Is the rising c-section rate in this country going ignored?

The current c-section rate in this country is hovering at about 33 percent. I don't expect everyone to know the exact percentages, but it would be nice if some people for whom this might pertain would at least know and understand, simply, that it's definitely on the rise.

I had a conversation yesterday with two friends, one of whom has had two vaginal deliveries - both induced - and the other, two sections due to breech presentation. One woman has a sister currently five months pregnant with her first child, and she's scared to death of having a c-section. "Well, the current c-section rate in the US is at about 33 percent," I said, stating that her fears were completely founded. Both women looked at me in complete shock and had no idea that that many sections were being performed.

How can you not know? Based just on the experiences of our common friends, it's so obvious it's like a slap in the face. When several of us were each expecting our second child, our friends held a baby shower. I recall thinking during that shower that all four of us had had c-sections, and three out of the four of us were on either our second or third section. I was the only one who had a successful VBAC. (One woman, a nurse, had attempted one with her second but was unsuccessful due to fever during labor. At least she considered it as an option, though!) Another of us - one who was also on her second section - mentioned to me that her doctor actually admitted once, somewhat tearfully, that she "loves surgery." Well, I wanted to say to her, no shit she loves surgery. This woman is on the American College of Gynecology Liability Committee, so VBACs are definitely a no-go in her book!

I live in a unique community. My husband is a teacher, and we're required to live on campus with other couples and families, many of whom are near my age and have small children. So in a sense, we are all 'victims' of the modern obstetrical system and all have similar stories. Of those women who are older - say, those who are over 50 - their birth stories are dramatically different, and reflect the days in which doctors had knowledge and experience at avoiding a cesarean. Breech vaginal births, twin vaginal deliveries - none of them, that I know of, had c-sections, and know even less about the current trend in surgical deliveries because they are far-removed from their childbearing years.

All these women my age, then, reflect different levels of income, education and backgrounds. Most of us have different obstetricians and some of us have labored in different hospitals. And even though I obviously haven't talked to every pregnant woman in the US, we reflect that trend of an increase in c-sections. How can that not be troubling, or even obvious?

When I think of the people I know who have had children in the last 15 years or so, I am one of three women who've had a VBAC. I know of only two women who have dared to have a successful home birth. And yet, I know 17, including myself , who've had c-sections, all but one of them repeat, and from what I can tell, only one was truly a matter of life or death (the mother had advanced HELLP Syndrome). That figure could actually be substantially higher, but I haven't discussed birth with all of them, so it's hard to say.

It seems that obstetricians aren't held very accountable for the increasing rate of sections they are performing. Yes, there are a number of reasons for them - some of them even legitimate - but it makes you wonder about the not-so-good reasons for them, and why OB's are still getting away with it. The World Health Organization recommends that the rate not be above 15 percent, and our rate is more than double that - and yet no one is waging a mass offensive to change this. That's not to discount the groups, individuals, bloggers and organizations who make it their life's passion to educate people about this - but, even with their efforts, there are still large circles of women who either think people like Ina May Gaskin and Henci Goer are "fruity," or don't even know who they are. ("Ricki Lake? She had that talk show, right? What's she got to do with this?" *sigh*)

Essentially, the increasing rate of cesareans is going unnoticed by the people it should matter most to: those who think VBACs are extremely dangerous and yet don't bat an eyelash at having their second, third or fourth c-section. Those whose doctors still get away with inducing for convenience because their baby had the grave misfortune of being due near a holiday weekend. Those first-time mothers, past their due date by 48 hours, who are sectioned after the Pitocin drip failed to work because their cervix wasn't ripe yet and only were allowed to labor for a measly eight hours. And now with the revelation that some health care providers are refusing women who elect for a repeat section - no doubt at the dire advice of their doctors - it appears clear that, no matter which choice women make, they are being punished, instead of the people who are really to blame. When a fear-mongering doctor builds his practice around half-truths and misinformation in order to protect his bottom line instead of yours, it's not a wonder.

Birth Day

Well, it's been over three weeks since my last post. Little did I know that the very night I last posted, I would go into labor and have such a crazy, yet wonderful, experience that would test my human strength and intuition. I was putting my faith into action, while God worked behind the scenes on my behalf!

Several hours after I blogged that Tuesday night, we ate dinner - something told me not to eat too much. I went to bed but couldn't sleep because of random, painless but uncomfortable Braxton Hicks contractions and some back ache. I think I slept for probably an hour, because I do remember having strange dreams. By the time I got up and walked around for the millionth time, the pain suddenly went up a notch - and then I lost my mucus plug. Because we didn't know what position the baby was in, we headed to the hospital about half an hour after labor started in earnest. 

We arrived at the hospital around half an hour later and headed for L & D. As I was signing the insurance papers, my water broke in a tremendous gush everywhere. For a split second I panicked, like the fact that I had made such a mess was my fault, or that now it was really gonna hurt. They wheeled me into a room and I got undressed and took a shower, which helped a bit. As I was coming out, the nurse took one look at my belly and told me she didn't think the baby was in the right position. 

