That’s what Jennifer Block argues in the LA Times:
Pre-term births are on the rise. Nearly one-third of women have major abdominal surgery to give birth. And compared with other industrialized countries, the United States ranks second-to-last in infant survival. For years, these numbers have suggested something is terribly amiss in delivery wards. Now there is even more compelling evidence that the U.S. maternity care system is failing: For the first time in decades, the number of women dying in childbirth has increased.
The Centers for Disease Control and Prevention last month released 2004 data showing a rate of 13.1 maternal deaths per 100,000 live births. For a country that considers itself a leader in medical technology, this figure should be a wake-up call. In Scandinavian countries, about 3 per 100,000 women die, which is thought to be the irreducible minimum. The U.S. remains far from that. Even more disturbing is the racial disparity: Black women are nearly four times as likely to die during childbirth than white women, with a staggering rate of 34.7 deaths per 100,000.
These high rates aren’t a surprise to anyone who’s been investigating childbirth deaths. Physician researchers who have conducted local case reviews across the country consistently have found death rates much higher than what the CDC has been reporting. In New York City between 2003 and 2005, researchers found a death rate of 22.9 per 100,000; in Florida between 1999 and 2002, the rate was 17.6. Other reports by CDC epidemiologists have acknowledged that deaths related to childbirth are probably underreported by a factor of two to three.
Disturbing indeed. Block, like many other women’s health advocates, argues that the rise in unnecessary c-sections is threatening the health and lives of birthing women. Too often, C-sections are used because doctors are (understandably) trying to avoid malpractice suits; people injured by medical professionals (understandably) file malpractice suits because that’s usually their only recourse. Women also lack choice in the matter. Some hospitals will simply require a c-section for a second or third birth. Doulas and other birthing helpers aren’t covered by most insurance policies; choosing a non-hospital birth can also compromise coverage. Doctors also have a bad habit of not listening to women — all the stereotypes of women being weak, hysterical and verbose create a situation wherein women’s self-assessment of their medical condition isn’t taken seriously. We see this everywhere from heart disease to menstruation to pregnancy complications.
All of it adds up to women dying in childbirth, in absurd numbers. I’m not against the medicalization of childbirth and I’m not a “natural-is-always-better” person. Give me my birth control ring, and if by some chance I ever give birth, drug me up, Scotty. But I’d sure like to know that my doctor is catering her care to my individual case, and not making decisions based on what will avoid lawsuits. And I’d sure like to know that other women have the right to refuse medical childbirth and c-sections, and that they’ll still have access to affordable and responsible care.
In semi-related news, Radical Doula is blogging about the Feminism and Breastfeeding Symposium. Check it out.
This is misleading at best and intentionally deceptive at worst.
For example, it states that the # of women dying in childbirth has increased. However, there are a variety of reasons to believe this report is the result in a change in the way those deaths are reported. See this link for more details. Furthermore, irrespective of reporting issues, it fails to account for the reality that population changes in mothers may also be a confounding factor–which, while supporting the rise in deaths, would render the “bad medical care” argument moot.
Second, it suggests that the rise in C sections is, in some fashion, related either to the large number of preterm babies, or the high mortality levels. This is also false. C section is believed to be essentially similar to birth in terms of safety, and recent studies suggest it may actually be quite slightly safer (looking at mortality and nor morbidity.) In fact, the lack of CS availability in some countries is though to be a significant contributor to their higher mortality rates. See this article in Birth for an example.
Even the much-lauded statistic about the U.S.’ high mortality rates isn’t really true; it’s affected both by how the various countries op to classify the deaths of infants or feti, and by certain population demographics. Though this one is “more true” than the others.
But really, if you think women are dying in childbirth in “absurd” numbers, you’re simply not aware of the stats. The mortality rate is nature in astronomical; is the U.S. it’s about 12 per 100,000 births.
To put that in perspective, the mortality rate in countries that lack our medical system is INSANE. See this PDF link showing a few countries’ reported maternal mortality. You can easily Google other countries’ maternal mortality rates. Though (this link is an example) they also suffer from test bias, so it’s not all that clear how much lower, or higher, they really are.
Obviously the medical care in the U.S. has some issues, and obviously maternal mortality can be improved. But we’re already doing a very good job; it’s nowhere near absurd.
