Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Don’t Let This Happen To You #22: Gina & Tony’s “Elective” Primary Cesarean Section, PART 1 June 8, 2009

Continuation of the “Injustice in Maternity Care” Series

 

Throughout my time as a labor and delivery nurse at a large urban hospital in the Northeast, I have mentally tallied up a list of patients and circumstances that make me go “WHAT!?!  Are you SERIOUS!?  Oh come ON!”  Because of this I was inspired to start the “Injustice in Maternity Care” blog series, or more appropriately the “Don’t Let This Happen to You” series.  If you are pregnant or planning on becoming pregnant, this series is dedicated to you!  If haven’t already read it, I invite you to check out the first addition to the countdown: DLTHTY #25: Sarah & John’s Unnecessary Induction.

 

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Sometimes I feel like I am starting to sound like a broken record….  Why?  Because I am about to start this post the same way I started my last “DLTHTY” post.  But with a national cesarean section rate of approximately 32% and a c-section rate rapidly approaching 35% at my place of employment, I feel like I cannot write about our country’s cesarean crisis enough! 

 

You might be thinking to yourself, “Why is it the case that when I or a loved one enters the hospital in the United States to have a baby we have a 1 in 3 chance of ending up with major abdominal surgery?  One thing I hear often, both from health care professionals and lay persons is that women are the cause of our country’s embarrassing cesarean section rate; that women are requesting and demanding cesarean sections as just another way to have a “designer birth.”  I hear this all the time.

 

For example, the other day I was at a birthday party and I was conversing with the grandfather of the birthday boy.  We got to talking about our careers, which were quite different being that I am a labor & delivery nurse and he is a computer engineer.  Long story short he remembered an article that he had read in TIME magazine in the beginning of the year, and from his description I have concluded it was probably Using C-Section Scars to Predict Future Deliveries by Kathleen Doheny.  He said he was surprised and concerned to read that the c-section rate in the U.S. was approximately one third of all births!  I echoed his concern but stated that a big part of it is related to the way we practice obstetrics in this country, mainly defensive medicine and control obstetrics.  “Yah! I know!” he said as if we were on the same wavelength, “It’s because of all those 40+ women who chose career over family for all those years that have now decided to use fertility treatments to get pregnant.  And then they go and demand a cesarean section so they can complete their quest for a ‘designer birth’ and ‘designer baby.’  It’s ludicrous!!”  With all due respect I had to disagree with him and it turned out that in doing so I inadvertently ended the conversation.  I guess it’s not politically correct to call someone out at a birthday party, no matter now nice you do it!

 

But is this really true?  Does the research support the hypothesis that women are driving the cesarean rate up?   

 

The answer is a big fat N – O, NO!  In the DVD Special Features section of the amazing 2008 documentary Orgasmic Birth, Dr. Eugene R. Declercq, PhD, a professor of Maternal and Child Health at the Boston University School of Public Health, is featured in a 20 minute clip entitled “Birth By The Numbers” where he presents the sobering statistics of birth in the United States today and shares the most recent data available from the National Center for Health Statistics as well as Listening to Mothers II, the largest survey of women’s experiences during pregnancy, childbirth, and the postpartum period.  Dr. Declercq shares that one quarter of the survey participants, who had undergone either a primary (first time) or repeat (second or more) cesarean section reported that they had experienced pressure from a health professional to have a cesarean section (more on that below). 

 

The following is a list of other mind-blowing statistics and research results that I learned from watching “Birth By The Numbers.”  I have posted about this video clip before and I am posting about it again because it is that important to watch it!  If you have any questions about any of these bulleted points, please watch the video for yourself first, look at all the graphs and tables presented (since I could not directly post the images here), and then feel free to comment!

 

Lets Talk About Stats

 

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    • In 2005 there were 4,138,349 births in the United States therefore even a 1% change in any statistic impacts approximately 40,000 births a year!
    • In 2005 there were 1,248,815 cesarean surgeries performed on women in the United States.
    • Cesarean surgery is a valuable and potentially life saving operation but is an overused intervention in the U.S.
    • In low income/developing countries, an increase in the cesarean section rate is related to a lower neonatal mortality rate, since access to this life saving operation can address the tragic situations that occur because of a lack of resources.
    • In middle income countries, regardless of the cesarean section rate, the neonatal mortality rate is not affected either positively or negatively.
    • In high income countries, like the United States, there is a slightly positive relationship between the cesarean and neonatal mortality rates.  That is, the higher the cesarean section rate, the higher the neonatal mortality rate which means that there comes a point in time where more and more cesarean sections are not helping and are even hurting our mothers and babies!

