researchers from the University of Connecticut released a study which looked at the relationship between cesarean rates and malpractice rates.

“When I compared the malpractice rates to cesarean delivery rates prior to 1999, both were declining at a similar rate,” says Spencer. From 1999 to 2005, however, both were increasing. “I can’t say one led to the other or visa versa,” he says, but he speculates that rising medical malpractice rates are driving up cesarean delivery rates.  “With our data, we cannot prove a causation but only suggest an association.”

An insightful read from the UK, especially:

“Since the 1970s, the medicalisation of childbirth has been a hot topic for obstetricians, midwives and feminists. There exists in maternity services a clear division between the interventionists, typically headed by the obstetricians, and those, such as midwives, who favour a low-intervention approach. Caught in the middle are the women giving birth. Those who opt for high-tech hospital births are condemned for giving in to unnatural patriarchal models of healthcare and betraying the sisterhood. Those who eschew medical and technological assistance are deemed irresponsible and reckless. They can’t win.”

No, we can’t seem to win, especially those of us who have already been cut once.  To put our babies through a “trial of labor” is considered irresponsible and reckless at best by a growing majority of care providers and the general public.

And finally, I’ve never liked Dr. Phil.  I’ve watched enough of him on TV at various times in his career to know that he has nothing new to add to my knowledge base.  I find him to be a subversive character – wish I could remember the exact moment I decided that, but it was many years back and had something to do with him blaming a wife (in front of her husband) for their marital distress.  I don’t know who was at fault, but Phil pinned the whole thing on the wife and was using this icky patronizing tone.  Ick.

I digress.

Over at Inspired Mama I came across this post – Dr. Phil is asking for homebirth disaster stories.  <sigh>  I’m reproducing it below so you don’t HAVE to click on the link unless you want to go to the horse’s ass, I mean, mouth.  (Keep in mind that when you click active links it raises their “rating” in search engines.  Click at your own risk.)

DO YOU REGRET HAVING A HOMEBIRTH?
Did you have a child at your home?

Did you want to have a soothing experience where you were in control and could bond with your child?

Did it not go the way you planned?

Do you regret having a home birth?

Do you regret using a midwife instead of going to a hospital?

Did you have your second child the traditional way in a hospital?

If you or someone you know regrets having a home birth please tell us your story below.

Be sure to be specific and include details!

Here’s an idea – instead I recommend flooding the Dr. Phil show with letters about how wonderful homebirth can be, how difficult VBACs can be to achieve within a hospital environment, and how the current maternity system ruins natural childbirth.

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Labor “Drama” Misrepresented

This idiotic take on labor is what “could have been avoided.”  Why is it that people don’t understand that labor isn’t something to be avoided except in extreme circumstances?  Many benefits for both mother and baby occur thanks to labor, the benefits of which are known and proven.

When asked about his girlfriend Camilla’s labor, Matthew McConaughey said: “I wouldn’t say she’s (Alves) suffering but she’s having to dig deep… She’s tired, she’s exhausted, she’s in pain.”  Camilla’s 40 hour labor ended in cesarean but doesn’t regret the process in which they were engaged, claiming that “it was a great journey for both of [them].”

Click here to read an insightful take on the media’s treatment of McConaughey’s “alternative” perspective on birth.

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Childbirth Connection Report Raises Concerns

NEW YORK, NY, August 5, 2008 – Childbirth Connection, a leading national not-for-profit organization that works to improve the quality of maternity care, today released New Mothers Speak Out, National Survey Results Highlight Women’s Postpartum Experiences. The report is based on new data from the national Listening to Mothers II Postpartum survey, and includes relevant results from the national Listening to Mothers II survey, which was conducted six months earlier and focused on childbearing experiences of the same women. Combined survey results from these landmark surveys provide an in-depth look at women’s postpartum experiences during the first eighteen months after giving birth.

The broad categories addressed include:

  • Persistent physical and emotional health problems (such as post partum depression, feeling stressed, lack of sexual desire, cesarean-related problems, weight control)
  • Breastfeeding experiences (most women who intend to breastfeed do not continue as long as they would have liked)
  • Co-sleeping and demographic variation (these experiences vary widely by race/ethnicity and need more research)
  • Nonexistent or insufficient social support from husbands, partners, and others
  • Meager paid maternity leave benefits and multiple employment challenges (in other words, most women who work suffer for it)

To read the report in full, the press release, listen to podcasts, or find out more about the study, click here.

