1.20.2010

The Unnecesarean - A Growing Trend in Mainstream America

The trending topic of the day in my world has been c-sections. I want to preface by saying that I do not hold anyone's birth against them. I don't think women who have c-sections are bad people and I don't think I am better than anyone. Whenever I bring up a controversial topic such as cesarean deliveries I get a whole bunch of women who are either offended or arguing that women have the right to choose their own birth and I should not give people shit for choosing to electively have a cesarean.
First of all, why would anyone choose to have a c-section? Medical reasons aside here folks. I have heard everything from they want it over and done with, they want a date and time, they don't want their vag to get messed up, and scared (scared of a vaginal delivery but not major abdominal surgery?).  I just don't get it. I never want to have a c-section. Ever. It's my greatest fear and I just can't wrap my finger around why women choose it.
In 1965 the cesarean rate was 4.5%. The WHO (World Health Organization) recommends no higher than a 10-15% cesarean rate. So, what is America's current c-section rate? A whopping 31%. That's 1 in 3 women will deliver their baby surgically. Despite the WHO recommendations and pressure on doctors to lower their rate, the numbers are still climbing. The amount of unnecessary c-sections is astronomical, yet preventing them is simple.
It upsets me to see or hear women talking about c-sections like they are no big deal, when in reality they are a huge deal! The doctors are doing a terrible job of informing their patients, and people are doing a terrible job of seeking out all the risks and benefits before agreeing to a major surgery. Not one person is to blame, society as a whole needs to step up. I can do my part to try to raise awareness and normalize the birth process, and hopefully I can make an impact on at least one woman.

The following is taken from Childbirth Connection:

"Reasons for the Rising Cesarean Section Rate

The following interconnected factors appear to be pushing the cesarean rate upward.

Low priority of enhancing women's own abilities to give birth
Care that supports physiologic labor, such as providing continuous support during labor through a doula or other companion and using hands-to-belly movements to turn a breech (buttocks- or feet-first) baby to a head-first position, reduces the likelihood of a cesarean section. The decision to switch to cesarean is often made when caregivers could use watchful waiting, positioning and movement, comfort measures, oral nourishment and other approaches to facilitating labor progress. The cesarean section rate could be greatly lowered through such care.

Side effects of common labor interventions
Current research suggests that some labor interventions make a c-section more likely. For example, labor induction among first-time mothers when the cervix is not soft and ready to open appears to increase the likelihood of cesarean birth. Continuous electronic fetal monitoring has been associated with greater likelihood of a cesarean. Having an epidural early in labor or without a high-dose boost of synthetic oxytocin ("Pitocin") seems to increase the likelihood of a c-section.

Refusal to offer the informed choice of vaginal birth
Many health professionals and/or hospitals are unwilling to offer the informed choice of vaginal birth to women in certain circumstances.
The Listening to Mothers survey found that many women with a previous cesarean would have liked the option of a vaginal birth after cesarean (VBAC) but did not have it because health professionals and/or hospitals were unwilling (Declercq et al. 2006a). Nine out of ten women with a previous cesarean section are having repeat cesareans in the current environment. Similarly, few women with a fetus in a breech position have the option to plan a vaginal birth.

Casual attitudes about surgery and cesarean sections in particular
Our society is more tolerant than ever of surgical procedures, even when not medically needed. This is reflected in the comfort level that many health professionals, insurance plans, hospital administrators and women themselves have with cesarean trends.

Limited awareness of harms that are more likely with cesarean section
Cesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. Short-term harms for mothers include increased risk of infection, surgical injury, blood clots, emergency hysterectomy, intense and longer-lasting pain, going back into the hospital and poor overall functioning. Babies born by cesarean section are more likely to have surgical cuts, breathing problems, difficulty getting breastfeeding going, and asthma in childhood and beyond. Perhaps due to the common surgical side effect of "adhesion" formation, cesarean mothers are more likely to have ongoing pelvic pain, to experience bowel blockage, to be injured during future surgery, and to have future infertility. Of special concern after cesarean are various serious conditions for mothers and babies that are more likely in future pregnancies, including ectopic pregnancy, placenta previa, placenta accreta, placental abruption, and uterine rupture (Childbirth Connection 2006).

Providers' fears of malpractice claims and lawsuits
Given the way that our legal, liability insurance, and health insurance systems work, caregivers may feel that performing a cesarean reduces their risk of being sued or losing a lawsuit, even when vaginal birth is optimal care.

Incentives to practice in a manner that is efficient for providers
Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat "global fee" method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. A planned cesarean section is an especially efficient way for professionals to organize hospital work, office work and personal life. Average hospital charges are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit.

All of these factors contribute to a current national cesarean section rate of over 30%, despite evidence that a rate of 5% to 10% would be optimal." 


It's time we take control of our bodies and let them do their jobs. Birth is not new, your body was meant to do it!

Here are some great links to check out:

ICAN (International Cesarean Network)
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.

More C-sections, More Problems - Los Angeles Times

National Advocates for Pregnant Women (NAPW) works to secure the human and civil rights, health and welfare of all women, focusing particularly on pregnant and parenting women, and those who are most vulnerable - low income women, women of color, and drug-using women.

CIMS is a coalition of organizations, professionals, advocates and families who share a commitment to Making Mother-Friendly Care A Reality. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.
Mother's job is to dilate --
Baby's job is to rotate!

Nature designs a way for baby to rotate, before or during labor, through the pelvis during childbirth.
Most of the time, labor contractions and vertical birthing positions help the baby rotate. Sometimes, though, the starting position of a baby’s head makes this rotation more difficult. Happily, you can do something about this! Spinning Babies is about helping the baby by helping the mom - not by manipulating the baby.

An organization whose mission is to improve maternity care by providing the public, especially childbearing women and their families, with the information necessary to make fully informed decisions relating to how, where, and with whom they will give birth.



Our aim is to provide access to information from a variety of sources; scientific studies, professional guidelines, government reports, successful and safe established VBAC programs, and the midwifery model of care. Our goal is to help women make informed decisions about how they will give birth and to encourage an honest and respectful dialogue with their caregivers. Providing accurate information and resources about VBAC can help childbearing women and their families avoid the risks associated with cesarean section.

Cesarean Risks - American Pregnancy Association

2 comments:

Shell said...

I agree- having had a C-Section (it was my biggest fear as well but we had a medical emergency.) my advice to those who are considering it: DON'T. It's not fun, it's not pretty, and it doesn't matter that you "know" when your baby will be born, especially when afterwards you won't be able to move unassisted for a minimum of three days. It's not worth it. &I WILL be having a VBAC for my next child- even if I have to bring in the consent form from your previous post. :P

Jessica Lyn. said...

Oh mama, I am sorry you had to have a c-section, but you go on the VBAC! And I think every doctor should have to sign that consent form ;)

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