 

 

Cesarean Sections for Low Risk Moms Just Don’t Add Up!

 

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    • To get a cesarean rate of over 30% (which the U.S. currently has), you have to be doing cesarean sections on low risk mothers!
    • When you perform a cesarean section (which carries many risks for both mothers and babies) on a mother because either the mother or the baby has a true medical indication that requires surgery to assure the safety and wellbeing of all, then and only then do the benefits of the surgery outweigh the risks.
    • When you perform a cesarean section on a low risk mother and there are NO true, unavoidable, or untreatable medical indications for the surgery, then the mother and baby carry all the risk of the surgery without any of the benefits to her or her baby.  (Side note:  I like to think of this point in this way.  If you are on the 3rd floor of a burning building and not jumping would certainly result in serious physical harm, disfigurement, or even death, then the risks of staying in the building outweigh the risks of jumping out the window and hence, even though you might acquire some serious injuries in doing so, jumping out the window is the best option for you.  On the other hand, picture yourself on the third floor of that same building but this time there is no fire.  Do you think it’s a good idea to jump out that window?  I didn’t think so.)

 

 

What Is NOT To Blame For Our Cesarean Rate?

 

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    • It is NOT the case that the rising U.S. cesarean rate is because of U.S. women requesting cesarean surgery (a.k.a “Maternal Request” cesarean section).
    • It is NOT the case that the rising U.S. cesarean rate is because of age related factors (i.e. more very young or older moms are having more and more cesarean sections and therefore throwing off the rate.)  In fact from 1996 to 2006, the rates of cesarean section jumped the same amount (a 50% increase!) in every single age group at the same rate. 
    • It is NOT the case that the rising U.S. cesarean rate is related to the gestational age (how old the baby is at the time of birth) of babies being born by cesarean.  In fact, from 1996 to 2006, the rates of cesarean section jumped the same amount in every single gestational age group at the same rate. 
    • It is NOT the case that the rising U.S. cesarean rate is caused by upper middle class white women demanding their cesarean by appointment (aka “Maternal Request” cesarean).  In fact from 1996 to 2006, the rates of cesarean section jumped the same amount in every single racial/ethnic group, but not at the same rate.  Cesarean sections rates for black mothers are higher than for any other race/ethnic group. 
    • State by state, strong regional patterns exist regarding cesarean section rates.  That is, some areas of the country boast cesarean section rates that are greater than 30%…with some regions higher than 50%!…while others are less than 25%.  While this may be related to local obstetrical culture, it is NOT a reflection of evidenced based medicine being practiced at the same level in every state.  If evidenced-based medicine was being practiced at the same level in every part of the country, different regions of our country would not vary so wildly in their c-section rates!

 

 

Maternal Request Cesarean Section:  Are They To Blame?

 

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    • According to the Listening To Mothers II survey “Maternal Request” cesarean was defined as a cesarean that 1) the mother had made a planned request for before labor began, and 2) was performed for NO medical indications (either mother or baby).
    • The survey found that only 1 respondent out of 1600 survey participants (252 of which had had a cesarean) had planned a primary cesarean for no medical reason.  Research studies from England and Canada confirm very low rates of maternal request cesareans as well.
    • While they do exist and are being carried out in the United States, MATERNAL REQUEST CESAREANS ARE NOT TO BLAME FOR OUR COUNTRY’S SKYROCKETING CESAREAN RATE!!!

 

 

So What IS To Blame For Our Skyrocketing Cesarean Rate?

 

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    • PRACTICE CHANGES, that is, changes in the nature of maternity care in the United States, ARE TO BLAME FOR OUR RISING CESAREAN RATE!
    • The current philosophy of contemporary maternity care in the United States is much like the “One Percent Doctrine.”  That is, when you set up a system that focuses on the 1% of problems that might occur, you undermine the care of the 99% of mothers who don’t need those services and interventions.  

