Cesarean Awareness Month 2011

© Amy Swagman, 2010 -www.themandalajourney.com

© Amy Swagman, 2010 -www.themandalajourney.com

So another year has passed, and I’m back to wondering where we are with our cesarean awareness ‘campain.’  I’m somewhat ‘skirting’ the loop (not really inside or outside of it, just around), so I’m not your most up to date source.  For truly outstanding resources related to cesarean awareness, read Unnecessarean and VBAC facts for starters!

A couple of things that have my attention lately:

  • Our national cesarean rate is staggering, and some predict that by 2020, 1/2 of our births will be done by cesarean.  We must be vigilant!
  • Montana needs a Friends of Montana Midwives group
  • Montana’s cesarean rate is 29% just below the national average.  However, some counties in MT have super high cesarean rates.  Why is that? (Carter County had a 65.4% c/s rate 2005-08 according to the March of Dimes!!!!)
  • Birth activist are working so hard – it’s just awesome!  Thank you to all who are gettin’ it done!!
  • According to Childbirth Connection, “A high-quality, high-value maternity care system is within reach, and childbearing women are the most important stakeholders to drive system change.”  Have a look and see what you can do!
  • Also, through Childbirth Connection, I’ve learned about relevant legislation that has been introduced.  This legislation needs our support!!
  • ICAN is getting ready for the 2011 conference – wish I could be there . . .

Because I’m pregnant I’m in a great position to find out even more about what is being done locally and what still needs work.  I have found – contrary to what my OB told me – that a few OBs will consider VBA2C on a case by case basis.  I have discovered that our only independent birth center, run by a fantastic CNM, does VBACs (even primary!) but not VBAmC.  I have lots of friends who are pregnant these days and have learned a lot about local practices.

Because I’m pregnant with #4 and work a full time job (one that often has me out of town on weekends in the Spring and has me out at night), I haven’t had the time & energy to get more aggressive.  This too shall change, and when it does – LOOK OUT!  ;)

In the meantime . . . what can you do?

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% . . .

April: Cesarean Awareness Month

Cesarean Awareness Month (CAM) is an internationally recognized awareness month which sheds light on the impact of cesarean surgery on mothers, babies, and families worldwide.  Cesarean birth is major abdominal surgery for women with serious health risks to weigh for both moms and babies.  Cesareans may be safer now than they ever have been, but this surgery is being conducted more frequently than is prudent or safe.  The acceptable rate established by the World Health Organization (WHO) is 10-15% – what is your community’s cesarean rate?

The blogosphere is atwitter about Cesarean Awareness Month.  Here are some posts I found today that deal directly with CAM:

  • Instinctual Birth’s post
  • No Womb Pod’s post
  • Strain Station’s post
  • Cesarean Awareness’s post
  • CT Birth Experience’s post
  • She Got Hips’s post
  • CT Doula’s post

If you have blogged about Cesarean Awareness Month and don’t appear on my list, please leave a comment so we can read your post.

To learn more about cesarean awareness, support, and education, visit the Internation Cesarean Awareness Network (ICAN) website and/or look for a chapter in your area.  Another great resource to consult when weighing the benefits and risks of intervention in chilbirth is Childbirth Connection.  Also, I recommend looking at and considering the Mother-Friendly Childbirth Initiative.

How do you plan to honor Cesarean Awareness Month?  How can you let people know that natural birth is an important issue for you and for them?  I promise that there is some way, no matter how small it may seem, that you can have a positive impact on your birth community.  Even wearing a cesarean awareness ribbon several days this month will help.  If you need ideas, feel free to ask.

Too Late for Natural Birth?

In my google alerts today, one headline stuck out: “Too late to reverse rise in c-sections?” from the Boston Globe.  It is a letter to the editor from Lois Shaevel, co-author of “Silent Knife.

Shaevel states:

For eons we females had been capable of giving birth with very little medical intervention. Then childbirth went into the hospital, and the process became a medical and increasingly surgical event.

It’s sad really.  I’m not saying that all women don’t need a hospital and that all births can be achieved non-medically, but what makes me sad is the shift in how pregnancy and childbirth are viewed by our society.  Pregnancy and birth used to be normal and expected events in a woman’s life.  Now when you tell someone that you are pregnant they ask you if you have a first trimester ultrasound scheduled yet.  When you respond by saying that you don’t plan to utilize ultrasound technology unless it becomes medically necessary, they cock their heads, look at you funny, and respond with a suspicious “huh!”