As I am pregnant, it has become a recent area of research of mine. I am floored by both the statistics and the personal anecdotes. Hopefully, by finding a midwife with only a 10% C-section rate, I have taken myself out of the main line of fire.
I was talking to a friend recently, a pediatric nurse, and she insisted to me that c-sections were rare and only used in dire situations. I told her the rate from last year was at least 30% and she was quiet for 2-3 minutes, as she had no idea. I hadn’t even thought of it before I got pregnant, but as for her you would have thought the topic would come up at work. Some hospitals have rates over 50%, which I discovered when looking up rates in my local area, and getting worse. Once people know the true statistics, they will wonder if their doctor or hospital is putting them at higher risk.
For both the infant and the mother?
As it stands now, most medical care seems based on this, not just obstetrics or gynecology…
Sailorman,
The point is the numbers are going in the WRONG direction. Under no circumstances should it be rising. It should either be improving or staying the same.
Every woman who I have explained the plain facts of C-section and artificial induction rates to have been dumbfounded, even those who have had C-sections and inductions. Women are sorely uninformed about the care they are receiving. Even Jill here says she wants to be “drugged up” without saying that she accepts knowing that slowed labor and higher C-section risk is the natural consequence of that choice. At least I’ll know, going into my labor, that getting an epidural is not without risks/consequences, and if I choose that I will be able to own that decision. You can’t own your decisions if you bury your head in the sand and stay ignorant on the facts. For every death that shows up in these statistics, think of how many women are suffering from pain, re-hospitalization, and complications in later pregnancies. Hysterectomy, massive blood loss, and extra difficulty with breastfeeding and bonding. Not nearly as bad as death, granted, but real talk nonetheless.
This is true, I know absolutely nothing about the consequences of being drugged up — so please don’t take my comments as me promoting drugged childbirth. I don’t plan on ever giving birth, so I’ve never bothered looking into the details.
100% understood Jill. It never occurred to me to ever research these topics until I got pregnant. Since you will never have kids, you certainly don’t need the details, unless you decide to blog about it ;-)
Ah, but drugging yourself to the gills to birth is one of the contributing factors for c-sections in the US. It’s a vicious cycle of overly-medicalized birth that goes something like this:
*Induce labor if you’re even a couple of days past your due date (a date that can go 2 weeks either way, incidentally) with pitocin, which brings on hard, fast labor without any of the build that allows women to cope with the pain
*Tether the woman down on her back with an IV and an (often internal) fetal monitor, ensuring she cannot move in any way that naturally alleviates the pain.
*Stick in the epidural when the pain (understandably) becomes overwhelming almost immediately
*Lose the momentum of the artificially induced labor
*The hyperactive fetal monitor shows a slowing of heartrate (which is natural during contractions) or any of a number of ‘complications’ which may or may not actually BE complications
*The attending cries ‘FETAL DISTRESS’ and voila, you have a c-section.
I read the abstract of the Birth article, and it sounds like they are perhaps being a little disingenuous (or rather Sailorman is in his analysis). In a lower income country, the availability of C-Sections very likely correlates to a presence of prenatal care and modern medical practices that improve outcomes for mothers and babies alike. I liken it to antibiotics. To a developing nation, antibiotics are a boon that vastly improves quality of life and life expectancy. In a nation like the US, we have this wonderful class of drugs, but we are going so crazy with the prescribing that they are losing their efficacy and triggering the mutation of resistant strains at such a rate that they’re now partially worsening the problem they’re meant to solve.
I’ve now had one delivery each way (my first, my daughter, was a natural childbirth – 24 hours of labor, but no tearing and I was healed up remarkably fast. my second, my son, was an emergency section 5 weeks early to save his life). I have every reason to be deeply grateful for high-tech medicine, since it saved my son’s life both before birth with things like intra-uterine blood transfusions and after in the NICU. But I do think that while modern medicine offers a great basis for lower-risk childbearing, there’s no substitute in the world for a good midwife and doula and an environment where women are trusted with their own bodies and their own birthing.
