Category: Pregnancy & Birth

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c-sections Current Events Health Pregnancy & Birth

Maternal Death Rates Rise- C-Sections Now Considered a Factor

On February 2, 2010 California Watch, published a story about California’s maternal mortality rate.  It reported the maternal mortality rate in California had increased from 4.3 deaths per 100,000 births in 1996 to 16.9 deaths per 100,000 births in 2006 (the last year statistics are available).

The article cites some factors that are thought to be contributing to this upward trend, and it was not a surprise to me to read that C-sections, and repeat C-sections are one of the main factors officials are finally now considering for the increase in deaths.   The article points out that C-sections are now the number one surgical procedure performed in the United States.

How can California, have such a high maternity mortality rate?  One would think, after the way modern medicine is used in birth today, that the opposite would be true.  This trend is actually not just being seen in California- the entire US maternity mortality rate has also been increasing to the point that it is worse than in some developing countries.  As of 2007, the United States ranked 41st in maternity mortality out of 171 countries.

Officials are now conceding that the increasing C-section rate, might have something to do with the maternal mortality death rate.  As the California Watch article points out, “doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.”

Along these lines, while researching this blog post, I came across an interesting report from The Joint Commission dated January 10, 2010 on preventing maternal death.  It cited a study by the CDC which listed the six leading causes of maternal deaths between 1991 and 1997. The second leading cause was was hemorrhaging, causing 17% of the deaths. The fourth cause was infection at 13%.   The report goes on to identify and cites two out of the four common preventable errors that lead to death were: failure to pay attention to vital signs following a C- section, and hemorrhaging following a C-section.

It is interesting that a leading cause of maternal death is hemorrhaging, and one of the most common errors that leads to death is hemorrhaging after a C-section. The CDC reported on these findings thirteen years ago, and officials are just now seriously considering there could be a link between C-sections and a significant rise in the maternal death rate?   It doesn’t seem like this has been a hidden fact, or that the research wasn’t being done.  This seems more like a case where statistics and research has been emerging for years, but has been largely ignored or brushed off by medical officials.  Until now.  When California’s maternal death rate is worse than some countries like Bosnia or South Korea.

I have my own theory that the higher a state’s C-section rate is, the higher the maternal death rate will be.  While the CDC reports on the C-section rate for every state, not every state publishes their maternal death rates.  I could only come up with an handful of state statistics for 2006 on maternal death rates.  It’s not enough to draw a definite conclusion.  But consider that  Pennsylvania had 19 maternal deaths and their C-section rate was 29.7 percent.  Washington had 20 maternal deaths and their C-section rate was 28.4 percent.  Compare that to California who had 95 maternal deaths and a 31.3 percent C-section rate, and Texas, who had 90 maternal deaths with a 33.2 percent C-section rate.

It’s no secret that other countries who have lower C-section rates also have lower maternal death rates.  In Ireland for instance, the C-section rate averages around 21 percent.  A joint UN/WHO report in 2007 found that Ireland also had the lowest maternal death rate in the world for women dying during or after pregnancy.  Only one out of 47,600 women died, compared with one in 4,800 in the United States.  The C-section rate in the United States in 2006 was 31.1 percent.  It has been projected (but not confirmed yet) that the C-section rate in the US for 2007 will be 31.8 percent.

The California Watch article tells of a medical director in California, Dr. David Lagrew, who in 2002, banned elective inductions at his facility before 41 weeks  or pregnancy, except in rare incidents.  Inductions more than double the chances of C-sections.  The article says,  “as a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.” (bold print mine)

This should have been great news, but as expected, the hospital lost money.   On average a C-section costs twice as much as a vaginal birth.  Yet, we are constantly told that revenue has nothing to do with the increasing C-section rates.  It is because the C-section is “medically necessary.”

If Dr. Lagrew was able to decrease “medically necessary” C-sections in California, right when the maternal death rate was increasing, it ought to be done elsewhere. If Ireland can have the lowest maternal death rate in the world, despite not having all the technological advances that the United States has, and has a considerably lower C-section rate than the United States, that should tell all the officials out there who are trying to figure out why the maternal death rates are increasing, that C-sections are a significant factor in maternal death rates.

It is the white elephant the medical community, and hospitals in general won’t admit, despite research pointing them in this direction for years-decades in some instances.  And yet, the C-section rate continues to climb, and more women are dying during pregnancy and childbirth.

