Wednesday, May 13, 2009

Thoughts on OBs c-sections, and modern maternity care

Anna commented on my twins' birth story post with this:

I keep wondering about the hospital staff and their attitudes. Do you think they are actually malicious? Seems unlikely... Or just don't know any better? Or know better but want to take the path of least resistance (which often means C-section) to avoid law suits? Which is it? You must have thought about it a lot...

Here's my take:

No, I don't think that doctors and hospital staff are generally malicious. I do, however, think that a lot of doctors - OBs in particular - have a God-complex. I've experienced this firsthand with my own births, and also with the births I attended when I was setting out to become a doula.

I think that doctors have decided over time that they have come up with a better way for women to have babies than what nature intended.

I think the whole climate surrounding birth in western culture has generally become one of fear. It's become something doctors see as a process that needs to be controlled and managed, and this way of looking at it and treating it feeds on society's view that birth is a dangerous undertaking, and one that has potential catastrophe lurking just around the corner at all times. Very few people trust the natural process of pregnancy and birth anymore. Very few women trust their own bodies to do what they were made to do: have babies.

I believe that at last count, the c-section rate in the U.S. stood at about 33%. That means that roughly one in three births ends in c-section. I find that apalling. There are many reasons behind the sky-high c-section rate: convenience (doctors like a controlled process where the outcome is in their hands; women like to have a say in when their baby will actually be born); repeat c-sections (VBACs are once again becoming a thing of the past, so we're getting back to "once a c-section, always a c-section"); fear (women would like to avoid labor and the prospect of pushing something that big out of a place that small is terrifying because women have lost faith in themselves); and the bottom line, money. The fact of the matter is that maternity units tend to be the biggest profit centers for most hospitals, and c-sections bring in more money for the doctors and the hospitals than vaginal births do. There is also the matter of lawsuits. Yes, the high c-section rate is also driven in large part by the desire on the part of the doctors and the hospitals to avoid lawsuits. People don't tend to sue over c-sections, because they are viewed as life-saving measures. If a c-section is performed, then everything possible was done to preserve the well-being of the mother and baby, or so it seems (of course, people rarely talk about the very serious risks associated with c-section, like infection, breathing problems in the baby because they didn't go through the birth canal which stimulates and prepares a baby for breathing on the outside), surgical injury to other internal organs, blood clots, etc.

Hospital maternity care (and I'm speaking in generalities here; I realize that there are exceptions to this out there, but they're few and far between) is an assembly-line process. Once a woman is admitted to the hospital in labor, she is put on an unspoken time clock. She is expected to dilate a centimeter per hour, and if she doesn't, her labor will be augmented with artificial hormones, which have their own risks. Women are generally not allowed to give birth in optimal birthing positions either. Although women are no longer tied to the bed lying flat on their backs like in days gone by, they are generally still restricted to a semi-reclining position. The optimal position to give birth is upright: gravity obviously helps a baby descend, and squatting opens the pelvis to its widest possible position. Allowing a woman to give birth in an upright position alone could do away with a lot of c-sections. Instead, women are made to push in a semi-lying down position, where the pelvis is not completely opened and gravity is not helping the baby descend, and when this position doesn't work for a lot of women, they're told that their baby is too big and a c-section is necessary for the baby's well-being. And then the women are just thankful that the doctors saved their baby's life.

There's also the matter of withholding food and drink during labor. This is an archaic practice that was first implemented in the days of twilight sleep, when women were tied or strapped (literally) to their beds during labor and given a concoction of drugs that didn't actually knock them out but would leave them with no memory of the experience. Withholding food and drink during labor has continued to be common protocol, and the reason given is usually that they don't want the mother to aspirate the contents of her stomach in the event of an emergency c-section (where general anethesia would be used). What an awful practice. Let's go into this thinking the worst. It's silly and ridiculous anyway. Think of all the emergency surgeries that take place as the result of car accidents - should we all just never eat because of the remote chance we might need emergency surgery at any moment? A person put under general anesthesia has their airway intubated, so the risk of aspiration is pretty much nill. Withholding nourishment to a woman in labor is cruel. It's basically preventing her from taking in fuel when she is doing possibly the hardest, most demanding physical work of her life. And then they wonder why she's too exhausted to push - in a semi-lying down position, no less - after hours in labor and no nourishment. Well, let's just do a c-section! That solves that problem.

Yeah, I'm kind of passionate about this :) I really think that anyone who wants to know more about birth in this culture should see Ricki Lake's documentary, The Business of Being Born, and/or read Suzanne Arms's Immaculate Deception II. Very eye-opening stuff.


Jen said...

I saw that documentary. Scared the ever-living shit out of me. Unfortunately, I saw it AFTER I had three kids. No C-sections here, fortunately, but did have Pitocin pushed on me for the first two. Hated it, hated it, hated it. By number three, I knew enough to decline it, and how to avoid getting to that point in the first place. (i.e. prolong the epidural...sucky, but I didn't have that sickness or swollen legs for a week afterwards).

Anyway. Great posts on a really neglected topic. I don't plan to have another baby, but if I did, I'd seriously consider homebirth.

Anonymous said...

Another good book:

Keri said...

I loved your post. I've never given birth, but I've heard many birth stories similar to your own from friends and relatives. I used to work with a woman who used to be a mid-wife when she lived in the UK. She didn't bother transferring her certification to the US because she felt our medical system dealt with birth in a "cold and unfeeling way" and she didn't want to be part of it. Also, she said she didn't want to be relegated to being a birth coach or glorified nurse and be unable to actually deliver babies (she said that was the fun part!).