 

 

Mothers Feel Pressure From Health Professionals to Have Cesareans!

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    • In the LTM II survey, 26% of women that had had a primary cesarean section, 25% of women that had had a repeat cesarean section, 35% of women that had had a successful vaginal birth after cesarean (VBAC), and 7% of mothers that had had a vaginal birth reported that they DID feel pressure from a health care professional to have a cesarean section.

 

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“Unfortunately history shows that advances in the practice of medicine and surgery are rarely attained in a thoroughly rational manner, but that a period of undue enthusiasm, or even of almost reckless abuse, usually precedes the establishment of the actual value of a given procedure.  [Cesarean Section] requires only a few minutes of time and a modicum of operative experience: while [vaginal birth] often implies active mental exertion, many hours of patient observation, and frequently very considerable technical dexterity.”

~John Whitridge Williams, MD [1866-1931], early 20th century pioneer of academic obstetrics & author of biggest selling obstetrics textbook ever

 

 

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So let’s talk a bit about what these “Practice Changes” are that are causing our very scary and embarrassingly high cesarean section rate.  The Childbirth Connection is a national not-for-profit organization founded in 1918 whose mission is to improve the quality of maternity care through research, education, advocacy and policy. They promote safe, effective and satisfying evidence-based maternity care and are a voice for the needs and interests of childbearing families.  The Childbirth Connection is the group that developed the “Listening to Mothers” surveys which were conducted by Harris Interactive and carried out in partnership with Lamaze International

 

In their article, “Why Does the National U.S. Cesarean Section Rate Keep Going Up?”, the Childbirth Connection lists SEVEN evidenced based interconnected factors that appear to be pushing the cesarean rate upward.  (Please refer to the original article for explanations of each factor.)

 

#1   Low priority of enhancing women’s own abilities to give birth.

 

#2   Side effects of common labor interventions.

 

#3   Refusal to offer the informed choice of vaginal birth.

 

#4   Casual attitudes about surgery and cesarean sections in particular.

 

#5   Limited awareness of harms that are more likely with cesarean section.

 

#6   Providers’ fears of malpractice claims and lawsuits.

 

#7   Incentives to practice in a manner that is efficient for providers.

 

 

All of these factors contribute to the current national cesarean section rate of over 30%, despite recent studies that reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. According to the WHO and the research that supports its recommendation, the best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%.  High-risk hospitals have the best outcomes with cesarean section rates of less than 15%.  Cesarean rates above 15% seem to do more harm than good.

 

 

Bottom Line:  Our rising cesarean section rate is a BIG problem for our mothers and babies!

 

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Up For Next Time: 

 

* What is the difference between “Primary Elective” cesarean section and “Maternal Request” cesarean section?

 

* Are “elective” cesarean section, that is without medical indication, the same as “maternal choice” cesareans or should they really be called “physician choice” cesareans?

 

* Why were Gina & Tony scheduled for a cesarean section and was it really their choice?

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43 Responses to “Don’t Let This Happen To You #22: Gina & Tony’s “Elective” Primary Cesarean Section, PART 1”

  1. Shotgun Mary Says:

    Very interesting and informative. Even though all of this information is out there its difficult to get the powers that be (read: OBs) to accept the info and then draw the proper conclusions. I especially liked your analogy about jumping out of a window. I think I may use that in the future, with proper credit of course ;)

  2. Kathy Says:

    Yes, I think there needs to be differentiation between the different types of C-sections — for statistical purposes if for no other reason. There is entirely too much gray area as it is. For example, a fellow Bradley Childbirth graduate had a C-section for maternal exhaustion — after 28 hours of labor she was just done. Perhaps if she had had a doula or a more supportive hospital she may have been allowed up and about and might have had a vaginal birth; perhaps not. I’m pretty sure her C-section was labeled either “elective” or “emergency” — or possibly both. Which leads me to my next pet peeve — any C-section that is not planned prior to labor beginning is called “emergency” even when it’s a leisurely C-section done just because the doc is tired of waiting around.