I looked up the modern version of the Hippocartic Oath that doctors take upon graduation.  After reading these, it is hard to be convinced that most doctors have these oaths in mind in regards to C-sections and births in the United States:

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,…”

and the last one:

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

Maybe it is as simple as that.  Maybe if more doctors and hospitals realized a woman’s body is capable in most cases of giving birth without surgery, and let their bodies do what they are capable of doing-just like Dr. Lagrew did, maternal mortality rates would drop in our country. Maybe when “Big Business” gets out of the birthing process, C-section rates will decline, improving maternal health.

The answers to solving the increasing maternal death rate are out there, and have been for years. The question that demands an answer is, when will the majority of the medical community stop ignoring the answers?

Categories
Breastfeeding c-sections Health Mothering Pregnancy & Birth

The C-Section Difference

It has been a while since I have written on the topic of C-sections.  However, a post I wrote almost two years ago, The Reality of C-Sections, remains the most popular post on A Mama’s Blog.  It has received over 11,000 page views to date.  I decided to share my C-section experience and what I learned so others could be informed, and make decisions about C-sections based on knowledge.  I would have never been able to go out and tell 11,000 plus people my experience, so I am pleased the post has been successful. 

Of course not everyone agrees with me, and I get passionate comments from women on both sides of the issue.  Some women have chosen to share their own C-sections stories with me privately, and in the comments.  Some are horrifying.  Some are heartbreaking.  I have cried at many of the stories, because so many of the causes given for the C-sections seemed so unnecessary to begin with, and the toll the surgery has taken in these experiences, is extensive.

I have received many comments from women who say their C-sections were great experiences and they have no regrets.  I have received accusations from other readers who think I am trying to scare women.  I have been called every obscene name at least twice.  

I don’t mind a difference of opinion that is conducted in a respectful manner, but after my health issues last year, I have less of a tolerance for rude comments and readers taking personal shots at me.  Lately, whenever I see a comment has come in on the C-section post, I get butterflies in my stomach, and hope it isn’t a nasty comment.  I have defended my position so many times in the comments there really isn’t anything new that I can offer, that I haven’t already stated.  If it is a comment attacking me personally, I delete the comment.  It serves no purpose to anyone to state an argument in that manner.

I have been thinking about closing comments on that post.  At what point does a discussion run its course?   But then I will receive a comment from someone who has thanked me for writing the post.  Or a woman shares her C-section experience.  So many women have said they have cried while typing out their stories, and I believe just by being able to type out the words, it helps heal.  I know, because writing helped me start to heal from the unresolved issues I had from my C-section.

On Sunday a very touching story from Sarah was posted on her C-section experience. (It is the fifth to the last comment currently in that post’s comments).  Her experience brought tears to my eyes, and as soon as I read this sentence that she wrote, “i am not sure that i will ever get over the emotional trauma i experienced when my daughter was born,” I realized closing the comments would be a mistake.  Reading this from Sarah made me realize how deeply the emotional trauma can run from a C-section.  While it lessens, it never fully goes away.  Just like the positive aspects of birth never go away, the negative emotional tolls don’t either. 

Six years has passed since my own less than ideal and emotionally traumatic C-section.  It is disheartening on some level to read that some C-sections are even worse than mine was six years ago, and that they are still being performed at an alarming rate- almost one in three births in the United States is a C-section.  (This figure is from 2007, and is probably higher for 2008 and 2009 but the rates have not been released).  It seems at times for those of us who believe C-sections should be reserved for true medical emergencies, it is an uphill battle.  What difference really can we have?

I found out how much of a difference one person’s experience can have this past weekend.  I was getting my haircut, and only have it cut every few months now.  My stylist, “Emily,” told me she was seven months pregnant, and of course I congratulated her.  Emily is young- at least young from my perspective- she probably is not older than 25.  She knows I have two boys, and she asked me what hospital my kids were born at.  I told her, and told her I had a C-section with my first son and a VBAC (vaginal birth after cesarean) with my second son.  Emily asked me which was better- the C-section or the vaginal birth.

