Wednesday, November 2, 2011

Obstetric Lie #86- You Need A C-Section

I wish I didn't have to write this post.
I sincerely wish that every woman that birthed via abdominal surgery needed that surgical birth.

But that is simply not true.

Let me tell you a story.

When I went into labor with my first child I knew that it would be a long labor.  It was the day after my due date and I started leaking fluid.  Contractions started but they were about an hour apart, maybe thirty seconds long and not very strong.

I stayed home and labored.  (I am not recommending you do that, this was my choice and I was comfortable with it.)  I took my temperature often and waited for labor to get harder.  Maybe I could have made it happen faster but I was a little scared of the pain, so I waited and rested and just labored in the comfort of my home.

About 40 hours later my husband was convinced I needed to go to the hospital.  I was past the point of protesting so I went, even though I was convinced that I would continue to labor for much longer.  When we arrived I was eight centimeters dilated.

I got in a tub and quickly went the rest of the way.  I started to feel a little pushy and they dragged me out of the tub (policy) and I started pushing.  I pushed from about twelve AM until about four AM.  Four solid hours of pushing.

And then I birthed my eight pound six ounce baby boy.  He came out of my vagina.  People literally gathered in the room to see this woman who had pushed for that long and had birthed vaginally.  I did have an episiotomy and a second degree tear but he was out.

It was a glorious feeling.  I can not even describe it to you.  If you  have birthed your babies like that then you know what triumph really feels like.  It is the reason crazy women like me stay up late into the night pounding away on silly little keyboards.  It is the reason we have to bite our tongues when we see somebody making choices that will most likely end in a surgical birth.  The glory of triumphant natural birth is something we want all women to be able to experience. 

But few of them get to experience it.

About 30% of women will deliver via cesarean surgery.

When we talk about medically necessary cesarean we enter murky waters.  Why, you might ask?  Well, it is actually kind of easy to decide that a woman "needs" a cesarean for some reason, even if she doesn't.  I found this particular post, written by an obstetrician both deeply disturbing and very informative all at once.

The doctor speaks of a patient coming in who is minimally dilated (to a one) and he proceeds to describe how he augments her labor.  He points out something that is telling:

"The truth is, an obstetrician can persuade almost any patient at any time that a cesarean is the best choice. I could have told this woman that the transient dips in the heart rate concerned me and that I recommended surgery to prevent her baby from being harmed. Few patients, hearing those words, would refuse. If I performed a cesarean, I could eliminate the risk that something would go wrong later. In the mind-set of an obstetrician, this is critical."

Few patients hearing this will refuse.  Did you catch that?  Parents want a healthy baby.  It is more important to them than surgery.  I consented to an episiotomy I didn't want because I wanted that healthy baby.  I chose it over a vacuum extraction because I felt it was safer than the vacuum for my baby, but a cut on me only hurt ME.  Even though I wasn't a mother yet, I loved that baby more than anything else.

Though those who hate natural birth accuse natural birth advocates of choosing the "experience" over the health of the baby, they are dead wrong.  We care about our babies.

Many women who choose home birth do so not because they don't care about their babies- but they realize that the quote from above is brutally honest.  And they do not want to be lied to by somebody in authority and over such a delicate and important subject.  We want healthy babies-  but we also believe that we can most often safely birth our babies without a surgery.

This doctor goes on to describe how the birth of this child, to a mother desiring a natural birth, ends.  Again, this is very telling.

"SOME 20 HOURS after she arrived, my patient’s cervix finally became fully dilated. With the next contraction, she pulled her legs back and pushed as hard as she could. But now the baby’s heart rate, which had concerned us throughout the labor, dipped again with each push. Research suggests that even the most worrisome heart rate pattern rarely predicts injury. Still, I had to make a decision.

In my gut, I believed that my patient’s baby would make it safely to delivery. But I couldn’t predict how long it would take: an hour, two? Forceps or a vacuum wasn’t an option – the baby’s head was still too high up within the pelvis. I’ll admit that it crossed my mind that when my shift ended in two hours, my colleague would be annoyed to take over responsibility for a patient pushing that long and with a less-than-perfect heart rate pattern.

I sat down in a chair beside my patient’s bed. “I’m not worried about your baby right this minute,” I told her. “However, you have a lot of pushing yet to do, and I’m concerned that your baby will not tolerate it. My recommendation is that we do a cesarean now. I think it’s the safest thing.”