I have already decided that if/when I ever get pregnant, I will do everything in my power to keep the birth as natural as possible. A friend of mine recently gave birth, and was told she “needed” a c-section because her baby was breech. When I asked her if her doctors had even tried to get the baby to turn head-down, she said no. I asked her if they had given her a list of things to try (swimming, down on all fours, things like that), and she said no. Then she went on to say that she had tested positive for group B strep, so even if the baby turned at the last minute, her doctor had told her she would not be able to deliver vaginally. Which is utter BS. Her doctor just seemed bound and determined to slice her open one way or the other, and I was appalled. I tried to tell her that, but she insisted her doctor knew best.
Heaven forbid I ever find myself in such a situation. I’ve talked to women who are midwives, and done my own research, and it’s absolutely shocking to me how many doctors will insist upon a c-section simply for convenience’s sake. As afraid as I am of the pain of childbirth, I have already decided that I will not have an epidural. I’ve heard too many horror stories about nerve damage, slowed labor, low apgar scores, and the like. I’ll take my chances with the pain, thanks. If my mother could make it through two days hard, unmedicated labor, so can I.
My sister-in-law had a c-section with her first child 12 years ago, and the hospital required her to have another one because her medical records had been destroyed in the meantime (they only hold them for 10 years and, as with most employed people, her health insurance had changed multiple times so she wasn’t seeing the same doctor). Apparently, there are several c-section techniques, one of which gives you a lower chance of rupture if you try a vaginal birth later, and one that gives you a higher chance. Nobody knew what kind she’d had, and she didn’t have copies of her own records, so she had to have a c-section.
It’s good to have the option — my other sister-in-law had to have c-sections with both my niece and nephew because the particular birth defect they have (severe clubfeet) makes vaginal birth dangerous for everyone (inflexible infant feet = punctured vaginal canal). But it’s probably worth finding a doctor/hospital combination whose first response is not “c-section.”
Another interesting fact for this situation, even if you are insured and the insurance company covers 100% prenatal and postnatal care as mine does, the delivery itself is NOT considered a ‘routine’ part of being pregnant, therefore you have to pay the deductible and usually a percentage of the delivery. C-Sections are usually in the range of 15,000 dollars so performing an unnecessary one can really cost you.
I should mention, though, that even with free movement, bath, massage, proper breathing, labor can hurt like hell. I got through mine by screaming. So it’s perfectly understandable to me if a woman wants pain relief, and, considering how many of them do, there damn well should be more emphasis on encouraging labor to progress otherwise naturally when there is pain relief.
My second was at home, my main motivation being to avoid being stuck on IV antibiotics and the bleepin’ monitor. I’m all selfish that way.
I suspect one further contributing reason for the U.S. high induction rate is our pitiful time-off policies.
If you only get 4 weeks paid maternity leave, and you schedule it based on your duedate, the later the birth, the less time at home you actually have with the kid and to recover.
That makes no sense. If–as many people believe–the increased numbers reflect a changing population, and not changing results, then it’s perfectly reasonable for them to go up. You can’t act based no the numbers without showing they’re accurate!
If every woman in the U.S. decided to have kids when they were 21, and nobody had kids when they were over 40, then given the same level of care we have now the numbers would go down. But it’d have nothing to do with our health care system. Same in reverse.
You realize that it’s a TRADEOFF between Type I and Type II error, right? When you give fewer C sections based on equivalent information, you are making a conscious decision to decrease a certain type of risk (from a CS) in favor of inrceasing other risks. You can’t escape the tradeoff.
Problem is, a lot of the “anti-CS” or “anti-hospital” folks don’t seem to mention what, exactly, the tradeoffs are. And/or they present the issue as if it’s a reduction in risk, rather than a substitution of risk.
30% is probably too high, but the “ideal” rate is actually thought to be pretty up there; I think it’s above 20%. Not incidentally, the better we get at giving CS, the higher the “ideal” CS rate goes.
Hopefully, most women who become informed do it through medical journals, and not alternative medicine sites. But too few people in general are informed–it’s an incredibly complex subject.
So true.
How many?
It matters, you know.
And this is a bit trickier: “Not nearly as bad as death, granted, but real talk nonetheless.”
That’s pretty darn relevant.
The vast, vast, majority of obstetrical interventions are designed to keep the mother–or, more commonly, the baby– from dying. They may be unpleasant for the mother, or for the baby. But they’re hopefully going to keep either party from dying or being permanently damaged.
This INCLUDES c sections. They are generally given because people think the fetus might be in distress and need a section. The choice is really a transfer of risk from the infant to the mother.