I told her the VBAC by far.  I told Emily I was holding my baby seconds after he was born, versus not being able to hold my baby for an hour after birth with a C-section.  I told her I was able to eat 30 minutes after the VBAC, versus three days after with a C-section.  I told her I bonded instantly with Cole after he was born, versus five days with Ryan, after the C-section.  I told her I was nursing Cole within minutes after the VBAC, versus an hour with the C-section.  I told her I felt better three days after the VBAC birth versus twelve weeks, with the C-section.

Emily was quiet for a minute, and I was wondering what her reaction was going to be.  She put down her scissors and told me, “Thank you.”  I was a little surprised, because I was expecting her to tell me she had heard C-sections weren’t that bad.  Emily told me that she wanted a natural birth, and so many people have tried to talk her out of a natural birth.  She also said so many have told her that she’ll end up with a C-section anyway.   Emily said she was starting to doubt if she could really give birth naturally, but hearing my comparisons, it firmed her resolve.  Emily said unless she had a medical emergency, she was going to give birth naturally, and not let anyone talk her into a C-section!  It was so encouraging to hear a younger mother with that attitude.  I told her of a few resources that could help her even more, and she thanked me again for being honest about my birth experiences. 

I have thought about this exchange for a few days now, and after reading Sarah’s sentence, the realization became very clear.  Emotional trauma from a C-section does not ever completely vanish. It will always be- to some extent or another- with us.   It doesn’t matter if it was a week ago, twenty years ago, or if it was a medically necessary C-section or not.  We can never go back and undo what was done.   But our honest experiences with C-sections can be more powerful to someone who is seeking information than any books, or medical professional.

When women are told they need to “get over” their traumatic C-section births, by ignoring the parts of their birth experience which were negative, or traumatic, it doesn’t “magically” make everything better.  It harms the women again, because now it isn’t acceptable to share or to talk about anything that isn’t a positive birth experience. 

There are still women, like Emily, who believe their bodies are capable of giving birth the way they were intended to do so.  There are women who don’t believe insurance companies, hospitals, drugs and surgeries are the answer to birth.  These women want to know the truth, and are seeking answers.  On the opposite side, there are so many women who had no one who shared their C-section experiences with them, when they had to make their decisions.  There are women who have lost so much, and and have been hurt from C-sections.  How do these two sides come together?

By telling our stories.  It doesn’t matter that some won’t agree with you.  It doesn’t matter that some will tell you to get over it.  It doesn’t matter that some will tell you, you should be grateful your baby is healthy.  It doesn’t matter that some will accuse you of trying to be overly dramatic.   It doesn’t matter that not all C-sections are traumatic for everyone.  What does matter is ours was.  What does matter that someone else’s will be too.  What does matter is we talk about it.  It matters that we share our stories, and honor our birth experiences- all of them. 

For the women who refuse to accept a C-section is the normal way to give birth, by sharing our experiences, we confirm their instincts, and they confirm ours- a surgical birth is not usually the best way to give birth.  Most importantly, by talking about it your spirit starts to heal.  A little at time.  Never completely, but enough. Our experiences become patched together like a quilt.  This is enough to make a difference, one birth at a time.

Categories
Mothering Parenting Pregnancy & Birth Ryan

Six on the Sixth

This morning, my baby boy (who isn’t a baby any more) turns six!  It seems every year I am amazed at how fast the time has gone by.  I look back at Ryan’s baby pictures, and can’t quite comprehend where that baby went.  It also seems his baby days were over in an instant.  When I think back to those first few months with a newborn, it didn’t seem possible that really, in a blink of an eye, he would ever be six. 

One of my most cherished memories of Ryan was on the day we came home from the hospital.  I had been in the hospital for five days because I had some complications from a C-section.  The hospital was a hustle and bustle, and there was always someone coming and going, or a nurse in the room checking either on Ryan or myself.  I had so much pain, bonding with Ryan had been hard- I was trying to learn how to take care of him, and manage my pain.   

We came home in the afternoon, and Ryan’s dad left to get some food.  For the first time, it was Ryan and I at home, by ourselves.  I was sitting in a glider, just having finished nursing him, and he was asleep in that happy little milk coma, newborns fall into.  He had a little smile on his face while he was sleeping and his head fit in the palm my hand.  His body was not longer than my arm up to my elbow.  I remember just sitting there and looking at him, and I fell in love with him in that moment.  I had tears running down my face because of the feelings I felt for him- all 7 pounds of him!

