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.