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? 

More reading: 

Studies find pregnant women with prior cesarean choose the delivery method preferred by their doctor - VBAC Facts

I didn't realize the pressure to have a c-section until I was about to deliver - The Washington Post 

Mom sues doctor over c-section fight: 'I was treated like a child' - Yahoo News

Top ten signs your doctor is planning to perform an unnecessary cesarean on you - Frisco Women's Health

A loving (form) letter from my OB

After a few days' vacation I returned to find a couple of craptastic things in the mail. Besides the summons for jury duty, I also received a nice, warm robotic form letter from one of the OB's in my practice.

As I looked at the return address on the envelope my stomach sort of went sour. I immediately thought it was a bill. Upon opening it, I realized it was nothing like that - but rather a plea for me to follow her in her new venture as she branched out into a private practice of her own.

Considering my feelings for her, I read her letter with amusement. Equal parts fake concern mixed with complete arrogance, I immediately began crafting a response in my head before I even got to the "I look forward to seeing you again" that mocked me at the bottom of the page.

She writes:

I would like to thank you for the trust you have given me as your OB/GYN physician during the last three years. Your health and wellness have always been and will continue to be my top priority.

Unfortunately, your convenience is obviously top priority, too. As is your "just forget your quaint little plan to have a VBAC and let's just get this birth over with" mentality.

A little back story: when I gave birth to my youngest, I was in the throes of late-pregnancy hypertension. I never had any protein in my urine or other symptoms except for elevated blood pressure, and her attitude certainly wasn't helping, that was for sure. I was trying for a VBAC, and of course it seemed towards the end I got the heavy rotation of not-so-supportive care givers in the last weeks and days of my pregnancy. I called her "Dr. Congeniality" because of her perfectly coifed hair, trendiest clothes and slim figure - did this woman have kids? - she swept in and out of the room like a human Barbie doll and barely spent more than the allotted 4 1/2 minutes with me. At one point, she said I was measuring small, and I'm not even sure how she could tell because she barely took any time to whip that tape measure out. (In hindsight I'm sure that was a ploy to get me to consent to a cesarean and skip the VBAC, but the ultrasound tech confirmed my suspicion that the baby was perfectly fine.)

With less than ten days from my due date, my blood pressure was still a concern and now the baby had flipped into a transverse position. The head OB in the practice decided to admit me for observation for several hours, so I sat in a hospital bed being grilled by various residents, including Dr. Congeniality herself, who was on-call. Before I left for the hospital, I stole glances at the on-call schedule at the clerk's desk at my OB (as if I somehow felt I was not entitled to know that basic information of who would be available to deliver my baby) and found out that Dr. Congeniality would be on-call on my due date (as if that mattered). I memorized the schedule and silently prayed, Do not go into labor on Wednesday...do not go into labor on Wednesday...

Since I was just there for observation, no one except my mother knew I was there (and of course my husband was with me the entire time). The phone kept ringing in the room, and in my confusion, I didn't answer it - after all, I didn't consider myself a real patient. Who the heck knew I was there? And crap, where was the phone? I felt like I had to twist myself like a pretzel, somehow maneuvering around all the monitors and my huge belly, to even find it, and by the time I decided I should probably answer it and find out who the heck it was and what they wanted, it stopped ringing.

It must have rung twice, I can't even remember, and still we didn't answer it. In my mind, I was still trying to come up with a plan of action, and really didn't want to be there or talk to anyone anyway. So I ignored it. It rang a third time. This time I picked it up.

"Do I have to come down there?" a voice demanded. My brain turned as I tried to put pieces of the puzzle together and figure out just who the (!@&% this was, talking to me like I was a six-year-old child. I immediately went on the defensive.

