Wednesday, May 8, 2013

C-Sections Are Killing Women And We Must Speak Up


About one in three women in America deliver their babies via cesarean section.  The cesarean is a lifesaving and a truly beautiful modern invention when used appropriately.  But the c-section is also dangerous, just how dangerous we are only beginning to understand.  A c-section is particularly dangerous to a woman when she has more and more of them.  This phenomena of women having multiple c-sections is growing as resistance to VBAC (vaginal birth after cesarean) grows stronger.

I read this story today out of Utah.  A mother, pregnant with her sixth baby died from complications due to placenta accretia.  She had birthed every one of her babies via cesarean section.  Complications like that are GREATLY increased with each additional cesarean section.

There is certainly a possibility that she needed every single one of those c-sections.  I am going to assume that she did and that she was well aware of the risks that they posed and that her doctors had been honest and kind to her. 

But I can tell you right now that I have talked to women whose doctors assured them (after a quick diagnosis of CPD after a normal amount of pushing) that they could "Have 10 c-sections!" without a problem.  This is disturbing, particularly when we consider that real women with real families are dying because of our cut happy, impatient, fearful of liability culture of birth.  I sincerely believe that some of these women are dying unnecessarily.  

And I'm not crazy.

This news story points out that hospital c-section rates vary an incredible amount- from single digit percentages to around 70%.   This indicates that c-sections aren't done so often because of NEED but rather because of variations in CARE.

This article points out that the World Health Organization claims that cesarean rates over 15% are too high.

This abstract points out that the risk of cesarean birth is more dangerous than vaginal birth by a factor of 2-11.

But I have been a little scared lately to say anything about the truth regarding the risks of various birthing interventions. 

Why?

There has been a rash of political correctness spreading it's venom about the world as of late and it has taken its toll in the natural birth community.  Sometimes the proponents of this talk about how they "support all choices" or blab about how "judgemental" anybody is who dares have an opinion. 

My goodness, I said on my Facebook page the other day that stirrups in labor were dumb and people actually acted like I was an evil person.  Somebody said it was a "valid choice" if mom wants it.  Sorry folks, but if you think that the stirrup used for pushing during labor and delivery was ever designed for your comfort, safety (not to mention your perineum) then you are either blind or ignorant.  The stirrup was designed for ease of use for the physician.  More clearly, it was designed so that while you were laying flat on your back with your legs UP IN THE AIR (you defy gravity!  YAY!) he could easily cut you from stem to stern and pull your baby out with a metal object. (And even if stirrups and birthing on your freaking back was actually five kinds of awesome, I am entitled to believe it is dumb.  I am allowed an opinion in the USofA.)

Yes the stirrup is a valid choice for a birthing woman.  I just don't happen to think that it is a very good one (MOST OF THE TIME).  Did you notice my disclaimer?  You have to put those in or the vultures descend.

And now the c-section is a valid choice.  People get angry if I say I liked natural birth. This makes me "unsupportive" of "choices". 

I can't take it any more.  I am just going to say it.  C-sections are more dangerous.  They are necessary sometimes.  But 1 out of 3 women?  This is mind boggling.  We can take beautiful pictures of c-section birth.  We can talk about it being empowering.  We can talk about it being necessary.  C-section might be all of these things.  But the pretty pictures and the support of "choices" doesn't change the fact that women are dying because of this procedure.

And because c-section is done TOO OFTEN (I firmly believe that this surgery is performed far more than necessary) we can safely assume that women are literally DYING who didn't need to die.

Was that clear? 

Women are dying from surgeries to deliver their babies who didn't have to die.  Women are dying from c-sections they didn't need.  Women are having a lifetime of health issues from surgeries they didn't need.

You can talk about this all day long like it is a rose colored life choice but it is much more than that.

Cesarean is major surgery.  Cesarean is more dangerous than vaginal birth.  Cesareans save lives when they are used appropriately.  And cesareans (at worst) kill people when they are used inappropriately.

