From moment my family physician and an obstetrican decided that a caesarean was needed during my first labour, despite all evidence to the contrary, my whole world has revolved around caesarean and VBAC issues. The trauma I experienced from that decision effects me to this very day, though now it is in positive ways instead of the intensely negative ways it haunted me for years previous. My eldest son's caesarean delivery was fourteen years ago this month and I now see his birth as a blessing.
VBAC (vaginal birth after caesarean) was a viable and even preferrable choice for all women who had experienced a previous caesarean in the 1990s. With the low risk of 7 women in 1000 possibly experiencing a uterine rupture and 5 out of those thousand babies being compromised by complications resulting from a uterine rupture, VBAC was stronly encouraged. A high success rate, especially for women planning an HBAC (home birth after caesarean), ensured a low caesarean rate for women, physicians and institutions.
Then a funny thing happened. Obstetricians in the US found that their promise, to ensure a healthy baby with every pregnancy, was backfiring on them. They found that women, when faced with a fetal demise or compromise were suing the very physician who promised perfection. Interesting how that works. But instead of providing a better educational support system for their patients, they chose to limit their choices... severely.
With an already rising caesarean rate ACOG (american college of obstetricians and gynecologists), the trade union representing US Obstetricians and Gyaecologists, decided that despite the evidence to the contrary women wanting a VBAC could only labour in hospitals equipped with 24-hour ORs. With a primary caesarean rate already over 20% (despite WHO's recommendation that any caesarean rate over 10% increases the risk to both mother and baby because of a surgical delivery) this would automatically skyrocket the caesarean rates and would greatly increase the risks to mothers and babies. Well the CDC just reported an almost 30% caesarean rate in the US and an infant mortality rate so horrible the US ranks at 36th in the world.
Canada is no better, their own caesarean rates are rising right along with the US even though their organization, the SOGC (Society of Obstetricans and Gynaecologists in Canada) is much more evidence based in their guidelines. Given that they rank 22nd, and with socialized medicine, this is deplorable.
Here I am, mired in the statistics of it all, while I watch women shattered by their forced caesareans and yet I also see the miracles women experience in this dire pro-caesarean medical nightmare who have amazing VBAC births.
Case in point, last week a wonderful, well-educated woman went into labour with the complete support of her physician for her planned VBA2C (vaginal birth after two caesareans). Yet upon entering the hospital, she was told she would have to undergo another caesarean simply because her pro-VBAC physician was not on call. She is now recovering from her surgery and the nicked bladder she received because of her unnecessary surgery. She has a lot of healing to do, both physically and emotionally. In the same city another mother scheduled her ERCS (elective repeat caesarean section) based on her scaregiver's fear of uterine rupture which was then placed on her. Upon admitting was found to be in labour and she gave birth vaginally later that day despite her initial decision to birth otherwise (though she was thrilled).
Where is the logic in this? Women fight and fight for their right to birth vaginally, only to be coerced into surgery, or worse, given no choice. It is indeed a sad and scary time for birthing mothers. It is these very mothers that I support. Emotionally, informationally and physically during their pregnancy, after their births. It is their perinatal professionals that I train to support them, educating them about the unique fears and hurdles scarred mothers face. It is my passion to provide that support, information and training. So thank you to my self-focused, arrogant physician who wanted his weekend free the Friday I was in labour with Eric.
2 comments:
Great post! One question, though, can you link to document your sources to bolster your concerns?
Is infant mortality connected to a higher rate of ceasrean birth and poor care? I heard, but don't quote me ;-) Marsden Wagner say that the *maternal* mortality rate is a much better measure of quality of care. Surprise, surprise the USA is at the bottom of the barrel there too (don't ask me to quote it).
A local maternal child health epidemiologist once told me that for black women in Alabama from the 1940s to the 1980s fared MUCH better under the granny midwives than under the Medicaid system which drove them out. Margaret Charles Smith, for example, wasn't allowed to carry a blood pressure cuff or Pitocin and never lost a mother. Amazing.
Women deserve better. You ought to go posting on some OB and OB nurse's blogs and get a good discussion going.
I will email you my sources and blog about them later, thanks Anne. As for infant mortality, I hear your concern but maternal and infant mortality tend to coincide outside of areas/countries with high caesarean rates where the maternal morbidity climbs higher than infant because of the increased risk to the mother of surgery, its side effects and the long term risks to future pregnancies.
I completely agree with your thoughts on the better outcomes of Alabama granny midwives, their records prove that. Women indeed deserve better and thanks for the heads up, I will pay more attention to obstetrical blogs.
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