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.