Under bright lights, 20 minutes later, we delivered a little girl, who emerged screaming and pink. My patient and her husband were delighted and thanked me for guiding them to a safe delivery. I didn’t spend time second-guessing my decision: Everyone was healthy; the new family was content. None of us mentioned the fact that surgery would now almost certainly be required for the birth of their future children."

Did you hear that ladies?  This obstetrician, trusted to assist this mother in her birth, pretty much admits to doing an unnecessary, "medically necessary" cesarean.  And he admits it will probably result in other surgical births.

And he doesn't care.


How dare anybody lie to a woman about this?  How dare they?  

This is disgusting.  It is an abomination.  Unnecessary surgery that DOES increase risk to mother and baby is an appalling betrayal to what medicine is supposed to be.  It is supposed to save those who need it.  It is supposed to ensure life and health.  It is not meant to be wielded for money or to prevent lawsuits or cover anybodies ass.

Birthing is a sacred time for mother and baby.  We must birth with those and in a place where this is known and respected.  We must birth safely and in health and in trust of those around us.  But we must be able to trust them.

Women deserve to know that they NEEDED a c-section.  They deserve to have a c-section that saved their baby.  They should never have to question the motives of a care provider.  These lies are pushing women out of the hospital and instilling fear.  No blogger does this- the profession does it to themselves.

Why does this make me mad?

I could have been that woman so very easily.  I would have consented to a c-section to save my baby from trauma.  I would have done it in a second.  Any woman would.

Instead I was encouraged to birth my baby under my own power.  Three nights after it had begun and after four hours of pushing, I did just that.  My son is healthy and strong and he changed my life forever.  He probably would have been healthy and strong with a surgical birth too- but we would have missed out on something that we both deserved- the journey of triumphant birth.

I can tell you without a shadow of a doubt that my birth, my entire life, could have very easily been changed in those hours while I birthed my son.  I am so grateful that my life was changed- but not by unnecessary surgery.
 
We must demand care providers who we can trust when they say "You need a cesarean."  Then we must prepare ourselves to birth without surgery.

PS- One difference between me and the woman in that story is that I birthed with a midwife.  Food for thought.  


25 comments:

Liz said...

This makes me so sad. I gave birth via CS 4 weeks ago today. For basically the EXACT reason mentioned in this article...heart rate dropping SLIGHTLY, baby not coming down, 20+ hour labor. :( :( :( I wanted a natural birth SOOOO bad! But the minute that doctor told me it would be best for the baby...there was no doubt in my mind. I was not risking his health...forget about me...forget about the risks to MY health...get that baby here safe! Of course, it was NOT my doctor who was there, it was her colleague. The office I went to had 7 doctors, it's a crap shoot who is on call when you deliver. I want to cry everyday knowing I PROBABLY could have had a natural delivery, had I had the proper support from my caregivers. It literally makes me sick to my stomach. I am SOOOO very happy my baby boy is here, he is happy and healthy and just perfect...but I wish I could have given to him, a drug free environment to be born into. After birth I didn't get to see him for nearly 2 hours. I didn't get that skin-to-skin contact, that 1st breastfeeding session immediatly following birth I had dreamt about. I was stuck in a bed, not aloud to get up for 24 hours. I wasn't aloud to be alone with my baby for 24 hours.

NEXT TIME I WILL DO A VBAC! I WILL BIRTH @ HOME OR BIRTH CENTER WITH A MIDWIFE & DOULA...I WILL GIVE THAT TO MY BABY NEXT TIME!!

Susan said...

Well said. Your view of the article parallels mine perfectly. A part of me appreciated the candor of the person writing it, because it tells women the truth behind the words so many of them have heard during their births. But the icy cold arrogance displayed by the thought process sickened me. The fact that the author apparently had no qualms about admitting to the manipulation that women experience at the hands of care givers with this view of birth shows how skewed their ethical judgement has become. "First, do no harm." doesn't have a caveat about another doctor's shift starting.

Misty Pratt said...

Hey Mama Birth - I think we're both feeling mad after reading that! I just wrote this post yesterday on that exact same article: http://thechickadeetweet.blogspot.com/2011/11/we-care.html
I'm just so pissed - as a doula, I'm supposed to keep my mouth shut and smile like "it's all good." And yet I see this happening, ALL THE TIME. I'm so tired of being quiet, and it's very draining to pretend like this is all ok. Clearly, I support my clients in their decisions, no matter what. But I've realized that it doesn't mean that I have to be quiet outside of my job. My aim is to begin a push for hospitals in our area to become more transparent about their policies and procedures. Because as I wrote, OBs may not care about their c-section rates, but we women DO!!