    Then we have women pressured into repeat C-sections, and not allowed to choose VBAC, only to find out that their C-sections are labeled “maternal request”! :-0

    Ok, I’d better stop before I get really irritated. Deep breaths… deep breaths…. :-)

  3. Sarah Says:

    I have been enjoying your blog for a little while now. This is my first time to comment. I remember reading about this video clip on one of your other posts. I watched it then, and it was riviting. I appreciate how you spelled out some of the information. It helped me to picture the numbers better and get what the point was. (Statistics often confuse me!)

    Thank you for putting your well-thought-out and well-backed-up views out here for our education! I think in that same post I referred to above, you called yourself a research nerd. That’s why I like your blog so much. It doesn’t do any good to spout opinions (especially extreme ones!) if you don’t give sources and include solid facts. Real thinkers will not be swayed by emotion-driven opinions. So bring on the nerdiness!

    Also, I thought it was funny that the Miami Herald article kept spelling VBAC “V-back.” Seriously? Is VBAC *that* foreign in Florida?

    Keep up the thought-provoking posts! I can’t get enough!

    • nursingbirth Says:

      Sarah, hahahaha! That’s hilarious! I didnt even pick up on that! Oh brother, we need to send some good karma in Florida’s direction….boy do they need it!

  4. Sara Says:

    Nursing birth,
    Can’t wait for part 2…I am a big fan of your blog. Thank you for your well-written/researched posts.

    I am 39 weeks pregnant and hoping to have a natural VBAC birth–suggested and encouraged by my doctor (in FL). My six-year-old twins were born vaginally and by emergency CS (prolasped cord w/2nd twin). However, this baby is in a breech position, and although I am trying positioning and other home remedies to entice him to turn, I’m afraid I will end up with another CS. I’m being told that a breech VBAC is just not going to happen.

    • nursingbirth Says:

      Sara, thanks for reading! You are one hell of a woman for having to have gone through a vaginal delivery and an emergency c/s and then to go home and recover and take care of TWO babies!! WOW! I applaud you for doing your research and planning for a VBAC. I really really really really hope that your little one turns for you!!! I know how hard it can be (actually next to impossible) to find ANY to attend a vaginal breech birth, nevermind a VBAC breech. It is certainly almost impossible in my neck of the woods. I wish you the best of luck! Have you ever attended a local ICAN meeting?

  5. MomTFH Says:

    Excellent post. Thanks.

  6. Kate Says:

    Very interesting, thank you! It makes me so sad when I hear friends being persuaded to be induced with no medical cause, or encouraged to have a repeat c-section when they could have tried for a VBAC. There is so much work that needs to be done to educate and empower women as well as medical providers.

    Do you have any information on the rate of c-sections being affected by increasing birth weight of babies? In light of IOM modifying their weight gain guidelines for overweight pregnant women, I’m wondering if we’ve seen an increase in birth weights, either due to maternal weight or increasing rates of diabetes.

  7. EG Says:

    So here’s the question: Who gets to decide what counts as “true, unavoidable, or untreatable medical indications for surgery”? And should there be ACOG standards of that? And even if there are ACOG standards for that, the reality is that the doctor still has to make a judgement call on what is best for the patient at that moment. And the patient will still have to decide whether to agree.

    It’s all a matter of risk, right? None of your options are risk-free. And unfortunately, the risks change as the labor goes on, so now we have a tired, possibly drugged, mother trying to re-evaluate risks as they’re presented to her. And I think so many times we pick what seems to be a controllable risk of the c-section vs. the unknown of nature taking its course.

    I think there’s a HUGE gap in “informed consent,” as well. Most women, especially first-time mothers, just say “okay” to whatever the doctor says and they do not truly hear the risks and benefits of various options.

  8. Kathy Says:

    Sara, there are a lot of anecdotal ways to turn a breech baby; I’ve collected as many as I could find in this blog post. Also, after writing that, I read a lot of things connecting back troubles with breech (including one home-birthing MD whose last baby turned breech after she wrenched her back in a fall in the last weeks of pregnancy), so I wrote about breech and chiropractic. I hope they can be of some benefit to you. I’ve written several posts about breech on my blog, so if you want to read more, you can go to my left-hand sidebar and “browse posts by category” and choose the category breech (under labor & birth).