This is something that should be shouted from the rooftops.  This is something that every pregnant woman should know before she goes into labor with her first baby. 

I wish we would stop glorifying the "gentle" cesarean.  I wish we would stop acting like all choices are the best choice.  There are lots of choices.  They are probably mostly good some of the time.  But ALL choices aren't the RIGHT choice.  My saying so just means that I am willing to speak the truth. 

When we act like everything is good and nothing is wrong and any birth, anyway, anyhow, is just fine we help perpetuate a system that is killing women. 

I am not OK with that and I never will be. 

Women who care about birth can do better by each other.  We need to start telling the truth- not with hate- but truth nonetheless.  I can love a women who schedules her births and still honestly stand up and say that c-section is more dangerous than vaginal birth.  Because c-section is more dangerous than vaginal birth. 

I am so tired of women dying who didn't have to die. 
I am so tired of being told that all choices are equal and valid. 
I am so very sad that women have bought into this line of bull so that they can feel a little better about themselves.
I am so sad that women have given up rather than fight to change the system.
I am sad that the sometimes necessary c-sections are being used to justify out-of-control c-section rates.

Ladies- we can change this c-section rate.  We could do it OVERNIGHT.

All we would have to do is refuse to birth in hospitals or with doctors who have outrageous c-section rates.  Guess what?  They would change.  They would have to.  They need us to pay their car insurance. 

But change doesn't happen if we are afraid to speak the truth.  C-section rates doesn't get lowered when everybody pretends that c-sections are full of gentleness and pure awesome.  They just don't. 

But honesty.  That changes things.  Honesty even when it is hard or offensive.  That changes things.  That gets people thinking.  That saves lives.

Take back your birth.  Don't let the haters silence you.  Make your voice heard.  Make choices that are hard.  Be honest with yourself and others.  And then be smart enough to love people who choose different.  Respect the opinions of others even when you disagree. 

We can lower the c-section rate.  We can save lives. 

15 comments:

Diana J. said...

Agree completely! (Especially about the political correctness overkill.) Brava!

Elisabeth Epperbarry said...

I totally agree. And I do not want to be discouraging by sharing this story, and I know you and other readers are aware that this problem is very complicated. Anyway. My friend just had her first baby. Her water broke at onset of labor and she went to the hospital soon after. In any case, they started her "on the clock" to deliver within 24 hrs of her water breaking. She labored without medications for 20 hours and made it to 7 cm. However, she was told if in 4 hrs when the doc arrived she wasn't pushing, she would have a c-section. So this Mom consented to pitocin. Nothing was wrong with her or the baby. No signs of distress or infection (in spite of the frequent cervical checks). She just "had" to deliver within that 24 hr window regardless. Well, one thing lead to another. She had an epidural. Then she started to push. But baby was no longer taking labor well. They told her forceps or c-section. Baby came out easily with forceps but blood sugar was all over the place. She was in the NICU for 2 days. This Mom went from a perfectly normal labor, a long labor but not usually long, feeling fine and OK to continue on to being threatened twice with a c-section and having a baby in the NICU 4 hours later. She could have had a perfectly normal birth, but now we will never know. She could have easily ended up with a c-section, for no clear and obvious reason. Anyway, a LOT of policies have to change to lower the rate. These people don't even realize that they are the cause of fetal distress and other real problems that require a c-section. They just think the birth process itself is dangerous and happily save babies from the perils of natural birth every day. It's horrifying. It makes me so angry. I had a HB transfer for breech that was not coming down so I feel OK with my c-section. But every time I hear of a woman with a perfectly good labor getting messed with it makes me upset. Anyway, love the unapologetic post. You are right. And one thing you didn't say that I kept thinking is it's not a choice if you don't actually know the implications of what you are choosing. And they are careful at the hospital to make the choice for you. In my friend's case, the not yet realized risk of infection trumped any risks of medications to Mom, her ability to push, or the baby. It didn't matter that she almost had surgery, or that her baby ended up in the NICU. They have a policy.