However, the neonatal mortality rate is closer to 10/1000 (that’s 100 times more likely than the maternal mortality rate.) Generally, many people–mothers all–conclude that a minor increase in maternal mortality is worth a significant decrease in fetal mortality. So they accept the transfer of risk.
One can, of course, reject a c section; one can reject ANY medical treatment. But the Type II error increases, and most of that risk is borne by the fetus.
Categorically rejecting all CS might raise your neonatal mortality risk by, what, 1/1000? 2/1000? (that’s a complete guess; I haven’t looked it up. But it’s probably higher.) That seems like a pretty slim risk… until you realize that the maternal mortality rate which is complained about here is more like 1.5/1000.
This is a legal issue. It’s extremely difficult to prove that women really, really, understand the risk of a vaginal birth after caesarian (VBAC). So if they do one and die (or their baby dies) it’s a lawsuit waiting to happen.
Those hospitals that allow them frequently require safety measure to enhance the overall risk. It’s not uncommon for a VBAC mother to get an epidural (whether or not there’s anything going through it) and to deliver in, or near, an OR suite. This makes it easier to have an emergency CS and treat the rare but very dangerous complications like a rupture.
It is a bit ironic, though, to argue for VBAC on a mortality thread. VBAC are more dangerous, after all. Which, BTW, reminds me to make this point: Emergency CS are actually fairly dangerous and obviously fairly unpleasant. A lot of the planned CS is that the doctors and mothers are trying to avoid an emergent CS.
I was floored when my now ex-SIL was able to schedule both of her CSs prior to labor for no medical reason whatsoever. Then when she heard I was pregnant years later with our first, she told me I HAD to do the same.
No thanks! It did take 36 hours and I finally ended up having to be induced, but the baby was never in danger.
Of course the availability of c-sections is important, but the rate should be around 10%. Any higher than 15% and you’re introducing significant risks to both the woman and her fetus.
Unnecessary cesareans are a problem. Doctors who call for a cesarean for borderline indications are a problem. But the larger problem is the huge rate of interventions that cause indications (both significant and borderline) for cesareans. The biggest one is induction of labour. Pitocin induction of a primip at 38 weeks with a low Bishop’s score is taking a huge risk of needing a cesarean (studies show that 40-70% of primips who are induced end up having cesareans). But between provider convenience and consumer demand (much of it based on lack of information), inductions are increasing all the time. Hardly anybody “lets” their patients go past 41 weeks anymore, and many pregnant women clamor for inductions at 38 weeks. And again, while some of these inductions are elective, many of them are for borderline medical causes, like hypotension without other symptoms of pre-eclampsia or sciatica due to heavy fetus resting on the sciatic nerve.
Finally, there’s a myth out there that “vaginal birth puts all the risk on the baby, cesarean puts it all on the mother.” It’s mostly wrong, but even if it were right, so what? Only in our fetus-fetishizing culture is the fetus’s wellbeing always put ahead of the mother’s. This is exacerbated by lawsuits which award lifelong care costs: much more expensive for a disabled baby than a permanently injured (or killed) mother.
I meant hypertension, not hypotension, above.
And the other dangerous trend is early epidurals. An epidural given as soon as the first contraction hits, or at 3cm, is much more likely to contribute to fetal malposition and “failure to progress” than one given later in labour.
It annoys me how much OBs can interfere sometimes. I was induced with my first because I was 9 days overdue. When I went in for the induction, they found I was in light labor and gave me the chance to see if things would get going naturally, except that he broke my water, guaranteeing that I needed to have my daughter that day.
Frankly, I would have preferred to go home and see what happened. They finally gave me pitocin, which was one of the most miserable experiences of my life. Took the anesthesiologist over an hour to come, despite my frantic nurse, by which point I almost had the pain under control myself.
With #2 I was all too grateful for the C-section. Mine was one of those cases where I could have miscarried – almost no amniotic fluid left and a breech presentation. My grandmother lost a baby the same way, and I could see that even 60 years later that memory hurt her.
But even with that I would want to think before doing a C-section for another pregnancy. I’d talk a lot about the risks of VBAC, but I’d do it if it were reasonable.
