1 in 3 Pregnant Women Face Surgical Delivery

I copied this article directly from the ICAN website

FYI the percentage of cesarean sections in AZ in 2007 was 26.2%

More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery

Redondo Beach, CA, March 18, 2009 – The National Center for Health Statistics has reported that the cesarean rate hit an all-time high in 2007, with a rate of 31.8 percent, up two percent from 2006.

“Every pregnant woman in the U.S. should be alarmed by this rate,” said Pam Udy, president of the International Cesarean Awareness Network (ICAN). “Half or more of cesareans are avoidable and over-using major surgery on otherwise healthy women and babies is taking a toll.”

A major driver of cesarean overuse is underuse of vaginal birth after cesarean (VBAC). The VBAC rate currently hovers around 8 percent, far lower than the Healthy People 2010 goal of 37 percent. Driving this decline is the growing practice of hospitals banning VBAC. In February, ICAN released the results of a new survey showing a startling increase in the number of hospitals banning VBAC. The survey showed a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with “de facto” bans (1). Full results of the research can be seen at the VBAC Policy Database.

Between formal and de facto bans, women are not able to access VBAC in 50% of hospitals in the U.S. Research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean. According to an analysis of medical research conducted by Childbirth Connection, a well-respected, independent maternity focused non-profit, in the absence of a clear medical need, VBAC is safer for mothers in the current pregnancy, and far safer for mothers and babies in future pregnancies (2). While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life-threatening risks as well.

“The choice between VBAC and elective repeat cesareans isn’t between risk versus no risk. It’s a choice between which set of risks you want to take on,” said Udy.

Studies from the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, one most recently published in the February 2008 issue of the Journal of Obstetrics and Gynecology, demonstrate that repeated cesareans can actually put mothers and babies at greater clinical risk than repeated VBACs (3).

In October 2008, Childbirth Connection released a report called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (4) showing that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

“All pregnant women are faced with important choices in their pregnancies. It is critical for women to understand what their choices are, and learn to spot the red flags that can lead to an unnecessary or avoidable cesarean,” said Udy.

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit ican-online.org for more information. In addition to more than 110 local chapters nationwide, the group hosts an active on-line discussion group that serves as a resource for mothers. For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients. The resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure. The guide can be found here.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

The Business of Being Born

I was finally able to watch a documentary called The Business of Being Born, and I really enjoyed it. It is chock full of birthing statistics and information that was very mind boggling. I even got DH to watch half of it. He stopped as soon as Ricki Lake started showing some unsuspected boobage while giving birth in her tub, but don't let that keep you from watching! Afterwards DH told me that he realizes now why I would even consider having a home birth. He's been very skeptical, so him saying that was a pretty big deal. Knowledge is power my friends. I would highly recommend this movie to any woman who is planning on becoming pregnant and giving birth in the U.S. It has become more obvious to me that birth is a HUGE business here in the U.S. These Obs and hospitals need to keep pregnant women coming through their doors as they are bringing in a lot of money. If we were like the other countries (with better mother and baby mortality rates) more of us would be going to midwives and Ob's and hospitals would lose a lot of their business. Birthing shouldn't be handled this way, it should not be about trying to make more money, it should be about doing what is safest for the mothers and their babies. Ultimately we (as parents) are responsible to make the important decision to put ourselves in good situations.

You can watch the movie trailer here.

Sugar Coating

When I sat down to write out my birth story I realized a few things. First of all, I posted it to public forums (including my blog) where I knew others would be viewing it. This made me edit out parts as I wanted to keep things light and upbeat, so I didn't include the negative. Why did I do this? I think I did it to dismiss them in a way. I made it through my pregnancy with flying colors and had two healthy baby girls to show for it, what was there to complain about?

Well, I could start with the first experience I had at the hospital even before the birth of my girls.

I went to the OB triage when I was 25 wks along because I was having contractions every 10 minutes and was afraid I could possibly be going into pre-term labor. After being monitored and given an IV they put me in a room. My nurse who was very kind by the way, was leaving as it was the end of her shift and the new Nurse came in and was introduced. Soon after she told me that they wanted to do a FFN test to see if I had a high chance of going into preterm labor. I agreed, as any patient would. The nurse held a long q-tip in her gloved hand and I figured it would just be a quick swab as she didn't seem to make much of it. As I relaxed she began to shove the swab up into my cervix without any warning. It hurt more than any pap smear I had ever experienced. As most women could understand having something hard and dry shoved up there can be extremely painful. I immediately began to cry and tense up due to the pain and shock. The nurse continued and told me to relax. She said that if I didn't relax that she would have to get the metal device to help get the swab through (which would have been a much better choice to begin with). I tried really hard to relax as I breathed through the pain. The nurse was completely unsympathetic and afterwards remarked, "You better get used to these because you'll be getting a lot of them," in a rude sneer. Fortunately I never had to have a FFN again as it came back negative and even better I could say goodbye to that horrid nurse. That was my first experience in a hospital. When I started getting consistant contractions again the next day, I was too afraid to even think of going back there, so I didn't.

To be honest, there were many experiences during my stay at the hospital that were not what I had expected.

#1- After being admitted to the hospital for being in early labor I am not allowed to eat or drink anything. They don't know whether I will for sure have the girls today but I can't eat even though I haven't eaten all day and I am a 38 wks along with twins. Really?

#2- Sleep is a joke in a hospital. 2 heart rate monitors for the girls and 1 for contractions were strapped to my stomach and hurt like heck. Because the girls kept moving the nurses kept coming in to readjust the monitors so I hardly got any sleep that night.

#3- I didn't expect that there would be rock and roll music played while my children were being born. While it didn't hugely bother me it at first, it made me feel more like a vehicle being worked on in a body shop then a woman having her babies in a hospital. Did they ask me if it was ok to play the radio right next to us during the c-section? No.