  9. Linda Says:

    You know, I kinda wonder about “maternal request” c-sections. I’m due with my first child in August, and I’ve been reading an online forum for people who are due around the same time. A truly alarming number of the participants have had inductions or c-sections scheduled for months, and they seem quite happy about it. It’s common for someone to ask about whether they should seek out such a thing, and several people will always respond with a resounding “yes.”

    Maternal request may not be a major factor in the rising c-section rates, but I get the impression that it is at least somewhat of a factor. Even so, I believe this is a problem of lack of education, or inappropriate education, which of course goes back to the “obstetric establishment.”

    • nursingbirth Says:

      Linda, I hope you stay tuned for PART 2 because I am touching much upon what you are talking about. I also agree that many cesareans (and I didnt say all, but many) are related to the obstetrician putting their preferences upon their patients, lack of education, inappropriate education, etc etc.

  10. Awesome post! I’m going to link to it! What great information!

  11. enjoybirth Says:

    Great post. I think that if we had better distinctions between the types of cesereans it would help us to determine what percentage are “elective”

    Here is a blog post I did about the types of cesareans.

    http://enjoybirth.wordpress.com/2008/12/29/types-of-cesareans/

  12. Joy Says:

    I just posted a link of this to a major medical board I’m involved on. Recently we’ve had SO MANY women come on, asking about c-sections. One woman had a c-section, followed by 2 vag. births, and now her doctor said she HAS to have a c-section with her fourth baby… all because she had a c-section with her first?! There’s no reason for it. He said their hospital doesn’t do VBACs EVEN THOUGH she already had 2 vag. deliveries after her csect.

    Oh it angers me!

    • nursingbirth Says:

      Joy, it really really angers me too!! It’s called a “de facto” ban. And it’s all a big mess and related to ACOG’s most recent position statment (I think from 2003 but I’d have to look it up) that states that VBACs should only be performed at hospitals that have 24 hour anesthesia in house and 24 hour OB in house. The book “Born in the USA” by Marsden Wagner goes into this in DETAIL! If you are interested check it out! Perhaps you could post a link to ICAN’s website as well. They have a whole page dedicated to this subject entitled “My Hospital Is Currently Not Allowing VBAC” check it out here: http://www.ican-online.org/vbac/My-Hospital-Is-Currently-Not-Allowing-VBAC

      Also, you could maybe post to the Childbirth Connection’s Right of Childbearing Women: http://www.childbirthconnection.org/article.asp?ck=10084

      Thanks for reading and commenting….and spreading the word!! I really appreciate it!

  13. I am such a fan of your posts! They are so thorough and well documented. I also write blogs from the perspective of a prenatal yoga teacher, labor support doula and lamaze teacher and love finding research and statistics that support “normal” birth. I find my students respond best to documentation and studies. Thank you for providing such clear information.

  14. Here is ACOG’s 2006 practice bulletin on VBACS: http://www.acog.org/acog_districts/dist9/pb054.pdf

    Blaming women for the increase in C-Sections is laughable. Rarely do we see a mom requesting a C-Section, especially a primary one. Only about 20% of our previous C-Section patients request a VTOL (vaginal trial of labor), and of those about 10-20% delivery vaginally. Why do women not choose to try and VBAC? My guess is that the information provided to them concerning VBAC scares the sh*t out of them. There is also the problem, like you and your commentors stated, of providers just not offering VBAC. I am beginning to feel very lucky that I was able to VBAC.

    • nursingbirth Says:

      realityrounds, I COMPLETELY agree with you. And I see it often with my own eyes. Women are scared to try VBAC because their obstetricians build up the risks of VBAC and downplay or even OMIT the risks of repeat cesarean. BTW, just the other day at my work we had a mom in the ICU because she crashed in the recovery room after her repeat cesarean (first baby was a c/s for breech who is 3 years old now….this baby was cephalic and 7lb 14oz). Turns out when they opened her back up she had what they approximated to be a 3000, thats right 3 LITER blood clot behind her uterus. The surgeon knicked the uterine artery during surgery causing massive internal bleeding. She ended up with SIX units of blood, as well as platelets and plasma (FFP) and a trip to the ICU. So very very sad, haunting, and infuriating. She is doing much better now, but still in the ICU.