My cousin's husband was stationed in the UK during her first pregnancy. She said that she had such a wonderful experience (birth in a suite that was like a studio apartment where the baby was also kept in a bassinet next to her bed, coaching from the mid-wife on breast-feeding, follow up housecalls from the mid-wife the day after she brought the baby home and then again each week for the next 3 weeks to check on both her and the baby), but didn't truly appreciate it until she gave birth to her second son in the US. Then, she checked herself out of the hospital AMA because the Drs were insisting she have a C-section because her labor had stalled and they considered her pregnancy high risk because of other health condition (same condition she had giving birth in the UK, where her condition is far rarer). She gave birth to a healthy baby about 1.5 hours after she went home and consumed the 2 liters of cola she made her husband stop and get for her on the way home! She said that if she ever had any more kids, she was going back to the UK to give birth.

Leigh Anne said...

lisa lisa lisa lisa...can i just say that I LOVE YOU!!!!! haha. I love this post and I agree one million percent! We are planning a home birth for our next baby. My hospital birth with Sydney was fine once my midwife was there, but before then...all the staff was afraid to mess with me haha. I know one OB in particular whom I would love to knock on the head once or twice ;) But, I stood up for myself and unborn Sydney...They kept talking csection b/c her 38 wk u/s showed 8'12" (rather big baby quote unquote). That is how much she weighed though at 40w4d. My midwife said I could birth a 12 lb baby naturally..."pelvis from Heaven" were her exact words, LOL. Anyway, I digress. It's completely about money and planned births (hey, the OB is going on vacation next week, I'd better schedule and induction (which often leads to c/s) or a c/s quick! Seriously?! I love Ricki Lake's documentary and was convinced of a HB before seeing it, but Daniel wasn't quite on board with me until our experience this time. I consider myself very lucky that I was able to stand up for my rights and not be pushed around, which many women think that "dr knows best"...and it's unfortunate. I keep telling every woman I know that I'm planning to birth at home...that makes them it's spreading the word!

(my bff had an HBAC three weeks before sydney was born...i was so proud of her!)...

2 c-sections said...

I had 2 c-sections and I think they should be avoided whenever
possible- the scars create a shelf
where fat hangs over-
Very attractive-
Your body was made to deliver
naturally. I had c-sections
because my kids had huge heads!
I tried for 2 day to have my
first- you should have seen the molding of his head! When my second son was born- my
doctor said there was no way
I could have had him without
a c-section- again head 90%
(their heads look more proportionate now!)
I think you should really try-
unless the baby doesn't fit
to have them naturally- I sure

2 c-sections said...

I have to add that when I had my first son 17 years ago they
were actually trying to reduce the number of c-sections in Ontario.
That's why I laboured for 2 days
before it was obvious that the baby didn't fit. I really think
that today they would have done a c-section much sooner...

Lisa B said...

I wanted to add a hopeful post in this discussion - I think so much of it comes down to the (i) doctor's training - depends when they went through school and what was "protocol" then - my OB who is in her late 40s let my friend deliver her twins vaginally without a second thought - never a discussion of c-section - Santa Monica at St. John's Hospital 5 years ago .. and (ii) the hosp itself - I definitely think the lawsuit angle is huge as to what they do...

And I was very pleasantly surprised that at my sister's recent birth in a San Diego hosp that the birthing room was like a hotel room, not hosp room, no pitocin was given and her water was not broken, she was just let to labor on her own til it happened on its own...they also have no nursery as baby is expected to stay with momma from minute one and family is asked to stay away for at least an hour to let mom and dad bond alone with the baby. Nursing and parenting classes are held everyday and announcements are made encouraging everyone to go if possible. Doulas/midwives are part of the process if at least the Sharp Hospital chain is more on track with a natural process. Hope the rest go back towards that approach. L

Angie said...

can I say that I love you also Lisa! I agree with you 100% and you have such a passion and a way with words (I can't write like that to save myself) I just love reading your thoughts.

Chrystal said...

Great post! You taught me a lot. In a small group of mama's I partipated in online when I was pregnant, over half ended up having C-sections. Amazing, huh?

I didn't, but it was threatened at 9.5 cm. I also had Pitocin, which I hated. The awful swelling I had could have been from that? I had no idea before reading these comments.

Darla said...

30 something days away from my delivery and I am wistful over the home birth I have never had. All 7 of my previous children were born in a hospital, some I know I could have gotten away with a home birth in retrospect, and some that seem like they would have been risky. (arriving completely and thoroughly gift wrapped by my extraordinarily long and thick umbilical cords, Alexi even had a thick knot)

So far my baby Ashton is breech, and to complicate things I tested positive for Beta Strep early in my pregnancy and the treatment for that is 4 hours of antibiotics before the baby is delivered. I have never even had a 4 hour labor, so this means a probable induction.

My labors are really fast and sometimes out of control and I have been close to delivering in a car more than once. At least my doctor is open to delivering my baby breech if he tolerates it since this is my 8th (hopefully vaginal) delivery and I have had a baby who was over 12 pounds at birth. ( almost 3 weeks overdue ) I have never had a C section, although I have had many doctors try to pressure me into one over the years. I just wanted to trust my body unless there was a reason not to. I envy your home births and wish I could have a safe home birth. I have had some with epidurals (induced labors) and some without and some where the epidural did not even work ( bad insertion) but ended up causing me to be unable to stand up straight for weeks along with migraines. The pain during that labor never got to the point I was worried about ( due to induction ) and she was a 10 pound baby.

I would have loved a semi romantic birth with my husband and I welcoming our children in the privacy of our own home surrounded by my children. It's a fantasy that I have never been able to have so far.

This was a wonderful post.