Of course it was my "doctor," who felt that "oh, it's too bad you wanted a VBAC, but now I think you should just have the cesarean." As if she really cared for my plans - but I thought, I have to stand up for myself. I cannot just let this chick walk all over me and I have to be the advocate I'm always encouraging others to be. I told her I felt the doctors in the practice were being alarmist (after all, I had been through this before with my second pregnancy and there was nowhere near the fervor and intensity over it) and told her I wanted to give my baby time to turn on its own. "I am not having this cesarean for no reason," I said, which she did not like. She sighed audibly and said, "Well, okay then. 'First, do no harm,'" as she flippantly cited the Hippocratic oath. Yeah, as if, I thought.

Soon after a nurse (a wonderful one, I might add!) came into the room and said how she too had fielded a call from the OB, who didn't even identify herself. Wonderful Marilyn firmly said (before she knew who it was on the other end of the line) that she wouldn't put Dr. Congeniality through to me because I had been through a lot today, and was upset and confused about what to do next. Apparently Dr. C was furious, but Wonderful Marilyn stood her ground, bless her heart.

Five days later I had gone into labor on my own but the baby was now breech. Thankfully even though I had gone into labor on a Wednesday, the head OB was still on-call from the night before, and he did the cesarean. Whew. 

Of course, she did come in to examine (rather, what felt like punch me in the guts) my uterus, and made a snide remark about the baby's position and not wanting "feet coming out of my vagina." As if to scold me for my rash decision to avoid a cesarean sooner. I wanted to take down that Pitocin drip (you know, the one I didn't need because I was successfully breastfeeding) and strangle her with the tubing. I forget what I said, but I wish I could have come up with something in my typical smart ass fashion if it were not for the Percocet-induced haze.

...I have exciting news: I'm starting my own private medical practice, a comprehensive women-centered practice, where the patient comes first.

Unless she wants an atypical birth, right? You know, the ones that don't involve being coerced into induction or made to feel stupid for her decisions. And if she doesn't follow your advice, you'll just berate her and treat her like a child, I presume? Yeah, that sounds very "women-centered."

I will be offering a variety of hours to accommodate your busy schedules...

Yeah, we all know what a laugh this is. And that we'd probably be sitting there for at least an hour to be seen for a five-minute appointment, just like with your former employer.

As you transfer your care to my new practice ... 

Ha! This one made me laugh. How about, 'As I transfer my care far, far away from you and your former colleagues, whom the very thought of makes me want to vomit uncontrollably and reminds me of how completely crappy my last birth was'? It also struck me how forward this sounded, and I wondered if she left the old place on good terms. But then again, being this presumptive is right up her alley, I have found.

My highly qualified and dedicated team is committed to providing you with the outstanding care and service you deserve..

Oh yeah? How about supporting more mothers who want to have VBACs or normal, natural births?

Compassionate care has always been my focus, and along with my knowledgeable staff and state of the art technology, I will provide you with the most up-to-date medical treatments available. 

Except if you are delivering vaginally, in which case I'll likely tell you, based on outdated information, that you can't eat or drink while laboring; that you must lie down at all times to be examined and hooked up to monitors, and you won't be allowed to get out of bed for any reason. You'll also be subjected to monitoring that has been proven to raise the cesarean rate and failed to detect the very condition in babies that it's designed to prevent. You will also need repeated vaginal exams - even though you are GBS+ - although your body could just as easily tell you when you're hitting transition and it's time to push. And by the way, when it is time to push, we'll tell you how and when - even though in the average woman the urge to push is like an unstoppable freight train. And if you don't have the urge to push, we'll tell you to, anyway. And if you show up with a breech-presenting baby (which you seem to like to do), we'll insist on an instant cesarean, even though recent, up-to-date studies suggest otherwise.

Yes, that all sounds very compassionate and "women-centered." Never mind that even with all our "superior" state-of-the-art technology and care, we still have abysmally high rates of neonatal and maternal death.

I look forward to (never seeing) you again.

 I hope all your patients up and decide to hire a midwife.

Another cesarean? This time, I'm doing it my way

It's been almost ten days since my youngest turned two. On his birthday, I thought back to where I was - and how much of my birth story I still find triumphant, some parts completely dissatisfying and frustrating. From the time he was probably less than twelve hours old, the seed was already planted in my mind: I wanted another baby.

