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Friday, November 4, 2011

I am the 32 percent - but should anyone care?

Photo credit: Kirsten Ferree. 
The current cesarean rate in the US is hovering over 32 percent - and in my household, right now the rate is 66 percent - but as one doctor asked, Should anyone care?

Obviously a lot of people think you should care, for a number of reasons. Interestingly enough, several very good, informative articles have been done in mainstream publications about the rising cesarean rate, including Huffington Post, Time and others. (And perhaps rather ironically, I 'overheard' a conversation in the comments section on The SOB blog about how HufPo has become 'woo' in discussing childbirth matters, something that is probably far from the truth. And since when is telling people about the reality of high c-section rates 'woo?' Speaking of The SOB, her readers nearly swallowed their tongues when she wrote a post about the rising cesarean rate correlating with inductions. I guess they, too, don't want to believe the truth.)

When a doctor implies that he doesn't care about a particular aspect of his patient's care - especially something so serious as major surgery - it scares me. It makes me think of women who are pregnant with their first child, who may be relatively new to (or completely unaware of) the idea of "modern obstetrics" and many of the double standards and fear-mongering that many women are exposed to. Surely they've been to a doctor before, but something changes once you are expecting: as if the life inside of you means you have no individual rights of your own. If they come into it with little information or knowledge, like many of us have gained only through our own good or sometimes horrible experiences, it can be especially tricky. I hate to instill fear into the minds of people who are going through what should be a wonderful journey, not a fight; but how can I not tell someone, "You should be afraid of having a cesarean. And here's why."
"At a recent Las Vegas conference on obstetrical safety, some 125 members of the audience were asked to raise their hand to indicate their personal C-section rate. “Less than 15 percent?” the speaker asked. Two hands in the large auditorium went up. “Fifteen to 30 percent?” Half the hands were up. “More than 30 percent?” The rest. Then the speaker asked the room, “How many of you care?” No one raised a hand, and the room broke out in laughter."
"I watched mine with my
second, asked them to
keep the curtain down and
they said no...I watched it
through the light...and
listened to them talk about
me like I wasn't there. That
is why I think they want the
curtain - so they can pretend
like I don't exist." - Jade,
who had two cesareans
Since not everyone is into the Occupy Wall Street movement, I figured I would create a meme, of sorts, that some of us could identify with, if on another level. While the majority of people expressed how much they liked the image (if "like" is really the word), some were offended. One commented that it seemed to reduce us to percentages - and that's true. I agree, in that it does women reduce to 'just a number' to those doctors who are "dispensing" cesareans with a casual attitude. When you consider that a roomful of doctors laughs at the idea of caring about a 32 percent cesarean rate, where does that put us? Do they really care about your birth plan, or your wishes in labor? Do they really care that you don't want to be cut, or that, even more, you might not really need to be cut - that they hold the ultimate knowledge and power over you that says, 'I am going to do this, whether you like it or not'? Or that you trust them implicitly to not put you at additional risk unless it's truly necessary?

I'd like to think that what those physicians should have done was look to the two doctors who raised their hands and ask, "What are you doing differently?" The answers might be interesting, if only they'd listen.

When a room full of physicians laughs out loud about the high cesarean rate, it does reduce us to numbers, in probably the most callous way possible. It reduces us to a slab of meat on the table, a science experiment, a non-entity who provides entertainment, a conversation piece, a way to make a living, and possibly not much else. It certainly doesn't elevate us to mother of a child or human being. 

Related Posts:
The Myth of The Emergency Cesarean
My response to Free Advice Legal Forums: Childbirth Issues
Spreading the word on 'cut-happy' doctors


Bronwen B said...

Heh. I think I'm something like the 25% - by which I mean, about 25% of births were by C-section the year I was born, and that includes my own birth.

I don't know why I was born by C-section. My mom gets visibly uncomfortable and upset when I try to ask. I used to think there must be some dark secret that she was ashamed to tell me (but what could possibly be that bad? The only thing I can think of is herpes, but even that, I think she could have skirted the issue by saying "I had an infection"). I've recently started to wonder if she just doesn't want to talk a traumatic experience where she was treated disrespectfully and cruelly. Someday I'll ask her again.

Stephanie said...

I've experienced a beautiful cesarean birth where I was absolutely treated like a mother delivering her baby into the world. My music was playing, the curtain was down so that my husband and I could witness as our son emerged into the world, my baby and I were not separated after birth at all. He was born healthy, pink and perfect with apgar scores of 9 and 9, nursed immediately and vigorously and our bond was instantaneous. You SHOULD be telling women not to fear cesarean births, but to own them. Make a birth plan just as you would for a vaginal delivery. It is, afterall, the birth of your child. I didn't want a cesarean birth, I did Bradley Method and labored for 20 hours unmedicated hoping to birth naturally, but plans changed when they told me that it was what I needed to do to get my son out safely. I had hoped to VBAC with my next two, but it just didn't happen. And that is ok. I've experienced a vaginal birth and it wasn't all that peaceful because my daughter was not born alive. I'll take a surgical birth over a stillbirth any day.

Carly Marie said...

Amen Stephanie x

Crystal said...

Stephanie... my thoughts exactly!

I wish that I had been more prepared for a c-section. I think along with "natural" birth preparation... parents should be educated on c-section options. They should be encouraged to make a back-up birth plan, in the event a "natural" birth isn't possible. My c-section was an emergency that saved my son's life. It happened so fast they didn't even have time to wait for my epidural to fully kick in. With my second child, I was induced and labored, unmedicated for 12 hours before delivering my son, who had already passed (which was the reason for induction). Trust me, my c-section was far less traumatic than my "natural" birth.

The Deranged Housewife said...

I think that goes without saying. My condolences to those who have lost a child.

That said, I have also written posts (did I include them in the links at the bottom? I can't remember) about how to have a cesarean your way - which is a good way to 'own' that cesarean birth. Unfortunately I do not believe it's a very widespread option, and reflects the unbending attitudes towards policies and procedures that don't really take into account the wishes or feelings of the patient. If you're heading in for an emergency cesarean, sure - there's no time for music and all that stuff. But if it's planned, why should you specifically have to ASK for immediate skin to skin contact and nursing? With all three births, two cesareans and one VBAC, I was never offered - just because that's not the way it's done. I'm not saying no cesarean is ever unnecessary, or that they can't be definitely life-saving for all parties involved, but at the current rate of 32 percent, surely they are not all emergent.

Enjoy Birth said...

That is so sad and very telling that none of the OBs cared about the cesarean rate. We really are just numbers to them. I am one of the 32%. Some OBs see me as broken, others still see me as a woman who has the right to make choices regarding my births.

Indeed women should be educated on how to have a positive cesarean. I know it can be! But care providers should also value us as women and respect our bodies and our choices in all ways.