Tuesday, January 29, 2008

Ongoing Cesarean Controversy

Birth experiences are as varied as the women who have the babies. My own experience with Miss Thang was at times the most amazing and spiritual event and, at other times, completely miserable. I'm not even talking about pain (back labor). I labored for 28 hours before a completely unsurprising Cesarean birth (I had gestational diabetes and prepared myself for that possibility, though it didn't happen for the reasons I expected) and I had some pretty poor care (in terms of the way I was treated) except the nurse who helped me with the epidural, she and the anesthesiologist were two of the brightest spots of the whole experience). I had some really rotten nurses who pretty much treated me like a piece of meat - like they worked at Sizzler and I was a crappy steak. Oh, and the surgeon who helped get my baby out had absolutely no bedside manner, though she was an amazing surgeon. I was in the hospital for five days, the lactation consultant actually made everything worse and we were so sleep deprived (ever spent time in a hospital? they don't let you sleep) Mr B ran a red light at a huge intersection on the way home (we were fine, if a little shaken).

I have never regretted having a Cesarean birth. A lot of women feel like they did the whole birth thing wrong if they end up having a Cesarean, but I'm fine with it. Yes, I had gestational diabetes and that made it a possibility, but I've never wasted a moment feeling bad about it.

Why am I babbling so about this? Because 25% of births in the US are Cesarean and there are significant risks to both the mother and fetus/infant in the event of a Cesarean birth. I'm not going to go into the details of that, but it is a disturbing trend. Many people think that it's because American women can't be bothered to be inconvenienced by the messy birth process and prefer to schedule birth like a hair appointment. It turns out, this may not be the case. Nobody is really disputing the 25% figure, the question is whose idea is it? Are women requesting them or does it originate with the doctors? Research is starting to show that women are not requesting them in the rates originally thought. has an interesting collection of articles relating to this topic.

So, that leaves the medical community. According to this essay from the Annals of Family Medicine, one of the reasons for the rise in Cesareans was that doctors became concerned about complications arising from breech births (fetus coming out butt first) and Cesareans appeared to be less risky. More recent follow-up studies indicate that this may not be the case and now we have scores of physicians who are reluctant to deliver breech babies vaginally.

Another group of women who physicians are now reluctant to deliver vaginally are women who have already delivered via Cesarean. There is apparently increased risk of uterine rupture (along the scar) during vaginal birth after Cesarean (VBAC). Newer research suggests that fetuses can cope with such a rupture until an emergency Cesarean can be performed. Unfortunately, most hospitals lack sufficient staff to for this to become the norm. It also may be the case that repeat Cesarean births may be more risk to the mother (infection and hemorrhage) than VBAC.

So, here we are, another women's health issue where our choice is limited because someone else thinks they know what's best for us. Another women's health situation where the doctors' knee-jerk response is to do something that makes their lives easier; to hell with the patients (without whom they wouldn't have a job). I find it really hard to trust the medical community when they're constantly coming back and contradicting themselves. Now, I understand how the research process works and that there's always new information coming in, but what I don't understand is why so many women need to be guinea pigs. That's what all the women in the new research have been - guinea pigs. Does this happen to men with issues of the magnitude of childbirth? I can't really think of anything. The first birth control trials were held in Puerto Rico in the 1950s. The women were not told they were guinea pigs and they were given pills with three times the doses recommended today. This was a conscious decision by the doctors in charge because they wanted to make sure it was a success (success being defined here as women not getting pregnant while they took the pill). Two women died during the trial, apparently healthy women; no autopsy was performed to find out the specific cause of death.

Men get to make decisions about the things that affect them most. When do we get to know what that feel like?