Friday, February 20, 2009

The Trouble With Repeat Cesareans


TIME Magazine published an article by the above titled post just yesterday. What a wonderful article to wake up to! I am beyond thrilled to finally see a mainstream news outlet cover such an important topic and present a few facts on the issue. It's time that moms HEAR, loud and clear, that there are PLENTY risks you impose on yourself and your baby (and future babies) by undergoing major surgery unnecessarily. If you haven't read it yet, please go HERE to see the full article.

Just a few quotes:

International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them.

With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.

Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

[Zelop] says, "I don't know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid." So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: "When the problems with multiple C-sections start to mount, we're going to look back and say, 'Oh, does anyone still know how to do VBAC?'"

For my new (and silent) readers, I'll re-cap our birthing history:

Having had two unnecessary cesareans (first for FTP and second fear-induced), for our third baby we wanted a VBAC (vaginal birth after cesarean) and our local hospital refused it. So we went to a hospital TWO hours away having heard they were pro-VBAC, but they refused us, too. Our OB was supposedly on our side, but said the hospital wouldn't "allow" him to let this birth happen. So we took control of our birth and hired a certified nurse-midwife (CNM) for an out-of-hospital birth. Just after paying our CNM birthing fees and buying our home birth kit, the hospital finally consented--saying they couldn't "force a c-section" on me if I was adamant about a "TRIAL" of labor. This definitely wasn't a VBAC-supportive environment.

Because of our oppressive hospitals and ridiculous state laws on home birth (visit HERE to see where you can write letters to help change the law this spring), we had to drive FOUR hours and cross TWO state lines while in labor to get our out-of-hospital VBA2C. And folks, it was still worth every single mile.

Considering all of the fear, fear, fear I got from the hospital (about VBAC), the statistics on VBAC safety are shocking. I'm glad c-sections are available for the truly emergent situation, but truly emergent c-sections are very rare. Many moms who consent to a c-section THINK it's an emergency simply because they aren't fully informed by their provider during their labor. With a cesarean, we must be aware that we are subjected to multiple risks: risk of infection, increased blood loss, decreased bowel function, deep vein thrombosis, blood clots, risk of additional surgery, increased risk of postpartum depression, placenta and uterine problems in future pregnancies, risk of hysterectomy, increased the risk of premature birth complications, diabetes for baby, breathing problems for baby, injury during the surgery, risk of asthma, breastfeeding complications, death to mom/baby, and more...

I've known both the "fairly easy" c-section experience and the horrid "dear-lord-please-let-me-die" c-section experience--our VBAC birth (which was our largest baby, yet) was at LEAST a thousand times better than our easiest c-section. I've now walked through the valley of the shadow of death--and you know what? There was perfection on the other side. Recovery was bliss. "Birth" is WAY too small a word to encompass the natural act of bringing life into the world. I am so impressed with how perfect my body was made to do this normal, human thing.

Moms, it's really YOUR decision how you give birth, so take ownership of that decision. Don't let unnecessary fear guide you on either side. For us--we'd stay home again in a heartbeat if I was told, yet again, that I couldn't birth my baby without my stomach, layers of muscle, and uterus unnecessarily being sliced open and pieced back together with stitches and staples. It's far more complicated than most providers will admit.

Thank you, TIME, for bringing this topic to light. Although it is a fairly short piece, I'm hopeful that more moms will, over time, come to understand the magnitude of their birthing decisions. Everything from labor position to induction medications to epidurals to your support staff can affect whether you end up on the road to unnecessary cesarean. And once you're there, that may become your only future birthing choice at your local hospital.

Also from TIME was THIS article last month on early cesareans (prior to labor starting naturally). It's really worth a read if you are facing an upcoming cesarean!

For more information about repeat cesarean and VBAC, please visit Jen's website HERE. It provides a great overview on the topic.

Further, please visit ICAN if you haven't already. They have a WORLD of information on cesareans, VBACs, and all sorts of other birth-related things. National Cesarean Awareness Month is coming up this April and ICAN could sure use our support in birth advocacy--let's spread the news together!

3 ♥ thoughtful comments ♥:

Anneatheart said...

Hi there,

I just finished reading your vbac story from a website I can't remember :) It was very inspiring and thanks for sharing it. I myself am at a crossroads on this subject. I've had three c-sections- simply because the first one had some issues and had to come out at 37 weeks, and the second one came 11 months later and I was scared into a repeat. With the third I planned a vbac with an OB and at the last minute, she suddenly had to go on vacation and I was stuck. So I chose the c-section because I sick of being pregnant.

Sooo, where I live, I cannot find a doctor or a midwife to support me in a vbac now. My husband is with me- I believe all things are possible to those who believe and with God all things are possible. This is chance to step out in faith, to let Him be glorified in a seemingly impossible situation. Yet, I still have some fears. After reading birth stories and watching videos of live births- I wonder if I could actually do that. Yikes! But the driving force is recovery time- I will have 4 kids, two of which will be starting school shortly after this one is born. I have to be able to walk!

I was just wondering if you could tell me how you came to the point where you knew it was the right path. What were your back up plans? Feel free to comment on my blog if you like, or here and I'll come back to check. And thanks again for providing so much info about vbac. It helps :)

God bless,
Jessica

~Tara said...

Wow, I can't believe a hospital can deny you in having a birth the way you want!?! I think alot of people are misinformed about c-sections and vbac's...my hubby for one, doesn't believe me that it is possible to have a natural birth after a c-section...

When having our daughter 2 years ago, the doctor scheduled me to be induced and I had went into labor the previous night, very very slow labor, but still labor!! After being induced and being in labor for 36 hours (12 at home and 24 in hospital) I had dialated only 1 cm totaling 2 1/2 and I ended up having a c-section...I would love to experience a natural birth if we ever have a second child, but wouldn't want to be pressured into having another c-section just because...thank you for sharing your story and standing up for what you wanted and stopping at nothing to get it!

Michelle said...

WAY TO GO! I"m proud of you! They just want to scare us into conforming because they dont want to have to worry about a lawsuit. It's so frustrating.

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