Disclaimer: I am NOT anti-cesarean. Cesareans can be helpful or even lifesaving when appropriate. I'm thankful that cesareans are available for those who need them. I'm not trying to judge YOUR cesarean (or anyone else's, for that matter). This post is in response to Dr. Nicholas Fogelson/ The Academic OB/GYN's post today titled "The Myth of the Unnecessary Cesarean."
It would appear that Dr. Fogelson has gotten so wrapped up in the memorable blog name of Jill's popular site, The Unnecesarean, that he has overlooked the bottom line. The term "Unnecesarean" = "unnecessary" + "cesarean," get it? It's just a blog title, that's all! Those who have read extensively about births in general and cesareans in particular are aware that certain cesareans can be very *necessary* by the time they are performed, while some may have been utterly preventable. (If you still think that I'm talking about you, please read the above disclaimer.)
My friend Trebor's first cesarean story is a classic example of a preventable cesarean. She has given me permission to relate what happened. To make a long story short, her OB said that induction at 37 weeks was necessary because of "low amniotic fluid," despite the fact that the best evidence does not support inductions for such a subjective measurement when mother and baby are otherwise healthy. (She didn't know that, at the time.) Her baby's fetal distress during her labor after the induction was a direct result of the preventable induction; it was a predictable side effect of the induction medications and process. At that point, Trebor's cesarean was undoubtedly necessary, however, she now states that it was preventable. It all began with the Cascade of Interventions that was not medically indicated, in her case. Trebor feels that she was pushed into her induction because she was told that it was the only option she had; she now helps educate other women on their birth options and evidence-based care. She and I both hope to help empower women to make *informed* decisions (even if they decide on an elective induction or elective cesarean), so that they won't look back on any situation and say, "I would have chosen something different if I had only known __________."
The World Health Organization has stated, “It should be noted that the proposed upper limit of 15% [cesarean rate] is not a target to be achieved, but rather a threshold not to be exceeded.” From Henci Goer's post on Lamaze Science and Sensibility, "The WHO supports the 15% upper limit precisely because cesarean rates above the 15% ceiling result in higher maternal and perinatal death and morbidity rates." How can we then reconcile America's 32.3% cesarean rate? How can it possibly be argued that a large number of cesareans are not preventable?
Can we please stop arguing over the semantics? TheUnnecesarean.com is a catchier blog name than ThePreventableCesarean.com or InformedDecisionsAndKnowingAllYourOptionsBeforeChoosingACesarean.com. It doesn't mean that Jill--or anyone else who uses the phrase "unnecesarean"--doesn't understand the facts about cesareans or support mothers' rights to birth choices that they feel are best for them.
Sadly, I hear (my) same story over and over again by so many women I speak to about their birth experiences. Most often, I can fill in the blanks..ironic huh?
ReplyDeleteLet me sum up Mr. Doctor's blog in a few words...
ReplyDelete"waah, waah, waaah.....Unnecesarean.com has more blog readers than me....waah, waah, waah"
Thanks for sharing. Here's my reply I left after his article:
ReplyDeleteDr. Fogelson,
I am very happy to see you mention:
"I completely agree about looking at the factors that promote normal birth:
here’s a few:
1) avoiding unindicated inductions
2) control of gestational diabetes
3) delaying hospital admission until the onset of active labor"
In my area in WV, virtually all OB attended hospital birthing women are induced, and are thus in the hospital the entire labor. We also have the 5th highest rate of c-sections in the nation, and are running about a 50% chance of induced women getting c-sections. The only women I know who escape this are the homebirth moms I know, and the VERY rare lady who refuses induction despite enormous pressure from her doctors. These are done for the convenience and scheduling of the doctors, and always occur PRIOR to the due date!
I can not figure out why women in my area do not question the insanely high c-section rate. They happily go in for their scheduled inductions implicitly trusting that the doctor has their best interests at heart. How have humans managed to survive if so many women are incapable of birth?
I am a natural birth advocate, having had one birth center birth, and two homebirths (one unassisted.) I realize emergency care is sometimes needed, and I am very thankful we have such care available. However, treating all births like emergencies, intervening from beginning to end, causes the very problems women think they are being protected from.
If women are left alone to labor and birth as they choose, almost all will birth fine, and free from any complications. The best thing we could do to greatly minimize c-sections and other things like forceps or vacuum delivery and episiotomies, etc., for women who choose hospitals to birth, is to leave them alone! Give them peace, quiet, and privacy, and minimize interruptions. Let them labor as they choose, freely walking or moving as desired. Let them birth in whatever position desired. I've never known any women who actually chose to birth flat on their back, which hinders birthing efforts, as it narrows the pelvis and compresses blood and oxygen to the baby, often resulting in fetal distress. Keep the dreaded continuous electronic fetal machine away, shown to actually CAUSE unneeded c-sections. A doppler every 30 minutes or so should give plenty of reassurance that baby is well. Also, get rid of the timeline which says if a woman doesn't produce a baby in a certain amount of time, she has "failure to progress" and winds up with a c-section or a forced vaginal birth (forceps, etc.) Do not use pitocin to either induce or hasten labor.
The typical hospital scene however, treats women as cattle, herding them in and out as quickly as possible. Induction, pitocin, labor in bed, "failure to progress," c-section. I hear this story of induction to c-section all the time from women I know.
What's needed is a midwifery model of care for most women. Let labor begin and proceed on it's own. Let the woman do what her body innately knows it needs to do. Tragically, this scenario is the opposite of what most women encounter. Therefore, you will continue to have women who feel violated and cheated, and yes even medically raped.
Here's the rest that wouldn't fit:
ReplyDeleteBirth is a very special, sacred experience in a woman's life, which is not at all respected in our current obstetric model of childbirth care. Not only are most women cheated out of a positive birth experience, the aftercare of the newborn is deplorable. Separating the mother and baby after birth tremendously interferes with the natural bonding hormones and breastfeeding. So many women report feelings of detachment towards their infants, which they very often attribute to a labor and birth in which they were at the mercy of doctors and staff, who completely took over their labors and performed unneeded c-sections. Many of these women have found later healing in homebirth, which is infinitely more peaceful than a hospital birth.
I hope you will continue to advocate lowering c-section rates among your colleagues, and also seek to advocate for a far less interfering approach to childbirth, which will result in far fewer c-sections. Thank you.
ooh! prevent-a-cerean.com
ReplyDeletedone.