It’s definitely concerning that the maternal mortality rate is up. Whether it’s due to the change in the average age of mothers or due to inappropriate medical interventions, we need to figure out what’s causing it.
I would guess that you have to go far back from the c-section to prenatal care in general, and the fact that we DON’T HAVE UNIVERSAL HEALTH CARE. Women who are poor and/or lack sufficient care during pregnancy are going to risk having things like higher blood pressure, pre-eclampsia, gestational diabetes, etc. and etc. go undiagnosed and therefore become big, big problems during birth. I think it’s wrong to focus solely on c-section v. vaginal births because that could be influenced by so many factors beforehand. I think it’s health care through the entire pregnancy that can help lower maternal mortality rates.
Hey Sailorman,
I have shocking news for you: The age of mothers is going up in Scandinavia and the rest of Europe, too. The mortality rates are still not going through the roof!
And who invented this no-vaginal-birth-after-a-cesarian crap? Studies show it’s just as safe as any second or third birth, except for older women.
This topic always leaves me with this feeling that vaginas are only for men’s pleasure and eeewwwwwwwh, how gross, there was a time when they had another function… Just like the nursing debate. Can we please outsource all reproductive functions and just look pretty?
My understanding of some outcomes research on heart disease is that this factor contributes to racial disparities in treatment a great deal, and it’s possible that this factor could be a similar explanation for the disparity in childbirth-related deaths for women of color. Just a thought.
As for medicalized labor, I think a lot of women who haven’t been pregnant think it’s nuts not to get pain medication. It’s not generally known to never-pregnant women what trade-offs exist with respect to various pain and anxiety management medications given in childbirth or the drugs like pitocin that make labor more rapid. It’s certainly been an education for me to hear about what the issues are, and — now at 26 weeks along — I’ve come to the conclusion that I’d like to not start down the path towards medicalization of my labor to the extent I can help it. We’ll see, and I feel good about the interest my doctor shows in having an informed dialogue. I feel like that’s about the best we can do in the abstract, and the rest will come into play when my body decides it’s time to give birth.
Actually hope this will hearten some in this thread: at the hospital where I will be giving birth (NYPres/Cornell campus):
- they do not do episiotomies, period, trusting recent research that supports the idea that repairing a little tear is a lot easier on the mother than an episiotomy.
- the nurse who gave our hospital tour stressed that they place the baby directly skin-to-skin immediately after birth. Of course the baby must get his/her shot of Vitamin K within 1 hr after birth but you can hold them during this, and they will be seen by a pediatrician some time AFTER you have spent the first hour with the baby and breastfed (or tried to), unless the baby seems to be in trouble.
- the childbirth preparation class offered by the hospital was *very* informative – about all the risks as well as benefits of pain relief and caesarean section, and the “cascade of intervention.” Again, this is not from an “alternative” childbirth education source – it’s a huge, mainstream, busy hospital’s course offering. They even discussed and promoted doulas, though we have elected not to go that route frankly because of financial considerations.
I wouldn’t say I’m “give me natural or give me death” – you can bet if I start looking like I need intervention I will accept it, and won’t allow to happen to me what happened to a friend recently (35 hours of painful back labor, an additional hour of epidural labor but she was too exhausted to continue and the baby was facing the wrong way so they had to perform an emergency C-section). I won’t try to be a stoic any longer than I think is sensible. But given the facts – that while “normal birth” may be very painful, in the vast majority of low-risk pregnancies you have successful results and a faster recovery – I’m definitely going to *aim* for natural if I can avoid risking the cascade of intervention. I don’t expect it to not hurt.
(hah, watch me scream for the drugs. We’ll see. I remain optimistic. After all, there’s no way out of this but through it.)
One other note — a woman I know who is pregnant had some large issues with her insurance company (an HMO, natch), which was pushing something I believe was called “Active Management of Labor.” According to the information she was provided, its objective was to keep the time between when she checked into the hospital and when she gave birth to under 12 hours, which — for a first time mother — seems like a very short turnaround. The description didn’t discuss the patient’s role at all, because the patient didn’t really have one — it appeared to be an active project for the doctors, who controlled when they stripped the membranes and caused the patient’s water to break as well when they administered pitocin and the epidural, both of which were assumed, and the woman played a passive role. It sounded like a birthing assembly line, one designed to keep down doctor time and open up hospital beds without any regard for the interests of the woman in her birth experience.