But was it for a do-over? Was it for the right reasons?

I still think what I thunk before: I want another baby. And I must resign myself, if I ever get to that point, that I might have to have another cesarean.

The moments leading up to and following my son's birth still leave me frustrated with myself and completely hollow inside: I felt no joy when I first saw him. I only realized later that an adverse reaction to the anti-nausea meds they had given me prior were what made me feel like I was having a panic attack, a feeling of intense anxiety and a weight pushing down on my chest. The only thing I could do was thrash my head back and forth, since I was numb from the chest down. No one noticed; I asked my husband later if he remembers me doing that, and he said no.

I resigned myself to the idea that if I had another cesarean, I would want it done my way. More attention paid to me as the mother, rather than standing over me having a conversation that didn't even pertain to me. Somehow making me feel like more of a participant, instead of just lying there like a dead fish. Perhaps asking me if I wanted to see my baby being born, or at least be able to hold him immediately following the surgery. Keep him in the room with me as they're cleaning him up, where I can see him, instead of in another room where I can only hear and just imagine what is going on. And the ability to hold him skin-to-skin, and nurse as soon as possible, with no immediate separation for newborn testing.

It's sad that you even have to ask for such things to happen, rather instead putting up with things like having your baby immediately whisked away because it's a matter of course, rather than something really being wrong. I've heard many expressions of "You've waited this long to see your baby, you can wait another couple of hours." The immediate hours after my first cesarean were such a blur that I don't even remember where my son was most of the time, and their idea of separating us so "I could rest" is the biggest bunch of bullshit I've ever heard. A half-attentive nurse was popping in and out over the course of several hours to check my beeping IV, which she had inserted improperly, causing that very important post-surgery pain medication to actually leach into my tissues, instead of into my veins. Nurses didn't believe me or even take notice when I said it hurt just as badly to inject myself with pain meds, and actually told me I couldn't have any more because I'd already gone past my ten-dose-per-hour limit. Not, "Are you still in that much pain?" or "Let's see if there's something wrong."

Ironically my VBAC in the same hospital three years later was a totally different experience. I had no epidural, so was able to walk around and move freely, and felt great. My labor was pretty short upon arriving at the hospital, and I was in a post-partum room with a matter of hours. The nurse brought me my food (they told me after the first baby that I was responsible for getting my own, after just having had major abdominal surgery). I was puzzled, but am still curious why I got better treatment after a vaginal birth than I did a cesarean. I decided before my third was born that I would never give birth in that hospital again.

Not that long ago, a friend shared her link with me on "Gentle Cesareans." Curious, I realized it was basically a "Cesarean, My Way" plan, that involves the mother more in the birth process and makes it feel more like a normal birth. (I hesitate to call this "natural," because, after all, if surgical birth were truly natural we'd all be born with zippers on our abdomens in addition to a perfectly working vagina, in my opinion.)

Like this article, I ask many of the same questions: Why do our arms need to be strapped down? Why are we so shielded from ourselves, and why aren't we asked - which I never was - whether we wanted to watch our baby being born?

Taking my history into account, if I should become pregnant again I'll have to consider my options carefully: I've had two cesareans, a history of late-onset PIH, and two prior breech presentations. I know that decision might come sooner rather than later, if the baby is breech - either I find a care provider who will deliver me anyway, or I consent to another cesarean, this time on my own terms:

I want to see my child being born.

I want my child to be cleaned, weighed and measured where I can see. (My first wasn't even in the room with me while this was happening.)

I want the baby to be handed to me immediately, and as much skin-to-contact as soon as possible.

I want the baby to be with me, or nearby, if I can't hold him, at all times.

