Wednesday, March 18, 2009

Stop the madness! Please.

“The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States.”This quotation and table come from the CDC's National Vital Statistics Report--"Births: Preliminary Data for 2007."


Please. Please. Please stop this trend.

Need I remind you that certified nurse-midwives typically have cesarean rates below 15% and home birth midwives frequently below 5%... safely and with much higher levels of satisfaction with their care. (My midwives range between 1 and 3% depending on whether the mother has given birth before... and that's with consistently good outcomes.)

Is there really any question whatsoever about the solution to the U.S.'s cesarean epidemic?


Anonymous said...

I know that a lot of people participate in unnecessary c-sections but a lot of moms, like me, HAD to have a c-section. I already feel like less of a woman for not doing it the "normal" way and reading things like this just makes me feel like more of a failure. It was not the ideal birth but it was the safest for me and my baby, who was completely stuck in my pelvis face first. I think it's great that you are going to do a home birth and that you are really into midwives and natural birth and stuff but not every woman has that option. I still bonded with my baby, I still was able to breast feed right away, I still recovered just fine. Yet I still get negative comments about my c-section from friends and relatives, as if they know better than my doctor. So yes, while I agree that the c-sections may be unnecessary at times, we should still respect the decision of those women and their doctors because we don't know always know their situations.

Buscando la Luz said...


It breaks my heart that my post made you feel like a failure. Clearly there's nothing you could have done to change your baby's face-first presentation. I have other friends whose cesareans were equally necessary due to transverse presentation and other issues. I would never call you or any of those brave women a "failure."

Unfortunately, far too many women don't have the luck you did--with an easy transition into breastfeeding, bonding, and recovery. I have a friend whose cesareans have created nightmares for her efforts to bond and breastfeed, and she has experienced daily pain at her incision site since her first cesarean nearly 6 years ago (she has since had two more cesareans). I can't even imagine how difficult it would be to recover from major abdominal surgery while trying to care for a newborn, establish breastfeeding, and adjust to parenthood.

I apologize that my tone was painful to you. Each case is unique and must be taken individually. I would not hesitate to let a doctor cut me open in a true emergency. As you said, your baby was born by cesarean because it was the safest for you and your baby.

But I DO get angry when I hear about the rise in cesareans. I am on a passionate crusade to prevent the cesareans that never should have been, to save those unnecessarily scarred women the feelings of "failure" you have felt and the pain and complications that far too often come with cesarean recoveries. So I share information. Sometimes that information makes me angry... like the way the cesarean rate continues to reach new highs each year. And I want to scream because it's almost certain that at least half of those cesareans were unnecessary. I refuse to believe that one out of three women is incapable of giving birth, especially since the facts show that midwives assist women safely with much, much lower cesarean and intervention rates.

I have no problem accepting the small percentage of true crises (like yours). But I have a HUGE problem with the rest of the cases where women have been led to believe they cannot give birth and must submit to incisions that will cast a risk-filled shadow on the remainder of their reproductive lives.

The tone of this post was definitely angry. But my anger is not directed at you or any other individual. My anger is directed at the faulty maternity care system that perpetuates sub-par care... the system that eats up more dollars than any other health care system in the world, but still ranks at the bottom in terms of mortality rates in the developed world. It simply should not be. It doesn't have to be. But it won't change until the truth gets out there... and that's why I blog. To get the truth out there and to get enough people angry that they'll want to do something.

I love what Marsden Wagner has said, "It seems there is at least one thing more powerful than the medical establishment: women, when they are angry and get organized" (Born in the USA, p. 215).

I hope you will forgive me. And I hope you will also join me in working to make things better.

HollySteffen said...

What is most disturbing to me is the amount of women that CHOOSE to have a c-section either by their own persistance or dr's recommendation. It's not as simple as they make it sound. The effects last forever.

I can see how you can think that Midwives can 'solve' the c-sect rate problem but you do need skilled drs for the emergencies that do need c-sections. It is important to remember they have had to attempt c-sections forever... there was just a much higher mother and baby mortality.

I think an effective solution is partially an increase for midwifery and a rise in compassionate doctors. They need to educate the drs not to care about the pay or convience of c-sections and to kepp the mothers' and babies' safety number one- always.

...just my thoughts =] but you are definitely right-- something has to be done.

Sam and fam said...

My hubby's uncle is an OB/GYN in Upstate NY. He would like to see a system where midwives and OB's work together and midwives handle the majority of the low risk and the OBs are reserved for emergencies, C-sections, other high risk, etc. If only more shared his thinking!

I see so many postpartum mom's who have had c's for "failure to progress" and wonder if they had been better educated about labor if they really would have been a true FTP. I think one thing people who elect to have c-sections DON'T realize is how risky it really is. I've been seeing/dealing with a ton of patients whose incisions have opened back up and require daily wound packing. Ew. That's enough to make me run FAR FAR away!!

HollySteffen said...

Sam, Where in Upstate NY?? What's his name? I live upstate and I'm always interested to see who shares those beliefs... I like to recommend those dr's to friends and family.

You can email me because you probably don't want to post it on here! Thanks!!

Buscando la Luz said...

Holly- You're absolutely right. I agree with you 100%. I'd never want a 0% cesarean rate because that simply wouldn't be safe for anyone. If we could only see the rate on that graph begin to decline I'd be thrilled!!

I see midwives as a partial solution simply because they have managed to maintain very low cesarean rates while still providing safe, high quality care. It seems they're on to something and it ought to spread.

Sam and fam- Right on! I love your hubby's uncle already. :-) I'd be ecstatic if we could adopt that kind of system. Midwives for the vast majority of women and obstetricians handling all the high risk and complicated cases. That would be fabulous!

And eww is right. And ouch I'm sure, too! :-/

The Roundy Fam said...

Amen Busca. :o)

I know you would never intend to hurt anyone's feelings - so, Anonymous, please let me reassure you that she is just simply trying to help all of us women know our options and therefore be able to make informed decisions when it comes to birth. :o) I know she would NEVER, EVER want to make anyone feel like a failure - especially at being a woman and mother! I hope that you can now understand where she is coming from! :o)

Sarah H said...

I have had two c-sections (one most likely unneccesary, one maybe neccesary) and I don't take offense to this at all. In fact, I am right up the alley with you in being angry.
I do feel like less of a woman for not having a vag birth but that makes me determined to try harder next time. It makes me want to fight for other women and just for a better system that will prevent more women from being scarred. It's sad to think that nearly a third of all childbearing women of this generation are walking around with a scar on their uterus.
BTW, my first c-section was for twins in breech position, and my second was because I was 8 days post dates in my VBAC attempt. That's the one that gets me really upset, because I think they took advantage of my vulnerability at the end of pregnancy by telling me I had to repeat just because I was overdue. And that was actually from a CNM. My baby had some complications from the c-section and spent 5 days in the NICU. It doesn't make me too happy about c-sections.
I do think midwives should care for the majority of women.