Linda Peterson said...

To Liz, above: I'm so sorry for what happened. You are so strong.

I am really grateful that my mom is a natural childbirth advocate and that I grew up knowing about the dangers of dishonest OBs. I know too many women personally who were flat.out.lied.to. about needing a c-section. What do you say to these mothers? What do you say to your friends who are still expecting? How on earth do you warn them that an OB might choose the slight convenience of themselves or a colleague over YOU AND YOUR CHILD'S HEALTH AND SAFETY? It is so horribly sad and wrong. I cannot believe that literally thousands of doctors do this every day to women. It is abuse.

Ellen said...

I appreciate your post, and agree with it, but I don't quite understand how pushing from 1 am to 4 am wound up being four hours. :-) Was there a typo?

(I also pushed for four hours with my first birth -- about 8:30 pm to about 12:30 am.)

Mama Birth said...

HA! Yes- typo- started at 12-

Reductio Ad... said...

Hmm, don't think this is cold and calculatingly manipulative. To understand it you need to understand doctors. Most doctors want to do their best, most are frightened of natural birth because they are expected to be responsible for the outcome but can't do anything. This makes them comfortable with medicalising birth not normally because they want to lie to women, in fact that isn't what they are doing. Medicine is about making decisions based on balancing risks and diagnostic skills - birth is tricky because it can go wrong very quickly and without any warning, signs are confusing and there are often several courses of action that need to be chosen between. Doctors are unlikely to consider a long term risk of future surgical birth as a big problem because they consider surgical birth to be safe and are thinking about the right now. Don't be too harsh on doctors, most try their best what is needed is better education, better funding and more communication with patients. Being angry and afraid of doctors won't help.

Rachel @ Lautaret Bohemiet said...

That was really sad.

I appreciate the way you frame things though, how you are able to be kind and diplomatic about such heated topics.

Well done!

Mama Birth said...

I don't think most doctors are cold and calculating- but I do think the system is very broken, and even started out broken. This is tragic- and I have a hard time feeling sorry for the major players in making it happen. Especially when women and babies are suffering. How can I feel bad for the one with the knife? I feel for the woman and baby that were sacrificed in this sad dance we call modern obstetrics.

mealzrox88 said...

so glad I live in New Zealand :-)

Mama Birth, you would LOVE it here and our mums would love you!

every woman in NZ gets access to FREE maternity care with a midwife- and that same lady takes care of your throughout your whole pregnancy (known as a lead maternity carer or LMC.) Unless you choose to go privately, women don't pay for any maternity care, including a c-section if needed, which means the financial reasons for C/S's aren't there as much

The LMC is usually with you the entire birth, even if you are at a hospital, meaning that OBs finishing their shifts and stuff has no effect on the birthing mother. (I had about 5 OB changes during my birth)

yep we still have a lot of C-sections, with the rate at our local hospital in my city being 1 in 3 but for our region it's actually 1 in 4, because so many people have home births and at birth centers.

VBACs are also common and a lot of OBs recommend (yes recommend!!!) them if the reason for the previous C/S was something unlikely to occur again

I have to have a c-section this time around, but the beauty is that I know I am not being lied to for financial reasons, or any other thing less than true medical reason :-) Which makes it all more...well, honest, true, and good for mothers and their babies!

Misty Pratt said...

@Reductio - you're very right. Many doctors are probably wary of natural birth because they hardly ever get to see it. Better training/education would be a first step. And, as the article pointed out, better support in hospital would be the next step, so that doctors wouldn't feel pressured to do a c-section strictly for reasons of time. I think liability is also a HUGE issue. OBs don't want to be sued! I think many of us are saying "we love doctors, we love nurses" BUT when it comes to labour/birth, doctors should be much more removed from our care. Birth is not a medical event, unless in the small percentage of women needing medical intervention. You make good points, and with lots of respect in your voice!

Laura @ our messy messy life. said...

Now if only non-birthy type mamas would read this blog and hear you preaching the word!

Christi said...

This EXACT thing almost happened to me! I labored for 21 hours and when I began pushing and his heart rate dropped. E doctor immediately recommended a c-section. My husband reminded her that when his heart rate had decreased a little earlier that it had immediately increased again once I turned onto my right side. He asked if she thought we were safe to try this for a few minutes before opting for the c-section. She said yes, I turned onto my right side and his heart rate increased almost immediately. She gave me about 30 mins to rest before restarting pushing. When I started pusng again I remained on my right side and he immediately began to crown. They called the OB and told her to come quickly but it was too late - my baby boy had arrived 1 minute before she walked into the room. He was healthy and everything was great. I am SO grateful to my husband for his suggestion that spared me a cesarean.