I’m not a person who generally fits into a crunchy lifestyle — I’m okay with a lot of processed and sanitized stuff in my life, and medicalization never bothered me at all when it came to diseases or injuries. I’m still going a more medical route, birthing with an OB at a hospital and not a midwife or doula, not ruling out epidurals or pitocin, etc. But pregnancy is not a disease, and going through labor isn’t an injury — it’s a natural process that, while risky, can be trusted in a lot of cases. Hearing about the AMoL approach disturbed me enormously and made me think that there are a lot of women who wouldn’t get good information, who don’t have the kind of time I do to research options, who don’t have decent health care choices and would be forced into a highly medicalized birth experience that they might regret, and all for the purpose of saving money for insurance companies and time for doctors. That situation sucks, and it’s part of the reason why people who are way more crunchy than I am (as well as people just learning about this stuff, like me) would rather trust alternative medicine and doulas and other folks than the medical journals, which promote stuff like AMoL.
Yep. Shows once again that while American healthcare is great with emergencies, we suck ass at preventative care that could save us from having those emergencies occur in the first place.
One of my friends recently gave birth. The Dr/hospital decided she would come in on a specific day and be induced. At that point she would only be two days overdue, so why did they pick that date for her? Because the rest of their week was already full with appointments. So of course she comes in, they induce her and after about 12 hours of labor they c-section her.
It just bugs the hell out of me that they would just randomly pick some day to purposely induce her unnecessarily. Nothing was wrong with the fetus to cause them think it needed to come out.
I have never read anything that has convinced me that the C-section rate should be much more than 10%. It is major surgery, for pete’s sake! Why does this part so seldom get discussed in the ‘elective c-section’ discussion? Or that it requires – in healthy women – six or more weeks to fully recover from, during which time carrying even a 7 lb newborn up stairs is painful? Because it’s *just* the mom? So, who cares?
Like ekf, I’m not very ‘crunchy’ at all in lifestyle, and drugs and interventions have their place. Especially c-sections. And so do other drugs. Both my labors were pitocin induced – one 10 days past due date, the other scheduled on the expected arrival date. (Completely for professional reasons, btw. I needed the kid born between semesters with enough time to recover before I went into the classroom ten days later – which, thanks to traditional vaginal delivery – was completely possible. But with better maternal leave policies wouldn’t have been necessary.) Anyway – the first pitocin induction, under the care of nurse-midwives – was really great. Seriously – I had been in mild labor for days that stopped – of course – when I got to the hospital- and they used the pitocin just to kick everything back into gear. A completely standard 12 hour labor after that – pain med free, because the 12 hours was plenty of time to deal with the pain with the techniques I knew.
So I was like, all cocky and shit, when i decided to schedule a pitocin induction in a hospital in a city that doesn’t have *any* licensed nurse midwives. It was mind bendingly painful. Because I went from not being in labor to full classic labor – hard contractions, 2 minutes a part, in an hour. Crank that baby. Fortunately my doctor was clear that I wanted no cutting and no spinal meds. So they gave me something lovely and warm in the IV, and just as I was coming out of it and they were threatening two to three more hours of same, the nurse suggested I roll over to my other side. Last six centimeters opened in a single contraction and kid popped out in 30 minutes.
What did I learn? That pitocin is usually a horror story, but that administered by folks who aren’t in a hurry, it doesn’t have to be. And that with so much of our health industry, it is so steeped in anti-woman practice and anti-maternal practice that even in a hospital setting where my husband and infant were the only men in the room – the pitocin was administered not to assist me labor, but to make delievery come on their schedule. On a floor without anyone else in labor – it’s not like they were stretched for staff or anything.
My sis didn’t end up having a c section, but the doc threatened it with nephew #1. We think it scared him out, because after 12 hours of pitocin induced, completely non productive contraction, he came out in another 30 minutes or so.
Here’s the thing I don’t get, though. (Never planning on having kids, myself.) A ‘due date’ is generally an estimate, right? I mean, yeah, it’s probably a good estimate, but still, and estimate. If the baby goes past the due date, doesn’t that just mean it isn’t ready yet? I’m not talking about a woman who plans a specific date, cause I’m great with that. I mean, in my sis’ case, she was off for the summer anyway, so anytime mid-june is still plenty of time, generally speaking, to recover before school. But she was 3 days past her ‘due date’ and the doctor told her it was now or never. She had a different doc for nephew # 2, fortunately, but I was still pretty dismayed that 3 days was enough past her due date that the doc felt intervention was required.
