Monday, December 05, 2005
...of babies were born via c/s in 2004, according to the latest NCHS report. Interestingly, the rise in c/s rates does NOT coincide with lower mortality and morbidity rates. So clearly, a higher c-section rate does not mean improved safety for infant and mother. Why is it, then, that the c/s rates in this country are going up and up and up? The World Health organization recommends that a country's c/s rate should be no higher than 15%. We're twice that. It makes me wonder about the state of maternal health care in this country. Sadly, probably about half of all c-sections performed could have been avoided. For women with a previous c/s, vaginal birth after cesarean (VBAC) is a safe option. However, probably due to malpractice lawsuits, the ACOG revised their VBAC recommendations in the late 90's, leading to more and more doctors not offering VBAC anymore. In fact, even hospitals put it in their "rules" that VBAC's are no longer permitted. I just saw an article stating that in OK, the major malpractice insurance carrier is basically prohibiting doctors from attending VBAC's. So much for choices... We're headed back to "once a c-section, always a c-section". Primary c-sections are on the rise, too, reaching more than 20%. Undoubtedly, increasing acceptance of elective medical induction of labor has at least some part in this. Induced first time mothers are at least twice as likely to end up with a c/s than first time moms who went into labor on their own. Yet convenience seems to outweigh the risks of induction more and more. And then there's the case of elective cesarean. Apparently, having major abdominal surgery is becoming more popular than merely pushing a baby out the way it's supposed to come out. Why women would choose this is beyond me. Studies have shown that women who birth vaginally are no more likely to experience incontinence later in life than women who gave birth by cesarean, yet this is one of the arguments used most often for elective c/s. My personal favorite, though, is "I don't want to go through the pain of labor and pushing a baby out." Makes me laugh out loud every time. Do women take into account longer recovery times, and doubtless more pain during recovery? Never mind the risk of chronic scar pain, or pain of adhesions some women develop following a cesarean. Never mind the increased risk of hemorrhaging, or infection. Oh well, I suppose it's really not that bad, since blood is readily available for transfusions, and after all, there are antibiotics to counteract infection. And who cares if you can't even bend down to pick up your baby for a week after giving birth? Who cares that having a c/s increases risks for future pregnancies (namely placenta previa, accreta, or placental abruption)? Are those risks, and they are very real, negligible enough that doctors and women don't mind taking them? Is it all about our convenience now? What about the baby's safety? Does it not matter that babies born via c/s are something like 5 times more likely to end up in the NICU than babies born vaginally? It really just boggles my mind that women are so concerned about eating well, exercising, not drinking and smoking, etc. etc. etc. to ensure a healthy pregnancy, yet when it comes to birth choices, it's all about bring on the drugs and cut me open. And as far as the medical establishment is concerned, whatever happened to "first, do no harm"? Sure, medical technology has advanced to a point where women can give birth numbed from the waist down, and the risks are fairly small. Yes, surgical procedures have improved greatly to make c-sections safer than ever. That does not mean, however, that there are NO risks to having a medicated birth, or even c/s. They may be small, but they still exist. I believe that one of the reasons we are seeing increasing rates of c-sections is that apparently, women and doctors feel increasingly comfortable intervening in the birth process, for any number of reasons. "The second Friday of the month would be the most convenient for me." "Since you're at 38 weeks, let's just induce before the baby gets too big." "You're 40w1d, that means you're past your due date. Your baby is in danger, we better induce." "You've been in labor for more than 12 hours, we should start thinking about a c-section." "You've been pushing for more than 45 minutes, obviously you're not made to birth vaginally. Let's just get the baby out." "You look like you're tired of being pg, let's just schedule an induction." "I've determined your pelvis is too small, let's schedule a c/s." Oh, and the list goes on. What has happened to our trust in our bodies? Trust that our bodies were designed to birth naturally? Yes, there are instances where problems arise. There are certainly good reasons for induction, good reasons for c/s. But really, are our bodies so faulty that almost 1/3 of us should not be able to birth without major abdominal surgery? I don't believe so. Sadly, I believe that politics increasingly limit birth choices. I believe that women are brought up to think of birth of torture. I believe that more and more doctors don't think women care about their birth experience, and sadly they may even be right. "I just want a baby, I really don't care how it gets here." How much women miss out on with this kind of attitude, how many unnecessary surgeries are performed. Doctors are afraid of malpractice suits, so they opt for c/s more and more often to protect themselves. And ultimately, it IS the women suffering. One prime example of a sad story is that of a friend of mine. With her first baby, she scheduled a convenience induction. Was she told that it would greatly increase her risk of ending up with a c/s? No. So she goes in, is eventually labled "failure to progress", the baby's heartrate starts showing signs of distress, c-section. With her second baby, she wanted to try a VBAC. She gets to her due date without going into labor, and her doctor advises her to be induced "so the baby won't get too big". Did he tell her that artificial induction would increase her risk of uterine rupture? No. Of course, her uterus ruptured, requiring an emergency c/s. On to her third baby. Scheduled c/s. The doctors tell her she had better not have any more children, as her uterus is "paper thin" around the scar area. Another pregnancy wouldn't be safe. How devastating for my friend, who was hoping for a large family (6-8 children). Why did it come to this? Because a doctor went along with induction plans when it would have been quite reasonable to wait another week and give the body time to get ready for labor on its own. Because a doctor suggested an induction to a VBAC mom, despite a well-known increased risk of uterine rupture. Why do I care? Because I have children, who one day are going to have children, and I'm truly concerned about the state maternal health care is going to be in by then. Because women are so utterly uninformed about normal birth, and nothing is being done to change that. Is ignorance bliss? I don't think so, and that's why I care.