Shaevel continues: 

When Nancy Wainer and I wrote “Silent Knife” in 1983, we hoped our work would reverse the trend and give women confidence in their bodies’ innate ability to birth their babies. If this trend of surgical intervention in the natural process of childbirth continues, the only women who will birth their babies naturally 50 years from now will be those who don’t make it to the hospital in time for their caesareans.

Some women are finding ways to become more confident in their bodies.  I joined the International Cesarean Awareness Network (ICAN) which greatly increased my confidence and understanding that a repeat cesarean would likely be unnecessary.  However, the doctors will always find a way to rob us of our confidence.  One ICAN list member was told early on in her pregnancy that s/he was supportive of her choice to VBAC.  Now at 36 weeks she’s been told to schedule a repeat cesarean.  This is not an uncommon story.

Here are my thoughts on how/why this keeps happening to women who desire vaginal birth after a cesarean (VBAC).  Perhaps the doctor just wants the business and thinks s/he will be able to change the patient’s mind along the way?  Perhaps the doctor believes in a woman’s choice but loses confidence along the way?  Perhaps in losing confidence in the mother along the way, the doctor is thinking about the legal consequences of not performing an elective repeat cesarean?  Perhaps the doctor, losing confidence along the way or thinking s/he can coerce the patient into surgery, also has the $$ in his/her eyes since surgical birth costs so much more than vaginal birth?  Perhaps the doctor knows that VBAC labor can take longer, and since s/he will have to be more readily accessible thanks to ACOG directives, s/he pushes for the quicker solution – major abdominal surgery?  Perhaps the doctor is more afraid of the uncertainty of normal (as in natural) birth because s/he is not familiar with it versus that which s/he is trained to do – perform surgery?

Shaevel’s letter was formed in response to this recent Boston Globe article.  Here are a couple of important points to consider from the article:

“It’s important for us to step back and say, ‘Why is this happening, and is it in the best interest of the public?’ ” said [the state's secretary of health and human services, Dr. JudyAnn] Bigby, whose research before entering state government had focused on women’s health issues at Brigham and Women’s Hospital. “This is not a minor surgical procedure; it’s a big deal. We need to understand why this trend continues.” [emphasis mine]

She is “sufficiently alarmed” that her state’s cesarean rate now eclipses the national average of 31.1%.

Obstetricians’ fears of lawsuits may also fuel some of the increase.

“There’s no doubt about the medical-legal burden; the litigious nature of society has an impact on this,” said Dr. Fred Frigoletto, chief of obstetrics at Massachusetts General Hospital. “Very few obstetricians have been litigated because they did a C-section. But they’re always litigated because they didn’t do one.”

Fear of litigation is NEVER an appropriate motivator for medicalized childbirth.  Interventive practices are only appropriate when there is sound evidence of need.  Basing medical opinion, advice, and practices on a fear of litigation is unethical and violates the oath and creed to “first do no harm” that all doctors agree to when they become registered practitioners.

It once was popular to deliver subsequent babies [following a cesarean] by vaginal birth, but by the late 1990s the practice began to fall out of favor because of potential risks.

Potential risks – yes, it is possible that a woman’s uterus may rupture during labor.  The risk of rupture may be as low as .5%, and any doctor who puts forward a rate of greater than 1% should be asked for the research to support such a statistic.  Avoiding induction and augmentation of labor and having continuous labor support (an experienced doula and/or midwife) will help VBAC moms achieve their goals.

Anyone who doubts the importance of natural childbirth for both mother and child should register for the “What Would Mammals Do” webinar through Conscious Woman

Day 2 of New Year Cesarean Watch

The first birth of the year announcements keep coming in.  Here are the births that came up in my cesarean news alert today:

New Year’s Baby
Wayne Independent – Honesdale,PA,USA
Dr. Hoon Yoo performed an emergency cesarean section, and Ruby arrived in the world at 8:47 am The 7 pound, 14 ounce infant is Wayne Memorial’s very first …

Sixteen babies born at Tema Hospital on New Year’s day
Joy Online – Accra,Ghana
She said with the exception of those delivered through cesarean sections, the rest had been discharged at the time of the visit.