Kaity said...

Wow...I'm so glad somebody had the balls to say this. I'm not a Mama yet but I believe you're so right. My sister-in-law has had all 3 of her babies via c-section. The last one, born last month, was ready to come earlier than her scheduled appointment so the doctor put her on a pre-term labor medication to stop her contractions so that she could keep her appointment. THE BABY WAS FULL TERM!!

She accepted it, because she really didn't have another choice. But her doctor's decision infuriated me!

Cam Wollner said...

I totally agree.

I've been horrified when I've had friends (and I've had several) tell me that they want to opt for c-sections for their first, electively. I've had three and oh-my-goodness... never, ever would I recommend it. After the first (up and about pushing for five hours) I was told that my pelvis was too small, but honestly I have no idea if that's actually true. The second I really regret, because I knew I didn't want a c-section and the hospital said they didn't do VBACs and I didn't know enough at that point to know that I could fight them on it. With my third I finally got a trial of labor again, with an awesome supportive OB (and I was super excited when my water broke naturally), but after 36 hours of labor (I was up walking around and doing hypno-babies) they did c-section #3, and found out that the baby, who had been head down when I got to the hospital, had turned and was transverse (what?!?!?!).

After all of this, I am definitely mixed about c-sections. On the one hand I am thankful for them because of my first and third experiences. On the other I absolutely agree with everything you've said and I think they're overdone and I hate the way I've heard people talk about them like they're just a way to schedule birth and avoid labor. Great post! I wish I'd known more with the first two... I do wonder how different all three labors would have been if I'd read the right sources (I read a lot, but nothing that encouraged natural childbirth) when I was pregnant the first time around!

Trbobitch said...

I agree 100% and I feel the exact same way about baby formula. Why are we encouraging it as a "valid choice" and "just as good" when it's far far far inferior to breastmilk? Why would any mother, knowing better, want to give her baby something inferior? She wouldn't, but because we are soooo politically correct, we have these women convinced that formula is just as good if not better.

Sorry, I know it's OT, but I just wanted to share that I feel the exact same way that you do about these things and cheers to you for saying it.

Midnight Agenda said...

I believe this ties into the state of health care in the US. I live in a major city and there are only three hospitals within 20 miles that my insurance will cover. Two have extremely high section rates and the other I have heard horrible stories about the bedside manner of the staff.

While I cannot wait to get pregnant and have my first baby, I am not looking forward to finding a safe place to deliver said baby. Birth Centers wont take me for my weight and Hospitals are designed to be against me for the same reason.

However. That bridge will be crossed when I get to it. First bridge, overcoming infertility.

Meghan said...

Totally Agree... Keep Speaking UP!

Tom and Juli said...

I read the story about the mom dying yesterday, and as my own mother's sixth baby born c-section it story really tugged at my heart strings. Luckily my mom and I both came out of it healthy, and I believe my mom needed her first two c-sections (she did attempt a VBAC with the second and then after that just had scheduled c-sections because it's what they did then).

Thank you for speaking out about this! I completely agree! We need to do something, women deserve honesty. Women deserve doctors who WANT them to have a successful vaginal birth (and I do believe some doctors want their patients to have c-sections even when they aren't needed- I've seen it first hand).

Christine M. said...

I am confused on as to who is glorifying family centered cesareans? As a 2 time HBC mama I have to ask what is meant by that comment? Are you speaking of the stories of "gentle" cesareans that some bloggers have posted? Do you take issue with that? More women need to know that in the event of a cesarean birth they can still have STS in the OR, nurse their babies, have minimal separation and have their birth treated in the same sacred manner as vaginal birth. Cesarean moms need to know that their births can have the same empowerment as a vaginal birth.

Jenn Carney said...