Bridgette said...

I have never had a child but I am pregnant now. Immediately after making my first appointments with OB/GYN's they concerned me. I didn't like that they couldn't answer my questions. I didn't like that my questions were met with intolerance. It made me start researching. During my researching I have been terrified at the things I have found. Not just with c-sections but with Doctors and Hospital births in general. I can legitimately say at this day it has made me rethink EVERYTHING that I felt in the past about doctors and for birth I would rather a totally unqualified person deliver my baby then to set FOOT into a hospital. That is how terrified I am of the hospital.

I am very fortunate that I have found two wonderful midwives who will be helping me birth at home. In the event we reach a "TRUE" problem we have a plan to transfer to the hospital. I would suggest that EVERY woman get themselves a midwife ... do not set foot in that hospital unless necessary. Maybe I don't have a PHD but I'm telling you that you risk your babies health by going to the hospital.

This comes with a person who has never said a bad word about hospitals before. I have always had 100% confidence in our medical professionals. Where birth is concerned though they learn things through routine and they do not know WHY they do the things they do. This makes them dangerous to you and your babies well being.

Bridgette said...
This comment has been removed by the author.
Jen said...

This post does make me sad that so many doctors push for a C-Section for multiple reasons, not for actual emergency.

Unfortunatly, I had to have a C-Section because my little girl was breeched. It was something that I didn't want and that me and my husband prayed about for her to turn, but she didn't. I did have talks about this with my doctor and she kept checking every appointment (they found out at 36 weeks), but there was no room for her to turn. Luckily, we both came out healthy and fine.

I will be trying for a VBAC the next time around. Hopefully everything will work out.

Crystal said...

I can understand where a lot of you ladies are coming from. But I have had 3 c-sec's and am very proud of them. I do not feel that I was manipulated/forced into having them either. My first one sounds very similar to what was said. I labored for 17+ hours, pushed for 4 straight hours in EVERY single position possible to try and get my baby boy out! At first it seemed he was on his way, everyone could see the top of his head coming down and kept commenting on how much hair he had. But no matter what position I was in I couldn't get him past my pubic bone. With every push I made his heart rate would drop drastically. So for the safety of myself and my child I was rushed into surgery. I absolutely loved my doctors and the care that they gave me. Not ALL doctors are out to do harm. They are not harming a woman or a child by doing c-sec's. I ended up having 2 more c-sec's after my first and I will forever be grateful for the scar left behind b/c I have 3 very healthy children. My scar is so thin and light now that it's almost not visible. Please don't make having a c-sec a bad thing. You're still bringing a baby into this world that you will love unconditionally.

Misty Pratt said...

Crystal, regardless of whether you enjoyed your c-sections or not (and I know lots of other women who liked theirs as well!), there are most certainly OBs out there who push for c-sections over vaginal birth for the wrong reasons. It sounds like the reasoning for your 1st c-section was totally sound, and I've also witnessed babies get "stuck" despite trying everything. However, there are many other women getting railroaded into an unnecessary surgery (there's a whole blog dedicated to this - Unnecesarean!) I think there are both necessary and unnecessary cesareans happening, and it's the unnecessary ones that need to stop. And it's the unethical OBs who concern me, and they need some checks placed on them.

Crystal said...

Misty,
My question then is: how do we know that it was truly "unnecessary"? What would a doctor have to gain out of doing a "surgery" over a "natural" birth? Why would they opt for a riskier procedure if it wasn't necessary? We can listen to what other woman have experienced and look back on our experiences and think that things should have turned out differently. But each woman and birth is different, we can have what seems to be the same kind of complications but with every woman comes a different outcome. I am not saying that I'm siding with the doctors whom you think are abusing the procedure, but we have to be realistic here and take everything on a "case by case" basis, as the doctors do. I agree that every woman should be completely informed about her options and even have 2nd opinions if they hear something they don't like.

Misty Pratt said...

Doctors gain a lot from doing c-sections. They get paid more, and they avoid potential liability. Plus, they get to use their surgical skills, which is what they went to school for. Many OBs find normal, vaginal births boring, because they feel like they didn't "do" anything. I think it's probably up to the individual herself to determine whether her c-section was unnecessary. If she is upset or traumatized by her c-section, does some research, and realizes that things could have been different, I think THAT is an unnecessary cesarean. And I agree, it is a case-by-case kind of thing.