Hmm. Let me try to address Sailorman’s first post as accurately as possible.
Your first link, “Homebirth debate blog” is run by an OB, who is well-known in the midwifery community for shutting down discussion and dissent among her commenters. And being an OB, well, it’s not inconceivable she has an axe to grind. Midwives take her business. OBs have a long, documented record of attacking midwives with slander and outright lies; there are many good ones out there, but you have to take this into account. I don’t consider her posts to be anywhere close to honest attempts to deal with the issue. Certainly she has the right to her opinion, but she’s not a reliable neutral cite.
What is an undisputed fact is that the World Health Organization recommends a 10% c/sec rate, and ours is triple that. This is a matter for concern.
A more interesting link from Birth than the one you cited is this: that seems to indicate that over-prescribing c/sections may raise infant and neonate mortality.
A French study last year showed that c/sections may also triple maternal mortality.
The upshot is that there are lies, damn lies, and statistics–you are going to be able to interpret the same studies differently if you choose. What there also is, however, is a high rate of surgery being practiced on American women, and you don’t need a study to understand that more surgery=more complications.
You also have a tremendous and growing body of anecdote from women themselves that they feel abused, assaulted, and put in danger by an increasingly mechanized and indifferent healthcare system. My mother in law is an L& D nurse and has been for 20 years, and not a person given to exaggeration. I could tell you some stories of cruelty and bad practice that she’s witnessed…far too many of them….that would curl your hair. If you were ever to go to an ICAN meeting (www.ican-online.com), you would hear even more.
Now, you can believe that American women are somehow feebler, less healthy, and less able to understand what kind of healthcare they need during pregnancy and birth, or you can ask yourself if something is going on. Given a long, documented history in this country of medical neglect and abuse of women and minorities, it is at very least a valid question to ask.
The most telling fact to me whenever this debate comes up is this one; very very few OBs have ever seen a completely natural birth without interventions. These are the people who are supposed to understand the birth process and guide women through it. And yet, they know absolutely nothing of how it’s actually supposed to look when it’s happening naturally. They are trained to be surgeons and manage crises, not to understand birth. Small wonder that so many are eager to redefine birth as a surgical process; to a man with a hammer, everything looks like a nail. The nail is not consulted about it, either.
Wishy-washy – about that vitamin K shot. If your hospital is one that waits until the cord stops pulsing before they cut it (a good thing), then expect the vitamin K shot to cause some level of jaundice. It will require that you nurse as much as you can get the baby to nurse to flush out the bilirubin. Not a bad thing, but something you need to know to expect.
I think some of the best books I’ve read have been Henci Goer’s books. She takes the actual medical studies and lists what they actually say. Once you read these, you realize just how much mainstream media distorts medical studies (no surprise to most of us).
I had two all natural births. One in the hospital, one in a birth center. I’ll take the birth center any day. My labor was harder than it had to be in the hospital because they kept coming in to disturb me just when I would get in my “zone”. Even so, I had what would be considered extremely easy births – less than 12 hours for both (and the first was OP).
Given the right doctor though, and the right procedure, it can be perfectly safe to induce. My son Shawn was an induced birth because I was swelling pretty badly and we had a 36 week ultrasound (I had a lot of ultrasounds, I was scared to death that this baby was going to die too, and so this pregnancy was fairly closely monitored) that showed him weighing just about 7 and a half pounds. Given the half a pound a week that they gain in the last month, my doctor was concerned about my ability to have a 9 and a half pound child naturally and coupled with the swelling I was having, we decided to induce 10 days early. It was the easiest thing I’ve ever done- I went in and had a pill inserted vaginally, 4 hours later they sent me home with no progress and was instructed to walk around and be active, but not over do it and come back the next morning if nothing had started. I was home 45 minutes before my water broke and 4 hours later my 8lb 10 ounce child entered the world with no epi. I begged for one, but the anesthesiologist was busy with a (ironically enough) c-section and was unable to give me one. I am so unbelievably happy and satisfied with the birth I had with my son that it’s hard to describe. That being said, I see a family practice doctor who doesn’t even do c-sections and her rate of patients having them is extremely low despite the fact that she is very open to medical intervention if the patient requests it. She’s also completely open to letting nature take it’s course if that’s what the patient wants. Just one of the many reasons I love my doctor- she really gets the whole trusting women to make their own decisions.
