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Tuesday, April 5, 2016

Cesarean Awareness Month: Check your emotions at the door

April is here again, and this year Consumer Reports magazine is doing a series of terrific, thought-provoking graphics on the rising cesarean rate. Aside from this being Cesarean Awareness Month, it's a great time to talk about it since the rate continues to rise, and especially as the nation is attempting to get single-payer healthcare off the ground.

However, this is also a topic that provokes a lot of emotion in people; that's understandable. As someone who has had two cesareans herself, it still makes me bitter to think about decisions I could've made differently, ways I trusted my doctor when I shouldn't have, and just how I could've managed my care better throughout the whole process. When I start going down that road, though, I realize a couple things: none of it matters anymore since I can't change it; my choices have led me on a complicated, sometimes stressful journey to this point; and I can direct my energy into advocating for women and educating people about the subject.

Ultimately we as women have to put those emotions aside when we examine raw data that leads us to one conclusion: the cesarean rate is too damned high. All kidding aside, it continues to put moms and babies at risk, sometimes in ways that are clearly apparent from the onset, and sometimes far into the future. How can we change things? By looking at the data, being open-minded about statistics and what they mean, attempting to understand why it's not necessarily a good thing and what can be done about it. Freaking out and attacking people, or feeling like you've been attacked when you clearly haven't, doesn't really fit into that equation.

Case in point: today on FaceBook CR shared this graphic.

Source: Consumer Reports FaceBook page

Right off the bat, the first comment mentioned something we've all heard before: My child and I would've died had we not had a cesarean, and it doesn't make me any less of a mother. 

A couple things: where in this graphic does it mention that you're less of a mother because you had a cesarean? Where is it even implied?

Either this person has been repeatedly approached or attacked by a-holes who advocate for nothing but vaginal birth (which is possible, but really) or she has some underlying issues regarding the defensiveness of her cesarean (which in and of itself is okay - it's okay to grieve the 'loss' of a vaginal birth that you may have preferred or desired, and no one should tell you to just get over that).

All it is is a statistic. A number that reflects that things have changed since 1970. Nothing more, nothing less. Consumer Reports is not in the business to make people feel bad; they just present the numbers and hopefully make us think, why? What's going on here? 

Instead of showing emotions and having temper tantrums, we need to ask, why is this? What has changed since then? It's not a neat and tidy answer that can be best summed up in a few words, so you as the listener have to be open-minded about what you may hear if someone tries to explain it to you. 

Aside from ongoing dialogue on a basic level such as this - with the understanding and acceptance that even laypeople who are not physicians can quantify and understand the risk factors and weigh the risks and benefits - there needs to be a continued dialogue between doctor and patient. Informed consent in making these choices is often a huge problem, and if patients have not done their research they have no information to compare it to. Just saying "I would've died" is not enough, in the sense that you may not be aware that your doctor has a high induction/cesarean rate, prefers all his patients to labor with epidurals, does not support VBAC and turns around and writes "cesarean done by maternal request" in your medical chart that you will never see, even though you very much did not want that c-section but did what your doctor thought was best. 

That is not to say that all doctors are unethical slobs who just want to speed the process along, but no one can deny that it is a problem. Overmanagement of care and excessive treatment can expose both mothers and babies to increased risk, and without access to information through campaigns such as these, you may never know the difference. No one should be sharing information with the intent to shame someone, but neither is putting those shocking numbers out there calling anyone's motherhood capabilities into question. 

Secondly, challenging someone on the ideology of "my child and I could've died had I not had a cesarean" is bound to open up a can of worms. No one should be made to feel like they have to explain or justify what happened, and sometimes yes, that cesarean was very much warranted and mom very much was in control of the situation. 

Sometimes, however, when they do explain, it's clear there was more at play and the reasons behind it were likely caused by the physician himself, a phenomenom that is not unique to obstetrics. This is an important crossroad that we need to consider, especially as we attempt to move towards universal healthcare. It reveals the motivations of some physicians and should call into question our relative difficulty in questioning their authority. Therein lies the problem: in order to understand the rising rates, we must go back a step and understand the primary reasons they happen in the first place. We need to be our own advocates, do our homework and ask questions. Instead of getting mad, we need to stop feeling blamed and look at this data objectively, asking ourselves, Why is this happening? What has changed? 

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