NEW YEAR, 2 NEW BABIES – part 1
Brainerd Daily Dispatch – MN, United States
He was born via Cesarean section more than two weeks after his due date of Dec. 18 after more than 17 hours of labor – including more than two hours of …

Family welcomes first baby of 2008
Providence Journal – Providence,RI,USA
PROVIDENCE — Rhode Island’s first baby of 2008 came six days before she was due, and by way of cesarean section, at 2:06 am yesterday at Women & Infants …

Gwendalyne can’t wait, becomes 1st New Year’s baby
Herald Times Reporter – Manitowoc,WI,USA
MANITOWOC — Lisa Wellner’s baby wasn’t due until the first part of February, and she had a cesarean section scheduled for more than three weeks from now. …

And one unknown due to subscription restriction:

Welcome, Samuel! Area’s first baby of ’08 checks in
Daily Hampshire Gazette (subscription) – Northhampton,MA,USA
Surrounded by friends at the Cooley Dickinson Childbirth Center, Samuel’s proud parents, Maria Lozano and her husband, Juan Jimenez, were all smiles after …

So, 5 reported cesarean births and 1 unknown (though likely a vaginal birth due to implied location) in today’s news.  The working total* then is:
10 “First Babies” born by cesarean surgery
2 “First Baby” born vaginally
*  See my post from yesterday for those news stories

So, based on news reporting, the emerging cesarean rate as of January 2, 2008 is 80%.  Do people just somehow get caught up in the mystique of January 1 birthdays?  How many of these cesareans were needed?  How many became emergent due to complications related to position, progressing on a timeline, augmentation, induction, and the like?

This is intensely distressing!

2006 Cesarean Statistics Released – it ain’t good

Today I was informed that the CDC released preliminary vital statistics for 2006 which includes state-by-state cesarean birth information.  Here in Montana the 2006 cesarean rate was 28%, earning us a rank of number 37 (of 51).  The national cesarean rate was 31.1%, an all-time high.  Although Montana was 3 percentage points below the national average, the rate still exceeded World Health Organization (WHO) recommendations by 13-18%!  The WHO determined that when cesarean rates exceed 10-15%, the risks of the surgery outweigh the benefits.  It is my understanding from a recent discussion with a hospital administrator that Community Hospital’s (Missoula) cesarean rate exceeded 30% in 2006.  Missoula’s cesarean rate is headed in the wrong direction. 

As a woman with one cesarean scar, these statistics are frightening.  Is cesarean birth becoming “normal” birth?  If one out of three babies is born through major abdominal surgery, then yes, I’d say the norm is swinging that direction.  You need to know that the percentage of birth by cesarean has risen 50% in the past decade.  This is straight from the horse’s mouth!  You also need to know that Montana’s VBAC (vaginal birth after cesarean) rate in 2005 was only 1%. 

For the second year in a row, ICAN has compiled a list of research from the past year that shows cesarean surgery should be used more judiciously and that VBACs should be routine/normal.  Currently, more than 300 hospitals across the U.S. ban women from having a VBAC, essentially coercing them into unnecessary surgery and feeding the growing rate of cesarean.  Very few Montana women have access to vaginal births after cesarean sections.  Only a handful of hospitals across the state allow VBACs – one of those hospitals is Community Hospital in Missoula

In August, the Centers for Disease Control released a report showing that, for the first time in decades, the number of women dying in childbirth has increased.  Experts note that the increase may be due to better reporting of deaths but that it coincides with dramatically increased use of cesarean.  The latest national data on infant mortality rates in the United States also show an increase in 2005 and no improvement since 2000.  “At a time when maternal and infant mortality rates are decreasing throughout the industrialized world, the United States is in the unique position of having both a rapidly increasing cesarean rate and no improvement in these basic measures of maternal and infant health.” says Eugene Declercq, Ph.D., Professor of Maternal and Child Health at Boston University School of Public Health.

Another report released in October by the World Health Organization, the United Nations Population Fund, the U.N. Children’s Fund, the U.N. Population Division and The World Bank, and published in the Lancet shows that the U.S. has a higher maternal death rate than 40 other countries.  “Women in the U.S. think they’re getting top notch care, but our death rate for mothers shows otherwise,” says ICAN’s President, Pamela Udy.  The U.S.’s maternal death rate tied with that of Belarus, and narrowly beat out Bosnia and Herzogovena.

Research from 2007 also shows that VBAC continues to be a reasonably safe birthing choice for mothers. “The research continues to reinforce that cesareans should only be used when there is a true threat to the mother or baby,” said Udy. “Casual use of surgery on otherwise healthy women and babies can mean short-term and long-term problems.” For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients. The resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure. Click here for a pdf copy of this important resource.

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican-online.org for more information, to find a local chapter, and to receive support.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. http://www.ican-online.org/resources/white_papers/index.html Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.