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Lack of Birth Art?

I skimmed an interesting article from the Guardian this morning that suggests that whereas art often depicts life events, childbirth has not been well-represented by artists.  I hadn’t really thought about that.  Women have been regularly depicted in art as domesticians, as sexual beings, as dancers, as objects of beauty.  What is not domestic, sexual, dance-like, or beautiful about childbirth?  Why is the image of a slim naked woman (commodified) so desirable in contrast to the burgeoning of life from a woman’s body (abjectified)?  What is not attractive about a body blooming from pregnancy?

I decided to look for [childbirth art] and ["childbirth art"] via Google and was surprised by the number of irrelevant hits.  A few things that piqued my interest included:

Childbirth in Renaissance Italy was encouraged, celebrated, and commemorated with a wide range of objects, from wooden trays and bowls and maiolica wares to paintings, sculpture, clothing, linens, and food. This groundbreaking book examines for the first time the appearance, meaning, and function of these childbirth objects. It also describes the social and cultural context in which they were created, purchased, and bestowed. In doing so, the book offers many insights into Renaissance daily life.Jacqueline Marie Musacchio draws on surviving works of art as well as contemporary and largely unpublished inventories, diaries, and letters, to illustrate the strong bond between the art and rituals of childbirth in Renaissance Italy. She describes a family-centered society seeking to rebuild itself in the wake of the catastrophic population decline wrought by the Black Death. Birth objects were symbols of fertility that encouraged pregnancy. But they were also rewards for procreation that congratulated the new mother. To demonstrate this, Musacchio investigates how objects were given, lent, bought, or commissioned as part of marriage and birth rituals, and how particular images and objects were regarded as aids to pregnancy and birth. For a variety of reasons, she concludes that childbirth objects served as necessary mediating devices between the real and ideal worlds.

In contrast, women who have suffered cesareans (not to suggest that all women who have had a cesarean feel like they suffered) have created some incredible artwork.  Click here to find related images.  I assume that cesarean art falls into the “abject” arena.  Furthermore, pregnancy and the birth process haven’t become mainstream depictions of the female body in art.  I hope more artists will be interested in changing that.

Choosing cesarean limits future choices

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]

  1. Risk of post-partum depression and post-traumatic stress disorder
  2. Negative impact on breastfeeding, bonding, and other key mammalian birth-related processes
  3. Stillbirth, miscarriage, infertility
  4. Pain, adhesions, slow recover, unsightly scaring
  5. Negative impact on relationships with other family members, particularly partners/spouses
  6. 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.

Upcoming Interview

In about an hour I will be interviewed for a local news station regarding Montana’s cesarean rate.  I don’t know much more than that.  The reporter has a young child.  The reporter is supposed to be meeting with a local hospital official.  Other than that, who knows what her focus will be.  In anticipation of this interview, I decided to review some things that I have read and wrote regarding cesarean rates.

With regard to rates, it is important to consider that the US cesarean rate (2006, preliminary) is 31.1%.  The rate has increased by 50% since 1996.  The rate recommended by the World Health Organization is 10-15%.  Once the cesarean rate exceeds 15%, the risks (statistically speaking) outweigh the benefits.  The Montana cesarean rate (2006, preliminary) is 28%, nearly a 3% increase from the year prior.  According to a source at the local hospital, our local rate is around 31%.  I was told that only 16 VBACs took place in 2006 at my hospital.  (A local CNM questioned the accuracy of the VBAC figure, suggesting that VBACs were under-reported.)

I can list many contributing factors to the continued increase in the cesarean rate:

  • Medico-legal concerns on the part of doctors, hospitals, and insurance providers (it’s HUGE, actually)
  • “So and so had a cesarean . . .”
  • Hollywood stars having elective cesareans
  • Young and underpriviledged mothers are more at risk for cesarean surgery
  • An unchecked trust in care providers – most women do not seek second opinions when it comes to maternity services
  • Sensationalization of birth – Baby Story and OR Live come to mind
  • Society – our view of birth has changed; the culture of fear has spread to childbirth
  • Cesareans ARE more safe now than they ever have been

Of course I’ll direct the reporter to resources such as:

  • ICAN
  • The Mother-Friendly Childbirth Initiative
  • Childbirth Connection
  • Conscious Woman