  15. Krista Says:

    I definitely agree that blaming women for the c-section increase is pretty ridiculous. I did have a conversation with a friend a few days ago that was interesting, though. She made a comment that her c-section recovery was easier than her vaginal birth. Of course, she then told me about her horrifically traumatic vaginal birth, complete with episiotomy, which then tore further and forceps delivery. She said she didn’t feel normal for over a month. Her then Dr. encouraged her to try for VBAC, but she got another opinion from a different Dr. who said “if you aren’t big enough for a 4.5 lb baby (her baby was premature), how will you ever deliver a full term baby?” She believed Dr. #2 and signed up for a c-section for her second. I thought “oh my gosh, I’ve never met a maternal request cesarean before.” She then said her c-section recovery was considerably easier and if she ever has any more children (although she’s not planning to) she’ll have repeat C’s. I was thinking how sad that some women will never know how wonderful a vaginal birth can be because of all the technology that can get in the way. They equate vaginal birth with fear and trauma and would rather avoid that altogether (which is completely understandable). Equally sad is that providers remedy the fear of vaginal birth by offering c-section instead of realizing that a low-intervention vaginal birth usually offers the greater experience.

    • nursingbirth Says:

      Krista, you write “I was thinking how sad that some women will never know how wonderful a vaginal birth can be because of all the technology that can get in the way. They equate vaginal birth with fear and trauma and would rather avoid that altogether (which is completely understandable). Equally sad is that providers remedy the fear of vaginal birth by offering c-section instead of realizing that a low-intervention vaginal birth usually offers the greater experience.”

      I couldnt agree with you more. However, I see your friend’s cesarean in a different way. Because she was not explained the risks and benefits of a cesarean (or I highly doubt it considering she was told “if you aren’t big enough for a 4.5 lb baby, how will you ever deliver a full term baby?” which is horrific and most certainly false), and had unresolved fears from her first vaginal birth (aka tocophobia) then in my opinion she does not meet the criteria for “Maternal Request Cesarean Section” which is “a planned first or “primary” cesarean initiated by the mother with the understanding that there is no medical need.” If she understood there was no medical need, then she wouldnt have been told she was too small to birth a full term baby. Situations like this get me all upset! And you really pointed out all the problems with her first vaginal delivery…who WOULDNT have been scarred after that!! Especially since she delivered a premie that had to spend time in the NICU, also a HIGH STRESS situation. None of that made for good memories of a positive or empowering experience I am sure. So personally I would consider your friend’s C/S a “physician preference” C/S. Stay tuned for PART 2 of this story…I go into a lot more detail about this!

      Thanks for sharing! :)

  16. Oh wow! I had no idea. I agree that C-section should be the last resort.

    I am going to spread the word every time the subject comes up from now on.

  17. Renee Says:

    I’ve been holding my breath for another post! Excellent as always. I wish that I could call upon facts like these off the top of my head when I talk about maternity care with people. I think I get too aggravated to do much good! I think I need to just refer them to your blog! It will only happen more often when we get pregnant again and the questions start.

    • nursingbirth Says:

      Renee, I am a lot like you too! I have all this knowledge in my head but sometimes when I get into conversations about it and I am really passionate about it and getting frustrated, especially with really intimidating doctors, I feel like I stumble on my words a lot or can’t find the right words to say! I’m working on it though!

  18. Stephanie Says:

    Because I (thankfully) haven’t had a c-section before I never put much thought into the long term impact it can have on one’s childbearing choices for the rest of their reproductive life. I am increasingly thankful that my breech baby was delivered at home as well as very frustrated and concerned at OB policy/practice concerning breech vaginal delivery. How dare somebody who barely knows me tell me that what my body can or can’t do – telling me the only option is a surgery which could limit my ability to have more children. It’s both infuriates me and worries me about my childbearing future. Thanks to your site with the increased awareness it has given me I’m able to look for ways to help change policies. Any ideas on how to change some of these policies (no VBAC’s, breech vaginal delivery) would be appreciated. I enjoy reading your blog and really appreciate all you do.