#4- Unlike the baby shows portray, when you have a c-section the Dr. doesn't get all excited when they lift the baby out and proclaim "Oh it's a ____" and hold it high so you can take the first peek. No, they pull them out and they go straight into a nurses arm and then into several others before you are ever able to hold them.

#5- I didn't expect my anesthesiologist during my c-section to be such a jerk. When I was feeling like I was going to throw up during the surgery I tried to lift my oxygen mask and he angrily snapped it back on my face. Nice.

#6- I had never experienced an epidural/spinal, I didn't realize how loopy and out of it I would be for the girls birth. When I first saw them, I didn't feel overwhelmed with joy and emotion, I felt overwhelmed with hardcore drugs.

#7-When in recovery I was finally able to nurse one of my daughters. The nurse who was there or whoever she was told some medical student that she should stand there and observe me nursing. She did this without asking my permission. As a first time mom and as my first time nursing, I did not want some stranger staring at me, I wanted privacy.

#8- Also while in recovery I began to feel like I was going to "blow chunks" which is a common side effect of the spinal. When I began saying " I'm going to throw up, I'm going to throw up" over and over again, I was ignored. After several minutes someone finally gave me a container to throw up in. It was like I was invisible.

#9- Brooke was taken to the NICU before I even had a chance to hold her. Once our room was ready they told me to stop nursing Brenna (who had only been nursing for a few minutes at the time and was in no way full) and so I had to take her off. She of course cried and I felt horrible and yet I didn't understand why I couldn't continue nursing her while being pushed to my room. It still doesn't make sense to this day.

#10- On our way to my room we decided to go to the NICU so I could have a chance to see Brooke and hold her for the first time. She was covered in wires, and laid out in an isolette. It was so hard to see her that way. Even today it makes my heart hurt when I think about it too much. I finally got to hold her. I remember at that point that my Mom asked me to smile while she took a picture. The sad thing was that I couldn't, I physically couldn't. I was so drugged, I felt like crap and my daughter was in the NICU, how could I possibly smile?

#11- Due to the lack of sleep and food and the large amount of drugs in my system I am in no shape to care for my girls. When trying to hold Brooke in the NICU and feed her a bottle (as they reccomended), I began to fall asleep. This devastated me to no end.

#12- Most people talk about c-sections as if it's almost like going in to get your hair done. Total routine procedure, everyone does it, no biggie right? Do they mention the side effects? No not really. They usually don't mention the pain of trying to stand and walk for the first time, the spinal headaches that can occur, the inability to urinate afterwards which results in yet another catheter. These are just a few of the many challenges that comes with this major surgery.

Wow, I sound like a Negative Nelly. So what can I conclude with?

Am I grateful for a Doctor who could preform a successful c-section?
Yes, because in my circumstances it was what was safest for my babies.

Am I grateful that my daughters were born healthy in a hospital with a NICU?
Yes, although I can't helpt but attribute Brooke's breathing issues and trip to the NICU to the c-section.

Am I grateful for anything else that happened in the hospital?
Other than a few angel nurses, great lactation consultants and a wonderful Pediatrician, no. Just thinking about having another child in a hospital scares me.

Would I have another cesarean section?

I would as a last option, and of course if the circumstances proved it to be the safest way for my baby to be born. While the recovery is extremely hard (atleast for me) there are extremely high health risks that come along having a major surgery. Add to that having to deal with the people and policies in the hospital and I quickly found myself in a bad situation. This doesn't mean to say that every c-section is a horrible experience. With the right planning and care provider one could definately achieve a respectful c-section when necessary. Once again these are *my* opinions.

VBAC on the brain

Six weeks after my cesarean section I went in to my OB/GYN to have my postpartum check up. After the exam I asked the Nurse Practitioner about having a VBAC with my next pregnancy. "Oh no, we don't reccomend those," she quickly replied. "There is just too much risk involved." Little did I know that the risk she was referring to, the risk of uterine rupture, is a low 0.4%. Quite a risk indeed. Fortunately my quest for a vbac didn't stop there and for the last 17 months I have had what I like to call VBAC on the brain. I've spent hours on end researching about c-section prevention, vbacs and birth altogether in an attempt to have a better birth experience with the rest of my pregnancies. I've joined groups like ICAN and AZ Birthing Circle and have even gone to meetings. I've also read up on the vbacs that have gone wrong and learned more about why they did. I'm striving to gain all perspectives. There hasn't been a day that has gone by that I haven't thought about my next birthing experience and how I can improve my chance at a better birth. It has become something very important to me and my role as a mother. Especially as a resident of Arizona, where VBACs are not greatly supported, where it is hard to find a real Pro-Vbac provider and it is illegal to have a HBAC (homebirth after cesearean) assisted by a midwife. Women who want a VBAC in AZ have their work cut out for them (no pun intended).

A woman's decision on how she will birth is a very personal one, and it is one that only she can make. I respect other women's opinions and choices as I realize they might not be the same as mine and of course I would want them to respect mine just the same. I created this blog to help document my journey from a cesarean to a (hopefully) vaginal birth, and not only a natural birth but one where I am respected. Along the way I hope to be able to help other women. I worry for women who are pregnant with their first child and don't know what to expect in the hospital, I also worry for those mom's that have had hospital births and are going in for another. The birthing system in the US is scary and the statistics prove it. I hope they will be better than me in becoming educated and in knowing their rights as a mother. I hope they will learn the statistics and find what is best for them and their unborn babies. There are so many things I didn't know going into my pregnancy and ultimately into the hospital. I feel that my experiences and challenges with my birth happened for a reason and I use them now as fuel to drive me to a better birth experience. All I know is that next time it's going to be different, and it's going to be better.