Anonymous said...

Thank-you for this article! I found myself in a position with my first son where the doctor told me on my VERY FIRST VISIT(!!!!) I would need a c-section. Because my husband is 6 foot 6. I thought this was a horrible reason, and so I was wary, and told him I wasn't having a c-section unless there was an absolute emergency. He smiled and said ok. Then as we got closer to my due date (within 8 weeks or so) I asked when he needed a birth plan submitted. He said " You can make one if you want". What I realized was that he was planning on doing a c-section regardless. With only 7 weeks left before my EDD I found another doctor. I planned on using a midwife, but I had GD and heart palpitations, and the midwife suggested the OB that helps with some of her patients. I am SOO happy that I did! I walked into the office of my new doctor and told him exactly why I was uncomfortable with the other OB and what I expected. He told me there was no reason to think I would need a c-section, and I delivered my son with no trouble at all. Thank-you for helping to bring awareness to this topic! I now have a friend who is a midwife and when I have another baby (will be #3) I plan on using the midwife she works with.

jenna said...

After reading your post... It made me sad as well . Although I agree with your post and your view of Having a natural child birth, I also felt a bit like moms who have a csection birth were down played in te fact that you called natural birth a triumph birth! Let me just say I have had both births a natural and a c section birth... My c section birth was due to my son was transverse and was unable to be moved ... I also lost consciousness and stopped breathing. I was 40 weeks when I went into labor. That being said yes I understand that a natural birth is in fact "triumph " for all the pushing and the feeling you have when you finally did it your baby is out! Well c section for me was also a triumph! I was in labor I felt the pain and even though I was under anesthesia i felt every pull, tug , pressure and just let me tell you it was work and it hurt! And when the dr said ok here is his head I felt it and when they pulled him through with his shoulders passing I felt it maybe not the same ripping pain but I felt the same pressure feeling and I literally felt like all my insides were being pulled out! Sorry so graphic) so after the dr finally pulled him out I did have the same feeling and relief a d "triumph" as with my natural birth" . My reason for posting was to just give a view that has come from both parts of births and te feelings of each and how similar MINE were. But as for dr saying its "medically necessary " for csection to cover their ass makes me sick and it does take away the beauty of what our bodies are designed to do... Give birth naturally.

Anonymous said...

I see your point - i would always choose a healthy vaginal delivery over a c-section. However as a mother of a stillborn baby girl, the goal is and should always be to deliver a healthy baby. To me, if a future surgery or two is necessary in order to be totally sure this goal is met, I am pleased to comply. Until you endure the pain of stillbirth (of which MANY OBs have witnessed), it would be wise to keep such harsh criticisms of the medical community to yourself. I do not believe my doctors were worried about being sued in the moment they told me my baby girl no longer had a heartbeat. They cried along with us. Doctors are not evil. Do you want to look new parents in the face and tell them the worst possible thing a parent can hear? Your baby is dead.
Any woman who has endured such a horrendous trauma would find your post to be naive, arrogant, and judgmental.

Anonymous said...

I am a proud mommy to 2 c section babies...
the first was an emergency due to my 40 hours with my water broke multiple organ failure massive infections and a dipping baby heart. Unlike this article I knew in my heart I was dying and they weren't doing their job to save me or my baby... after my 4th c section and 9th doctor switch I begged my original ob to kill me and save my baby.
Baby 2 was a scheduled c section with no added complications and I was up and moving less than 6 hours later...
now that I am pregnant with #3 I researched midwives and vbacs and I have come to terms that this is my bodies last chance to do what it needs to do but I have not found a provider even willing to try so ive faced facts that ill never experience a mothers triumph...

Miss Esspi ♡ said...

This is exactly why I do not believe in hospitals or doctors when it comes to labor and delivery. It honestly seems like they try to convince you to get a c-section mostly because they do not want to wait around for you to naturally give birth. Like the obstetrician you quoted above, he simply did not want the woman still in labor when he had to clock out of his shift. And he did not want to leave the "burden" of her labor onto someone else. THAT'S SICKENING.

They just want another healthy baby born under their belt or something. It's awful. It's even worse with young mothers, they love pressuring them to get c-sections and scare them with the babies heart rate or something of that nature. It's sickening. I had my first daughter in a birthing center with a midwife and doula, and I will be doing the same for the baby I'm carrying now. If I so happen to need a c-section, I know they would suggest it because it would save my life or the babies life, not because the clock was ticking and they had somewhere else to be.

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