  19. erin Says:

    I’m appalled by how casual obs are about the risks of repeat c-sections while simultaneously making sure that every mother discussing VBAC gets the statistic (im)probability of uterine rupture drummed into her brain; naturally, everyone interested in a VBAC who relies on their OB for information thinks that VBACs are inherently MORE DANGEROUS than a C-section and only a crazy birth fanatic would try to have one. Do these drs think that they are providing useful information to their patients? Do they really NOT KNOW the risks of repeat Csections? I can’t figure out why they’re so casual about them, when they’re so hysterical about VBAC, homebirth, going off the fetal monitor, etc etc.

    • nursingbirth Says:

      erin, your assessment of the situation is (unfortunately) so true! I, as well as many other members of the birth advocay community, believe that the doctors that rant and rave about the risks of VBAC but downplay or omit the risks of repeat cesarean sections are doing so the maintain control and to promote a procedure (cesarean) that only they (meaning obstetricians) can do.

  20. thefeministshopper Says:

    I, too, am HIGHLY aggrivated by the term “emergency” being applied to every cesarean that was performed without being scheduled months in advance.

    Mine was labeled “emergency” and the only “emergency” is that it was 5 pm and the doctor wanted to get the f*uck out of there.

    He actually called for the c-sec at 4:30 and said he’d be back to perform it at 7 pm after he’d finished up with all this appointments for the day. He came back right at 7, prepped me, and my child was born at 7:27 – THREE HOURS after he first called for it. Where the hell is the emergency in that?

    *must move along now before blood starts boiling*

    • nursingbirth Says:

      thefeministshopper, thank you for sharing your experience with us! I can see how your blood would be boiling! Mine is too!! I am so happy to hear you are speaking out about your experience (to help other moms learn) and also seeking out more information for yourself!! Kudos!

  21. Krista Says:

    Erin, my own opinion is I think its a control issue for many of these doctors. Most OBs think highly of their skills. They think since they are “one of the best surgeons in their __________ (fill in hospital, city, state, whatever)” that they can control the outcome, whereas they have no control over which woman will be that .5% and rupture (that’s in reference to UR in VBACs). Its THEIR comfort level that they project onto their clients and women make the mistake of assuming their recommendations are in the best interest of her and her baby….its actually in the best interest of the doctor and his practice.

  22. Adrienne Says:

    kate: regarding birthweight. I have have 4 children. each was born bigger than the one before, with the second being over 9.5 lb, the third 10 lb, and my 4th was 11 lb 6 oz! I am not overweight, don’t gain insane amounts during pregnancy and did not have GD. the largest birthweight in my family that I know of (other than my own) has been 9 lb 5 oz. how did my kids end up so big?

    one theory I’ve heard, though I admit I haven’t researched thoroughly yet, so I have nothing to back me up, is that high estrogen during pregnancy can cause the placenta to grow large, which in turn causes a larger baby. I don’t know if this was true in my case, but I certainly delivered a huge placenta, and I don’t think excess sugar/calories can cause that! it’s something to look into, anyway. speculation is that supplemental progesterone can prevent an enormous baby.

    by the way, I birthed all of my children at home without so much as a tear. it’s alarming to me that doctors suggest c/s on account of a “large baby”! one woman on a pregnancy forum I frequent just this week had an elective cesarean because her baby was suspected to be 9 pounds. he was 8 pounds and 11 ounces. and she had a major abdominal surgery for that, with no trial of labor!

    • nursingbirth Says:

      Adrienne, THANK YOU for sharing part of your very empowering and positive birth story! You are absolutely right, maternal risk factors as well as birth history (hey, if you have always had big babies, why schedule you for a c/s for a big baby!!) really need to play a big role in whether to go ahead with a “prophylactic cesarean” for a baby suspected to be > 5000g for a non diabetic mom like yourself. Again, these are just guidelines, NOT steadfast rules. I am so happy to hear your story. We just had a 11lb, 12oz VBAC at my hospital in the last month or so!!! THe nurses were freaking out when they weighed the baby. We section so many moms for “suspected fetal macrosomia” at my hospital it is as if the staff has forgotten that all moms and babies are different…and there are mothers who can birth big babies!!!! The patient I am referring to had three other children…all over 9 or 10 lbs.