Please tell me there’s a chance this was garbled in the re-telling. A 10 cm diameter head just passed through the vagina; how on earth could newborn feet then tear their way through, no matter what position they’re in? I have never, ever heard this excuse made for a C section before.
There comes a point where you get really sick of repeating over and over: no, I don’t want an induction. I was planning to let my OB schedule it and just not show up, since she wasn’t listening. Luckily, the kid decided that he was taking control of the situation and showed up 2.5 weeks early, but healthy. After a 4.5 hour labor, the majority of which was at home. The OB’s partner showed up at the hospital just in time to catch him.
And I’ve trash-talked my OB to every other pregnant woman in the area by now.
But here’s another story I heard from someone I trust: she was in L&D being monitored after a non-pregnancy-related issue (she broke a bone in her foot) while she was 36w pregnant. Her husband was standing out by the nurse’s station when an OB said to the nurses: “I have 7 inductions scheduled tonight, and I want at least 4 of them to be cesareans.”
Worthwhile read: Misconceptions by Naomi Wolf.
She points out a study that showed C-sections were more common on Fridays and before three-day weekends, indicating that doctors perform them often out of convenience rather then medical necessity.
You said:
Absolutely. When my sister gave birth she said “no drugs, I want to do it natural.” But the nurses and doctors didn’t believe here and they came in every 15 minutes asking if she was ready for drugs yet. They acted just like drug pushers. They just wouldn’t take no for an answer. Finally after hours and hours of saying “no” my sister finally gave in and got an epidural. (And then regretted it when she got the hospital bill.)
Then, even as she and everyone in the room said “no episiotomy” the doctor just ignored everyone and cut my sister. It wasn’t necessary. It wasn’t an emergency. She could have torn. Tears heal better than cuts. But the doctor didn’t want to wait. So he just did it.
After watching that experience, and reading Misconceptions, I decided if I get pregnant I don’t want to have a hospital birth. I want to have experienced mid-wives help me give birth at home or at a birthing center. Hospital births make me sick to my stomach.
Companies generally don’t pay “maternity leave”, even if they say they do. What you get is really disability pay. Which kicks in when you become medically unable to work, by pregnancy or any other medical reason. This is one reason why many women work up until the day they give birth–until that point they are medically cleared to work. There is a one-week waiting period and then you will get about 2/3 of your base pay. Disability stops when you are again able to work, which is generally 6 weeks after the birth (or 8 weeks after a c-section). None of this leave has anything to do with the care of the infant, it is about the health of the mother. You get extra time before or after birth if there are qualifying medical conditions that warrant you to be on disability.
Any extra leave that is taken (for FMLA if–and that’s a big if–you qualify for that) is usually unpaid unless you have accumulated vacation/sick pay to use.
During my first pregnancy, I was put on bedrest at 36 weeks for preeclampsia which qualified me for disability pay. I missed a week of pay and then received 2/3 pay until I was 6 weeks postpartum, at which time I was cleared to work. I wanted to wait until my baby was 3 months old, so I took the remainder of that time as unpaid leave–which was not guaranteed because even though I worked for a mega-corporation (a Tyco division at that) there were not 75 employees within a 50 mile radius so they were not bound by it. I returned after 3 months and had my job–but I heard later that they had tried to fill the position and had been unsuccessful, so there was no guarantee.
Kat – many companies only have short term disability for 6 weeks. I think on purpose. They say after that it’s long term disability and many don’t provide that. You have to purchase it either outside the company (AFLAC for example) or as an additional deduction through your company.
Yes, sorry, I didn’t mean to infer otherwise. My point being that there is usually no such thing (in most of the workforce) as “maternity leave”.
The disability pay I received was of the short-term variety. I think it would have tapped out at 12 weeks (10 years ago so can’t remember). Anything else would have had to go to long-term. I got 10 weeks total I think, between my bedrest and the postpartum. If I had a longer perinatal condition, I would have been out of luck on the other end.
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