Sunday, January 11, 2009

Putting Women and Their Babies Between a Rock and a Hard Place

Study: Early Repeat C-Sections Puts Babies At Risk

All Things Considered, January 8, 2009 · A new study published in the New England Journal of Medicine reports that elective, repeat C-sections performed earlier than the recommended 39 weeks increases the risk of complications for newborns. Dr. Catherine Spong, co-author of the study, says babies born under these conditions see double the risk of "adverse outcomes" such as nenonatal death.

This whole thing just angers me. I mean sneering-at-my-computer sort of angry. We as American women have been led to believe that birthing babies with a doctor in the hospital is a scientific event, supported by scientific truths, elicited from scientific studies. We have been led to believe that all interventions have been proven to be good for the mother and good for the baby, or at least not bad. We have been led to believe that questioning routine hospital policies is something reserved for the crunchy, anti-establishment, patchouli moms.

The reality is that we still do not understand fully the mechanisms by which labor begins. We do not fully understand the intricate interplay of the mother and baby and placenta which signals labor to begin and to be sustained. We do not know the effects of replacing naturally produced hormones, with their synthetic counterparts. We do not know how the deprivation of certain hormones (like oxytocin and dopamine) effects mother and child, their relationship, their bonding, or their long term development. The reality is that in a medical culture governed by litigiousness, that the illusion of firm knowledge has replaced a humble admittance of risk, and unknowing.

The article and interview above tells us that for women who have had previous c-sections, that elective c-sections before 39 weeks puts babies at risk. The doctor interviewed seemed to really stress that these c-sections had no medical purpose. Well that's all fine and good--but it is growing extremely difficult to find a birth practitioner and hospital who will allow a woman to attempt a VBAC (vaginal birth after Cesarean). The fear-mongering culture has stressed how dangerous VBACs can be, except that the evidence is skewed through interventions, such as inductions, which put increased stress on the mother's uterus. What is a mother to do? She is told attempting a vaginal birth is a no-no, and told that a repeat c-section is also a no-no.

The top priority for the majority of the medical birth professionals is to manage a woman's labor, to try to eliminate the unknown. The main end is to create an illusion of control and safety. The blame for this is wide-spread--it's doctors and women and their families and insurance companies and hospitals-as-money -generating-businesses. Like The Emperor's New Clothes, we have been collectively pretending that we both have full understanding of the mechanisms and systems involved in birth, and that we can take away all the inherent risks of birth.

Please don't misunderstand. I feel very, very blessed to live in a time and a place where the technology exists to improve outcomes for mothers and babies who would otherwise die or be very adversely affected through birth. It is a true privilege and gift. However, in my opinion, we have erred on the side of over-using technology. We have come to view technology not as a help when things have gone awry, but rather as a superior mechanism than the natural processes of birth. Furthermore, we have come to that viewpoint, without understanding the intricacies of the consequences of technological and pharmaceutical interventions. Obstetrics has a history of of using technology first, until it is proven to be detrimental; rather than demonstrating safety and outweighed benefit/risk ratio first. If you question that, think of scopolamine, DES, and the complete lack of long-term studies of the effects of sonography in utero.

It is so frustrating when information such as this new study comes out, and flies in the face of routine procedures adopted by hospitals and doctors. It is true that the ACOG has set their guidelines to reflect the 39 week marker as the determining factor in timing for elective repeat c-sections. However it is also true that finding excuses, or creating reasons to ignore this guideline is commonplace. If I am not mistaken, there was also a recent article about the detrimental effects of induction before 39 weeks floating around recently, though I cannot now remember from which source I had read it.

When, when are we as women-as a nation-going to stop cowering in fear--accept that birth has inherent risks, and start demanding that our bodies are honored!!? The process of birth isn't something which goes wrong most of the time. Our bodies aren't defective or incompetent as a rule. We have got to find some way to collectively muster up the courage to refuse non-essential technology at our births. We have to find a way to collectively demand that ALL routine procedures and medications given during birth are demonstrated to be beneficial both short and long-term. We need to insist that our birth practitioners tell us that they don't know, when they in fact don't know-for example the long term effects of sonography exposure, or the long term effects on mother and baby of replacing oxytocin with pitocin, or the effects on mother and baby of anything more than a brief separation in the days and weeks early post-partum, or the risks for their baby if they have elective repeat c-sections.