While we were waiting for the ultrasound machine, they checked me - I was already 10 cm dilated! I was blown away. Here was the test to see how far I could get without pain meds and what my body could really do. I'm sure after doing the internal exam the resident could tell the baby was not in position, because it wasn't without a bit of urgency in his voice that he announced I was completely dilated. Then they wheeled the ultrasound machine in and confirmed what we had all suspected - the baby was footling breech. For some odd reason, like my last labor, I had no desire to push - which was a good thing in this case. And as soon as they told me the baby was breech, I knew it was a boy - neither of my sons could find the right way out! 

I was a bit let down, but knew in my heart of hearts - I was disappointed but remained calm while they proceeded to stick me nearly half dozen times to insert an IV line. Meanwhile, my husband was beside me nearly turning green at the prospect of another c-section. One resident shakily said he didn't know how to perform a footling breech delivery, and I almost laughed. While the nurse asked me if I wanted to attempt a vaginal delivery, I said no - I know that OB's just aren't as knowledgeable or equipped to handle such a birth anymore since they almost always do an automatic c-section. In fact, the only such people truly capable of performing such a feat are midwives. Since there wasn't one of those around for quite a ways, I decided not to take my chances and signed the release form. 

When Baby A arrived, we found his cord wrapped around at least twice - which is a testament to me, at least, that the Lord had a reason for him being in the position he was in. Perhaps the frozen Brussels sprouts encouraged him to turn in the wrong direction, we'll never know; but whatever the reason, it must have been a good one. I thought back to my months' old 'premonition' that this baby would be a boy born via c-section and kind of laughed to myself - perhaps that still, small voice was preparing me early on and I just wasn't listening? My ultimate prayer of a safe, healthy delivery was answered, and also one for a healthy child. I kind of like to think the Lord compromised with me on this one. 

"So, when's this baby going to come?"

That's what I heard at my last OB appointment yesterday. I joked, "Well, I've put in my request." "When are we going to do this c-section?" he asked, not at all joking. Now that's just not something you say to a woman hoping to VBAC and expect her to take it lightly or think it's even remotely funny. 

At nearly the 40-week mark we've had some interesting, if not startling, revelations. After my OB appointment I spent more than three hours in the hospital for observation of high blood pressure and moderate ankle swelling, only to find out the baby was transverse. Not exactly what I wanted to hear, and it definitely puts a monkey wrench in the works. 

But the good news: I'm still pregnant. Barely. 

After an animated discussion on the phone with one of my doctors in the hospital, I nearly had to beg and plead with her just to let me remain pregnant until this baby chose it's day, malpositioned or not. Her insincerity and total lack of hesitation to pressure me into an immediate c-section was surreal, considering I had the same complications with even higher BPs and swelling in my last pregnancy and was definitely not admitted for observation. I basically told her this, and was in no way going to let her scare me into making an immediate decision. I wanted to go home and rest, think about it, and do some research. 

I feel lucky, considering the millions of women who seem to get duped into taking their obstetrician's word that it's a definite emergency and worthy of panic. I've also heard women say how their reluctance or outright refusal to follow their doctor's orders can result in being treated harshly or ignored, which is inexcusable. I wanted to ask my male doctor why it's only in obstetrics patients get treated this way - as if their bodies are not their own and they are at the mercy of some stranger to make decisions for them, or are completely incapable of making those educated decisions themselves. I wanted to ask, "If you went for a prostate exam, do you think the doctor would say, 'There's a chance you could get prostate cancer. Let's just remove the prostate, and while we're at it, cut off your genitals, too.'" No way would they say that, and no man would tolerate it. Neither should women!

I'm not blaming my doctors for this baby's position, but I can't help but feel ripped off slightly in the whole process. I'm trusting in God to take care of this baby and allow it to turn if it's His will. But in the meantime, it's hard to get over the anger of being made to feel inferior, like you're an idiot, and can't make your own decisions. The lack of support is overwhelming and does nothing but tear down your confidence and spirit - which is unfortunate, considering I have done this before. One nurse at the hospital told me "Good for you!" when she'd heard I had already had a VBAC, and I told her, "You don't normally hear that when you tell someone you've had one." You find yourself clinging to that one word of encouragement in a world full cynicism, apprehension, fear and indifference: as my labor doula put it, "They don't care what happens to you after the baby is born, especially if you have to come to taking care of three children after a c-section." As I told Dr. Congeniality on the phone, 'if this baby turns, I don't want to have had to go through all that for no reason.' 

My only prayer is that women everywhere else don't have to, either. You can't expect your doctors to fully educate you on the risks and benefits and be your advocate by suggesting, "Hey, why don't you do a VBAC?," or "Let's do what we can to avoid a cesarean." Only you can do that, and you owe it to yourself to keep your rights and stop giving them away to someone who only wants you in and out in order to move on to the next unsuspecting patient.