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

Why “I don’t care” hurts

My sister-in-law’s birth experience came up in discussion this week when we were home visiting.  We knew at the time of her cesarean that the baby was likely premature – even at 41+ weeks – because of the thick coating of vernix on her when she was extracted from my SIL’s body and based on her mother’s gestational pattern.  Her OB of course recommends repeat cesarean for future childbirth.  Perhaps some of the reasoning is valid, but personally, I think she’s being misinformed and discriminated against.

My husband asked her if she was interested in a VBAC or would go with the OB’s recommendation, and she said “I don’t care.”  She doesn’t care?  How can that be?  How can she say that in front of me knowing damned well that I DO CARE!

Because I do care!

Telling a woman like me that you don’t care is offensive.  I do care.  I care that my baby likely was unnecessarily removed via major abdominal surgery.  I care that the physical and emotional effects of this surgery may not be seen in and by my daughter until later in life.  I have just this year (at age 34) begun to learn about and remedy some of the ill effects of my own cesarean birth.  I also care that my brother’s wife was subject to interventions that lead to cesarean birth.  I really care that she was subjected to a surgery that could have prematurely ended her own life.  Stories of maternal death during or shortly following cesarean surgery are working their way into the mainstream media.

We know that this is not the best way for babies to be born unless it is an emergency situation.  We know that babies who are born via cesarean section risk breathing issues, spinal issues, being accidentally cut, being seperated at birth from his/her mother, needing NICU support, as well as emotional and chemical problems in the future.

Because of what “I don’t care” implies

She said she doesn’t care to my husband and me knowing full well that we do care.  She knows about my work with ICAN.  By saying “I don’t care”, she made me feel like she doesn’t believe in the work I am doing or honor my birth philosophy.  Instead of saying “I don’t care” so bluntly, she could have said something much more tactful.  Try “I’m not sure which path I will take, but given my reproductive health history I will likely do as my doctor recommends and schedule a repeat section.”

My whole being in invested in two very important personal issues: (1) cesarean awareness and advocacy through ICAN; (2) miscarriage – cause, prevention, “treatment”.  By saying “I don’t care”, I am left feeling like she doesn’t care about me.  (Now, I recognize this as a bit extreme.  I know she does care about me, but she didn’t care to think about how this statement would hurt me.  This happened days ago and I still hurt.)

Because of who says it

I’d imagine that you or I are more likely to hear something along these lines from someone we care about – a close friend or family member.  This makes it all the more painful.  If some idiot woman I don’t know or like said this to me, it would roll right off.  But the horrible things our family members and friends say to us are really tough to forgive and forget.  I know that I must forgive and forget, and that’s partially why I am writing this post. 

Because she should care

I recognize that I have no power over another person’s decision to care about health care decisions made for them.  However, does that mean that I back off and let a family member be led to medical decisions that could adversely affect her family?  This is tricky for sure.  I have no desire to badger her and don’t want to negatively impact my relationship with her and my brother, but it is really hard to stay silent when your family chooses to stick its head in the sand.  They’d just rather I stick my head in there with them than have to endure one of my “rants”, as I am sure they see it.

I don’t want to negate anyone’s birth experience.  I don’t want to tell another woman how she should plan childbirth.  However, I believe it is my Calling to advocate, support, and educate women (and their families) with regard to safe and ethical health care decisions specific to prenatal, childbirth, and postnatal care.

What is so offensive about that?  Why should my caring be taken so poorly or treated as trivial?

‘Tis the Season to be Reminded Why My Family Drives Me Nuts . . .
Fa la la la la!