  1. It's about putting the REAL information in the hands of the public and making alternative choices more known to the less informed. It's about putting knowledge in peoples hands. Something I have long thought about is that most women go to hospitals to be a part of a child birthing class which teaches some natural birthing techniques and gives a tour of the hospital, but there is little education about what is actually HAPPENING during the birthing process. There isn't talk of why you might not NEED to be on an IV and be monitored the whole time you are there. That is most people's only option for any form of childbirth education. It isn't common place for folks to LEARN about the process. We only talk about how hard it is or how painful it is, but we seldom go through the stages of labor, so that women understand their labor and their choices to move around and find positions that make them feel better. They don't understand the jargon our medical professionals use and we are scared that something might go "wrong" because birthing has been put behind doors. It is no longer a community celebrated event with everyone in the community there to give a hand to the coming life and support. We have strangers holding our hands and rubbing our backs rather than sisters and friends. There is also the issue that real knowledge often costs money in our lives. The really good child birthing classes are for the elite who can afford them or who can buy all the books they might need to read to be informed about what is happening to their bodies. So many have no choice but to put their faith in their doctors because they can't afford to do otherwise. Education is soooo important when birthing. Understanding what is going on and that it is hard work to get a baby here, but that most of us ARE capable of doing it on our own and that for those extreme cases there is help, but it is about being informed and understanding about your choices. Hopefully, in my lifetime, medical care will not be just for when we are sick, but for teaching us better nutrition and how to actually take care of ourselves so that we are sick less and we will come back to KNOWING how to have babies on our own.

  2. I will admit that I had a pretty good experience in making decisions in the birthing process. I do think part of that though is that I educated myself. While I am hundred precent in agreement with the need for the information to be made easily available for the public, I also think there is a duty for women to educate themselves. Preparing to be a mother is about more than readying a pretty nursery. I read up on things, either online, or through magazines.
    I made a birthing plan, gave it to my doctor, went over it with her and compromised on certain issues while holding my foot down on others. I didn't get an IV, but I accepted a hep lock. I had it put in my birthing plan that I wanted to be allowed to walk. I brought in a birthing ball, serene music, and some knitting.
    In the end, I ended up with a birth that was more filled with interventions than I had planned or wished for. But each of them was necessary and discussed thorougly. I refused the epidural until I knew I would be too exhausted and not up to pushing the baby out myself if I refused any longer. (I think after about twelve or more hours into active labour. *L* He really didn't want to come out!)

    Yes, the birthing was harder than average, and no I wouldn't wish for the same experience again. But I am happy with the amount of control I had.
    In a society as litigatious as it is here, I can understand medical professionals being scared to let nature take it's course. There is always the real risk that, if something DOES go wrong, they will be accused of not having done enough. Until we take our own responsability, I do not see much change. We need to inform ourselves. The information is out there, the questions will be answered if we bother to ask them.

  3. My biggest gripe is the lack of humility in the whole medically-based birthing process. There is a pandemic inability to simply sat "Well, we don't really know. This is the best we know to do for now, but we aren't precisely sure how it works, nor the long-term implications."

    However-my gripe is not just aimed at doctors and medical staff--as I wrote, I think there is lots of blame to go around.

    It ties in with something we talked a bit about in WD at CF--we live in such fear as a society--that we are ever ready to latch onto the illusion of safety, rather than accept that there are just things which are truly out of our control. There's that fine line between being prepared for reasonable events, and trying to avoid that which is not very likely to happen at all.

    One of the things which I think makes this all very difficult, is that people treat medicine as science--when frankly, in my opnion it is not. Its technology, applied science--and the application process can morph the truth of what has been discovered, or overshadow that the truth is yet unknown. It's all such smoke and mirrors, and we just buy right into it.

    (I don't, but I have the benefit of having had 7 babies and assisting at some births, as well as study to be a CBE and a doula--most people having one or two children, don't have the benefit of those advantages to become hyper-well-informed consumers of childbearing care)