British obstetrician Nick Fisk "pioneered" this "groundbreaking approach to surgical delivery," in an age where many doctors are clinically-minded and all about speedy deliveries. In a case of distress, that is obviously of the utmost importance - but in a scheduled delivery? And why do you have to ask specifically for this type of delivery - why isn't it done, whenever possible, to give the mom the very best birth experience possible? (And perhaps by acknowledging the "gentle cesarean" are they essentially saying that there is more to the birth experience than just a healthy baby?)

As Fisk started to examine the conventions of surgical delivery, he was struck by how easily they could be challenged. Why, for example, did they need to be done so quickly, when slowing them down would give the parents more chance to participate in their child's delivery and might give the baby a gentler experience of coming into the world? Why, too, was it so important for the parents to be screened off from the mother's abdomen? And was it really essential for the baby to be whisked off for an immediate medical examination, rather than delivered into the arms of his mother?

What I want to know is, what took them so long?

Some upset over ACOG's "April Fool's" Press Release on Elective Cesarean

In a recent April Fool's prank, someone, somewhere, issued a fake press release supposedly from ACOG that touted the headline, "ACOG announces plan to stop elective c-sections." Collective eyebrows, including mine, raised in a "What the (!&%(?" moment, before realizing the truth. (The smiley face in the ACOG logo was a dead giveaway.)

Some, including this blogger, thought it was in very poor taste. Perhaps, if it had really come from ACOG. Otherwise, I don't see a whole lot wrong with it.

(This author also said she tried looking for it, but couldn't find it on line and figured ACOG was taking measures to "remove" the falsified document from web pages everywhere. If you do a Google search, you'll still find a lot of hits - and ACOG would essentially have to ask web masters - including those from natural-birth supporting sites like mothering.com, to remove the offending link. Which I seriously doubt they would agree to do.)

At any rate, I agree with the author, who sums the elective cesarean debate up nicely: if you want to have one, and are truly informed of the risks and possible benefits of doing so, you should be supported in your decision. However, the same is not true, sadly, for those women do no not want a cesarean, or who decide to have a natural or normal birth.

In the comments section, it didn't take long before women were quick to be offended: "I had two cesareans and loved them! They were wonderful!" Thankfully, someone further down told this mom, "You are missing the point."

We can argue that these women need to be totally informed of their decision - but I grow suspect when I wonder where, exactly, they are getting their information from. The same OB who, in my last post, told his patient a cesarean was "100 percent safe?" To some, that's their idea of informed consent. To the rest of us, it's a complete joke, and a very misleading, potentially dangerous one at that.

I'd like to see this right to choose extended more to women who seek a VBAC, or perhaps those who refuse a cesarean and end up having an extremely healthy, normal birth and baby - yet some entity in the hospital decides to have children's services investigate. If you have the right to an abortion, as one doctor suggests, you should have the right to choose a cesarean - but what about the right to not choose one?

It's clear to me that when it comes to the birthing choices of women, ACOG doesn't really give a crap. Because they aren't willing to actually make sure that physicians are adhering to their guidelines, it tells me they are all about the doctors, instead of what's best for the patient. Sure, they want to extend even women who have had two prior cesareans the "right" to have a VBAC, but what physician is going to back them up on that? I find many physicians like to get all preachy about what ACOG suggests and doesn't suggest - when it comes to something they mutually agree on, like the safety of home births. ACOG has definitely spoken up about that, and many doctors are in agreement. But what about the stuff they don't agree on? Is ACOG going to investigate a doctor who is unaffectionately known as "Dr. Cut and Slice" by many of his staff? When a moniker like that is given to a doctor, I feel so sorry for the patient, who is usually the last to know.

More reading:
Is ACOG pulling an April Fool's Day prank?
ACOG Announces Plan to Stop Elective C-Sections
The "C" in ACOG stands for "Castrated" 

The "100 percent safe" cesarean

Yesterday this lovely little gem came across my FaceBook news feed:

“Really, I don’t like any risk at all. If it were up to me, we’d just go with the 100% safe cesarean section.” – OB to parents during a VBAC discussion.