So to Ryan, six years later-I love you more than I could ever even imagined that afternoon.  You are simply amazing, and I learn so much from you every day.  At six, you love routine and order.  You love playing school (you are the teacher of course) and you like playing pharmacy (you are the pharmacist- of course).  I am very happy that you love school and learning so much.  You are becoming quite the reader, and enjoy reading to us.  

You are discovering sports and have played soccer and basketball during the last year.  You keep asking when you get to play baseball, and you can throw a baseball really well.  If I had to make a prediction, I think baseball is going to be your sport. 

Your favorite food is a tie between ice cream and macaroni and cheese, but you are trying more and more foods.  You also like spaghetti, ham, and chicken.   Your favorite breakfast is Cinnamon Life and waffles.  You would drink a gallon of milk a day if you could.

You ask a lot of questions now too!  The other day you were asking so many about football, for so long, I asked you if you could stop asking questions for a few minutes, and you asked “Why, questions are good.” 

Even at six, the love and patience you show your younger brother, Cole, is touching.  You think about him, and are concerned with his well being.  As we were taking down the Christmas tree, Cole was crying because he was sad Christmas was over.  You went up to him, and put your arm around his shoulder and said, “Don’t worry buddy- I know it is sad, but Christmas will be here next year, and Santa will bring us new presents.” 

With examples like this, I often think you are much older than you are- sometimes you seem like a little old man trapped in a much younger body.  That first afternoon at home with you, I loved you because you were my baby.  I had no idea who you were, what your personality was like, or who you would become.  Six years has gone by so fast Ryan, but every day, a little bit more of your personality gets reveled.  It is a joy to watch this, and I am so lucky and fortunate I am your mom.  

For the next six years, I plan to make sure you do your “job.”  You like to know what people’s jobs are, and sometimes you become too concerned with adult issues.  So your job is to be a little boy, to play, to have fun, to do well at school, and most importantly- eat ice cream.

Happy Sixth Birthday, Ryan.  I love you!!

1/16/04- 10 days old

October, 2009- Kindergarten picture

Categories
c-sections Mothering Pregnancy & Birth

The “Best Of” C-section Recovery Tips

I was recently contacted by Elizabeth McGee, who runs the website, Worryfree C-section.com.  Elizabeth’s purpose was very intriguing to me- she isn’t promoting C-sections, but is helping women understand what is involved in a C-section.  Elizabeth writes “Whether your c-section is planned or comes as a surprise, I’d like to help it be as momentous as possible by informing, educating and familiarizing you with the physical and emotional aspects of preparing, having and recovering from a c-section.”

I was honored that Elizabeth decided to post my blog article, Recovering After a C-section, on the site’s blog collection of the “Best Of” C-section Recovery Tips.  I also like Elizabeth’s article, Emotional Recovery After a C-section.  I feel this is one area that women are usually not very well informed on regarding C-sections, and it good to see it addressed. 

I always encourage women to find out as much as they can before hand about C-sections. If you are researching C-sections, I think you will find the information Elizabeth has compiled at her website and blog, from other moms and professionals very informative and helpful.

Categories
c-sections Current Events Health Mothering Pregnancy & Birth

C-Sections- Five Years and Beyond (Part 3)

Since the five years I have had my C-section, I was told many times that I should just be grateful my baby was okay, and I should get over the negative feelings that I had regarding the experience.  I noticed that almost every woman who responded to my questions had something about her C-section that she was not happy about, or had been unprepared for. 

I think our society is very harsh with mothers who have given birth by  C-section in this regard.  A C-section not only brings a new life into the world, but it is also a major abdominal surgery. If a heart patient has a negative experience with heart surgery, their feelings are usually not discounted and told to get over it.  Of course all mothers are happy their babies are born healthy, whether they are born vaginally or by C-section.  But that does not, and should not invalidate any negative feelings a mother may have giving birth by a surgical procedure.   

Simply saying a mother should get over it, and be happy her baby is healthy is like telling a survivor of an awful car wreck, “at least you didn’t die,” or “you should be happy you are alive.”  That is a given- but the pain and trauma from the experience also needs be to validated in order for the survivor to heal.  We acknowledge the pain and suffering of car accident victims all the time.  We do not invalidate the victim’s feelings just because they are alive.  