I've had two c-sections - one planned due to breech presentation and the other an emergency due to eclampsia and HELLP syndrome. I think you're right that we need to have frank, honest discussions about the role of c-sections (and other interventions) in maternal deaths and near misses. Part of that is talking about the cases where they are actually warranted - and informing women so that they can recognize and respond if and when they get to that point. If we don't have these conversations before women get to that point - they are left to make these decisions in the heat of the moment when they can't possibly interpret the information the doctors are giving them. I would love to see a discussion about c-sections that looks at the line between necessary and unnecessary.

Elisabeth Epperbarry said...

Mama Birth has posted a LOT to help women have empowering c-sections, Christine M. I can see why you would react that way to this post but you should check out her other posts, too. She posted a beautiful photo of mine c-section in one of her blogs about c-section birth and recognizes that they do happen and are necessary sometimes and Moms who need it deserve patience and love when recovering physically and emotionally if they are having a hard time processing it. You couldn't find a better friend to women who have had c-sections or someone who wants women who have them to experience them as empowering. But as a necessary c-section Mom myself I feel sick for women whe have c-sections and when you hear their stories you wonder if she really needed it at all. earlier I posted about a friend who was doing fine in her labor but was "on the clock" and pressured at 7 cm to take the first step...pit..and almost lead to c-section. It did lead to forceps and a stay in the NICU. She will never know if all that was necessary since pit and epis can interfere with pushing and increase odds of needing a NICU stay. All because she was taking too long in labor, she and baby were doing just fine. Stuff like that is just terrible maternity care, and science does not back it up.

Crystal said...

Sadly, this story hit close to home. My friend is the woman in the story's sister in law, so I heard about it from her first. Very tragic.
2 weeks ago I just finished my training to become a natural birth instructor, and saw her about a week ago. She was asking questions, and asked (genuinely curious, no attitude), "Why would someone WANT a natural birth?" I talked to her about the high maternal/newborn death rate in this country, danger of c-sections, etc...and now this happens. To her sister in law. I wonder if she thinks about that conversation we had. Breaks my heart.

Jennifer Shields said...

I AGREE!. I am so glad you said this. You had the guts to speak the truth. I had two c-sections for FTP (failure to wait!) and then two homebirths! Every time I say this I smile. I'm happy that I can say that instead of I had 4 cesareans or maybe I had three and then the doctor said I couldn't have any more because my uterus was too thin. I'm glad I discovered that home birth was safer for me. Thank you for speaking up.

JuneBlossom3 said...

Thank you for nutting up and not shutting up.

Meg said...

My sister in law is due to have her sixth C-section in about a month and this story has completely terrified her. She is so upset about it and worried that she could die from her sixth C-section. She does not have the complications that this woman had... but none the less it is a sad situation and is one of the big side effects of having many C-sections.

I too am expecting this summer, and planning on having my first natural birth as well as a VBAC. I am a little scared about doing it... but I want to try to avoid another C-section at all cost (which is why I'm on your blog reading good, positive natural birth stories! So thank you!). I find it very interesting that this same sister in law who is terrified to have her sixth C-section is also giving me a lot of flack for even considering a natural birth. C-sections aren't that bad... she says. It's nice to not have to deal with contractions and labor... HUH? I think that because the choice was taken away from her and she has no other option at this point she feels a little threatened by my taking a stand and NOT wanting another unwarranted C-section.

I completely agree that we have to make a stand. I recently also found a new OB at 22 weeks pregnant that is a member of ICAN and very pro VBAC and natural birth, where my other OB had a very high section rate. Yes, doctors are the ones with the degree and this is their job... but we are the client! They work for us! We are the ones that have to live with the side affects and complications from a C-section. And you are right, we are the ones that ultimately cut the pay check for them. So I'm taking baby steps on the way to this birth, and hopefully each one will take me farther away from another C-section. I agree that sometimes they are needed, but not at the rate they are being handed out.

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