Really... I bet!

And unfortunately, sometimes this is the closest women get to being "informed" about their options when it comes to childbirth.

I've been lambasted on at least one blog (not even gonna go there) for questioning what OB's say and suggesting that their white coats and medical degree make them sound more "right" and authoritative. I don't believe I've ever intentionally painted all doctors as bad, because I know they aren't. But I think there are a lot of people out there who think like this guy (woman?) - and simply don't want to deal with you because to them, you wear the words "potential lawsuit" on your sleeve. You are essentially perceived as a more difficult patient to deal with since you have a scarred uterus.

No cesarean is "100 percent safe." I'm not sure that anything in this entire world even is, honestly. There are clear risks to surgery - both short- and long-term - that it seems few physicians are open and honest about. If you plan on having more children, multiple cesareans can pose complications in future pregnancies and make it even harder for you to have a vaginal birth.

It seems ridiculous to think of future pregnancies and babies when you haven't even had your first yet, but remember: cesareans are forever.

Medical quackery in "modern" obstetrics

As a jumping off point from my last post (which would have been hideously long had I combined the two), I was left wondering how questionable medical practices and "quackery" could possibly relate to obstetrics. Obviously it wasn't all that hard.

No one's denying that a lot of advancements have been made in modern medicine, including obstetrics - mostly with monitoring devices, like ultrasound, fetal monitoring and the like. Mostly they have likely increased the survival rate of sickly, premature babies and those with major medical conditions that would have claimed their lives even a few decades ago. The surgery they can do before birth for spina bifida, for instance, is nothing short of mind-boggling, and technology that definitely benefits - if you need it.

But consider for a moment that the majority of the pregnant population is not at that great of risk. It often reminds me of the phrase, "Innocent until proven guilty." In the case of modern obstetrics, it's often the way around. As Marsden Wagner has often said, in modern obstetrics physicians often see pregnancy and birth not as a normal process, but as a disaster waiting to happen.

As a result, everyone is treated the same - with more technology and drugs, some of which is either providing dubious efficacy at best, or may create more harm than good. Some questionable obstetrical quackery might include:

• Ultrasounds. Many question their safety, ultimately, and claim they generate excess heat and sound, which is transmitted directly to the unborn child. At any rate, even those who say they are safe agree that using it too much is probably not a good idea. While used diagnostically, like in the case of an unborn baby with spina bifida, they can detect conditions that can now be treated before birth so as to greatly improve outcomes. (For the record, the Spina Bifida Assocation says that it occurs roughly in 7 out of every 10,000 births.)

I often hear about women who get numerous ultrasounds, sometimes almost at every appointment. Some are given transvaginal ultrasounds for dating purposes in early pregnancy, even though they already know their last menstrual period and even their date of conception (which really isn't that hard for some of us, contrary to popular belief). In all of my pregnancies, I probably have had no fewer than three each time, some of which for legitimate reasons (unexplained vaginal bleeding) and to "re-check" for clubfoot (not life-threatening the least).

• Pushing in the lithotomy position, or flat on your back. Really it depends on the situation, as there are very few times when this position is beneficial. For the rest of those times, it makes it harder to birth your baby, and is convenient only for the physician, so he can get a head-on view of the baby crowning.

Somewhere I've read that culturally, women did not give birth flat on their backs until male practitioners took over the in field; before they often gave birth on birthing stools with female midwives. It actually creates a more narrow pelvic opening, which can often translate into a stalled vaginal delivery and a cesarean. For decades, if not centuries, this is the most typical mode of birth, which is likely what has negatively shaped many people's ideas about birth to this day.

• Episiotomies for everyone! Although not quite as popular as they used to be, they are still routinely performed even without much need. Which makes me wonder just how many doctors no longer routinely perform this procedure, if I'm still hearing about women getting them all the time?

It appears that the biggest benefit from them is that it speeds delivery, and God knows that mostly-impatient OB's are all about that. Because an extra half an hour or so to wait for the baby to come down on its own is just too much to ask.