  23. [...] Throughout my time as a labor and delivery nurse at a large urban hospital in the Northeast, I have mentally tallied up a list of patients and circumstances that make me go “WHAT!?!  Are you SERIOUS!?  Oh come ON!”  Because of this I was inspired to start the “Injustice in Maternity Care” blog series, or more appropriately the “Don’t Let This Happen to You” series.  If you are pregnant or planning on becoming pregnant, this series is dedicated to you!  If haven’t already read it, I invite you to check out part 1 of this post: DLTHTY #22: Gina & Tony’s “Elective” Primary C/S  PART 1. [...]

  24. leslie Says:

    i would love to hear what you think of epidurals.

    i live in europe (germany to be exact) and epidurals are still quite rare. esp. since a research was published that epidurals can cause long term damage on your child (e.g. adhd, post partum shock (i don’t know if that is the right word in english?) for the baby, and so on).

    feel free to email me when you don’t want to open a new thread here….

    thanks!

  25. kchugs4u Says:

    NURSING BIRTH.. I feel like I am one of those statistics.. My doctor performed a C-Section on me.. my sixth child.. second C-Section.. My first was born via C-Section (pre-eclampsia, toximia) and was born 28 weeks gestation in 1996.. healthy, happy, vibrant 14 year old now.. Had 4 vaginal births after her, ranging in weight from 7lbs 2oz to 10lbs 13oz.. then my sixth child, I had pregnancy hypertension, and it was controlled by BP pills, I am 35 yrs old, 34 when conceived.. different ObGYN.. since I had high BP, I got sonograms every week.. baby was tranverse in first one, but turned head down second, head down third, head down fourth, and at the last sonogram 2 hours before the induction, head down. Dr. kept asking me how long I am in labor normally.. told him 4-5 hours at most. Any time there is a Vbac, the Dr. has to stay at the hospital, until delivery.. got dialated to 7 and he says the baby’s shoulder is coming out.. not the head, that the baby is now tranverse.. so off to have a C-Section.. ended up getting celluitis from the surgery, in both legs, from my toes to mid thigh, had it before I left Research Hospital, and they did nothing, had go back to another hospital to get diagonosed and antibiotics, they wanted to keep me for 2 days, I couldnt do that with a newborn.. The pain and recovery from a c-section vs. vaginal birth is EXCRUCIATING to say the least, and then they give you very minimal pain control, or morphine which makes you feel bugs are crawling all over you.. I feel like he robbed me of my God given right to birth naturally.. I never got a second opinion, for some reason that option was never offered.. I know my body, I believe the baby would of turned in contractions, if in fact it was shoulder coming out.. When I told him that I felt he had an ulterior motive, (ie, such as wanting to get home to go to bed, not waiting for me to labor) he basically admitted to performing c-sections for anything he feels necessary.. I feel he is c-section happy, but w/out that second opinion of another Dr, or NP, or RN, I don’t have a stick to throw. I also feel Dr.’s use C-sections as a form of population control.. I honestly do, not to mention, they get paid more money and spend less time on C-sections. Now I have to find an Obgyn that will allow me to v-bac in future pregnancies.. I only wish I would of been able to get that second opinion.

  26. Claudia Says:

    Hi! Beautiful blog!
    there is actuallty a great website about vbac (soemthing along the lines of ‘I-can. com’ or similar to that. They basicly lay out all the excuses the docs gaveu for your C section and tell u which ones are total BS and whch one are real. I had a horrible experience. I has postpatum for over a year for having an unplanned Csection after 26 hours of labor which ended in multiple infections and reinfections. i was basicly in bed for a year with home care everyday. My husband had to stop working to take care of me. It was horrible, i had to stop breastfeeding cause I was on so many meds. Although the docs said it was OK to have morphone and antbiotiques while nursing I couldnt do it and the baby kept falling asleep and not eating enough. I had to supplement and to be quite4 honest, there was so much pain in my body I didnt have the energy. I only breastfed for les than 3 months which was hard for me to accept. my son is amost 2 , I am petrified of having to have another C again. I cant bear the idea. the failure to progress excuse is really not REAL. DO NOT GET INDUCED! because the baby hasnt come out yet. Instad offer to go everyday for a stress test, Its big time worth it!
    Good luck


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