Yet that is what happens to women over and over again, who share their negative C-section feelings. Their feelings are invalidated and they are told and expected to dishonor any negative feelings they have about their C-section births. 

Birth is one of the most powerful things a woman experiences- what kind of message does that send to a mother when she is told her feelings she has regarding her C-section are not valid?  

The C-section rate continues to rise in the United States every year.  According to Childbirth Connection, in 1965 the C-section rate was 4.5%.  It is estimated that when the 2007 figures are released, they will show the rate over 30%, or one in three births are a C-section. In some hospitals, the C-section rate is 50%. 

My C-section made me doubt my body.  I trusted my doctor more than myself.  Doctors are experts in medical procedures, and we are all grateful to have them for medical emergencies.  However, women are the experts on their bodies.   For thousands of years, midwives- other women- assisted during birth.  Birth is normally not a medical experience or emergency.  Yet, that is how the entire process is generally approached.  Women are made to feel that they are not capable of giving birth without a doctor present in a hospital. 

Ina May Gaskin, one of the most famous midwives in the world, who has her own birthing center in Tennessee, did not have a woman who needed a C-section until the 187th birth that she attended.   The next C-section birth didn’t come until after the 300th birth.  Contrast that with one in three births being a C-section today. 

It is my opinion that women are losing the ability to believe that their bodies can give birth, and birth is not a medical condition.  Add to this, the women that are told to “get over” their negative birth experiences and not acknowledge their feelings.  How does this attitude in our society prepare a woman for her next birth?  How does this psychologically affect her?  Is she more likely to believe in her body for the next birth or decide she needs a C-section?

C-sections have their place, and I am the first to acknowledge that.  But with every C-section that is performed that is not a true medical emergency, I believe we are teaching women and girls- the next generation- that their bodies are inadequate- incapable of giving birth without a major surgery.   As long as women allow doctors to make the calls for them, the C-section rate will continue to grow, and our choices for birth diminish.

Women need to support each other and share their birth experiences.  Perhaps one story of a successful VBAC will encourage another woman to try a VBAC.  One story of a woman’s experience with a C-section will help another woman avoid one.  We can support each other and learn from one another.  By sharing the good and the bad of our birth experiences, we lay the groundwork for allowing women and girls to trust their bodies.  After all, women are the experts in childbirth.  Who better to learn about birth from than another woman who has experienced it?

Karen Walker, a midwife, believes that “obstetricians will continue to encouraging the birthing mom to sacrifice her body on the operating room table until women begin to take the responsibility of her birth upon herself.”  She says, “Doctors will get off their pedestals only when women get off their knees.” 

The Unnecesarean.com was the first place this week that I read about Lauren Plante of Thomas Jefferson University’s essay, Mommy, What Did You Do in the Industrial Revolution?   In her essay Plante compares industrial obstetrics with the industrial revolution.  One profound statement she made when comparing modern obstetrics:

Industrial obstetrics strips the locus of power definitively away from women. The history of childbirth in America reflects a persistent trend of increased control by physicians and increased medicalization. Childbirth moves, first, out of the home, and now out of the vagina.  (bold print mine)

It is interesting to note that Lauren Plante is an OB/GYN. 

It is my hope by sharing my C-section experience, other women’s experiences, and by continuing to write about  C-sections,  that women who are considering a C-section for a non-medical emergency, can find real life experiences, thoughts, and information from other women that will enable them to trust their bodies can give birth. 

We each are given the power over our bodies.  The power is there- in all of us- to give birth to our babies.  We have to trust that our bodies can do what they were made for.  We have to get the information we need to feel confident in our bodies.  When will we feel we have given enough of our birthing power and choices over to the medical industry?  When the C-section rate nationally is at 5o percent? 75 percent? 100 percent?  

It is every woman’s right to attempt the birth experience that she feels is best for her baby and herself.  Please don’t give that right over blindly to a doctor simply because they are a doctor.  If you don’t want a C-section only because your baby is breech, then do what I didn’t do- fight to preserve that right.  Seek out midwives or another doctor.  If you are told your hospital doesn’t allow VBAC’s, and you want one, do what I did- find another hospital that allows it.  You don’t have to settle for a birth option, just because a doctor says that is the only way. 

If we, as women don’t demand better from our doctors and hospitals, then we, and our daughters, will never get anything better from them.  We will never get better choices, better information, better treatment, and ultimately better births.