• Continuous electronic fetal monitoring. While it seemed like a good idea at the time, fetal monitoring has become the standard of care in hospitals when determining if your baby is in distress or not. Too bad it more often than not falsely identifies babies in distress when they really aren't, which often leads to cesareans for no reason. Conversely, while it was originally invented to detect cases of cerebral palsy, it can't seem to accurately predict that, either. ("The false positive rate of EFM for predicting cerebral palsy is greater than 99 percent.") Yet it's used, continuously, on a majority of laboring women.

Not only does the strip alone falsely predict when a baby is truly in distress, but you are essentially confined to bed because of the monitor, which is another risk factor for cesarean. Interestingly enough, if true distress is suspected, they can break your water and insert a fetal monitor on the baby's head, which can also lead to cesarean (once the water is broken).

• Repeated vaginal exams will tell you something important. I referenced this in another post. If your doctor tells you that he really needs to do one to determine your "progress" or lack thereof, you might want to reconsider. At the very least, ask him or her point blank "What is this exam going to tell me? Why is it needed?" One woman I heard from asked her doctor this and he sheepishly replied that it basically told him "nothing."

• Being deprived of food and fluids in labor. Although some hospitals are doing away with this policy, not all are jumping on the bandwagon. Based on an archaic study done in the 1940s, it was determined that if you ate anything in labor, it could cause you to aspirate the stomach contents should you need general anesthesia. Sadly, as a result, women are also being deprived of much-needed calories and energy that they could use to endure long labors.

• A crazy high induction rate. Compare, if you will, the medically-indicated induction for a high-risk mother to chemo for the cancer patient: yes, the cancer patient would likely benefit from chemo and radiation, and it should be carried out posthaste. Likewise, if you truly need to be induced for a good reason, which does not include "baby too big," "fluid too low," or "I need a vacation and you're sick of being pregnant." In those circumstances, inducing without clear medical need is like using that radioactive toothpaste I mentioned in my last post - it might not sound harmful at first, but could potentially create serious risks and complications down the road (like longer, harder, more difficult labor or a cesarean).

• A crazy high cesarean rate. For pretty much the same reasons above - no one is arguing that sometimes, cesarean really is the best option. However, how many women that make up that 32 percent c-section rate are led to believe there is no other choice? Or that VBAC is too dangerous for them? What percentage truly electively choose cesarean for no reason? When you hear about things like "Patient choice" when it comes to c-sections, you really need to look individually at the women who are "choosing" these procedures and why: "because my doctor said so" (end of story), "Because my doctor told me my uterus could shatter!" and "My baby was getting too big, so we decided to deliver by cesarean," or "I was told it was dangerous to go past 40 weeks, so we decided to induce and it ended in cesarean." Until you ask women themselves what their prenatal care was like leading up to the c-section (like, did they include "My doctor brought up inductions at every office visit from 32 weeks on," words like "patient choice" don't mean very much.

• Discouraging natural, normal birth. Again, many people treat birth like an accident waiting to happen, instead of "normal until proven otherwise." You may find that in spite of all our "risk factors," things can and often do go well, if only allowed to. Boxing women into a category that defines them as "risky" is less like acknowledging that something could happen because of these factors, and more saying, "It will happen." Unless you see a crystal ball on your doctor's desk, (or there is some clearly defined, proven medical condition going on) tread lightly.

Many doctors scoff at natural birth because they either haven't attended one, or think that because 90 percent of all their other laboring patients are medicated to the gills that you should be, too. They also dismiss it because they either don't realize or don't want you to realize that often times, the midwifery model of care can mean less intervention and fewer cesareans.

While technology can be a life-saving thing, it becomes more of a risk when used incorrectly or too often. It's for this reason, that even with all the modern drugs and technology that we have, that the US continues to have an alarmingly high rate of neonatal deaths for an industrialized nation.

More reading:
Obstetrical Myths - Henci Goer