April is Cesarean Awareness Month!

31.1% of American babies are born by cesarean section, major abdominal surgery. The World Health Organization has been saying for years that rates above 10-15% for ANY nation are high enough that the risks of the surgery outweight any possible benefits. This means that as much as 20% of new mothers and babies are being put at unnecessary risk.

April has been designated as Cesarean Awareness Month. Take the time this month to learn more about the cesarean rates in the United States, in your state, and in your local area. Visit the International Cesarean Awareness Network's web site and get involved.http://www. ican-online. org.

Consider too, getting involved in fighting for VBAC (Vaginal Birth After Cesarean) by writing to your senators and hospitals that do not "allow" VBAC. In Colorado, the majority of Western Slope hospitals now have VBAC "bans" in place, directly interfering with the human rights of women to birth their babies as nature intended, physiologically. Research has proven time and again that VBAC is safer than an automatic repeat cesarean for the vast majority of women. Medical law makes such bans illegal because they remove a woman's right to choose what will be done to her body. It is a fight worth fighting. Again, the ICAN web site is one to visit to read about this issue.

Get involved. Make change. The health of women and babies depend on it.

Am I Too Small to Birth My Baby?

Unless you had a nutritional deficiency as a child, such that you have physically DEFORMED hips or you had a pelvic break that did not heal properly, there is no reason to think that your hips will not be big enough to birth your baby. Humans wouldn't be around if we grew our babies bigger than we could physically push out.

Trust your body. It knows what it's doing and all you have to do is be an active part of your labor throughout and let your body do what it tells you it needs to do.

Any tests that can be done to "make sure" your baby will fit are flawed to the point of uselessness. Only 18% of estimations that say a baby will be "big" are actually correct, and even when a baby is "big," that doesn't mean that the baby will have ANY trouble being born. Also, taking measurements of your hips and the baby's head do not take into account the drastic changes that occur during labor to both your hips and the baby's head to make sure everything fits. If anyone tells you that your baby will not fit, they are almost gauranteed to be completely and utterly wrong and they deserve no more of your time or attention.

Next, how to avoid a baby getting "stuck" is fairly easy:

1 - Do not lie on your back during labor, EVER. Lying on your back is completely unnatural for a woman to do during labor, especially while she is pushing out the baby. Lying on your back is so unnatural, in fact, that the best way to get a baby "unstuck" if the shoulders DO get stuck in the pelvis is to do this amazing thing... get onto your hands and knees. That's usually all it takes. So avoid the whole ordeal in the first place and push your baby out in a position other than on your back.

2 - labor at home for as long as you feel comfortable doing so. The longer you are at the hospital, the more interventions they will want to do to you and the more likely you are to just lie in bed and wait for the baby. Avoid this by staying home as long as you are comfortable doing so.

3 - hire a doula. Doulas are your constant support during labor, helping you get into active positions, reminding you of things you said you wanted to do during labor when you might not be thinking of such things, helping you ask the right questions to make informed decisions, and helping your partner be of the best help possible. Doulas have been found to reduce the chances of a cesarean by 50% (and shorten labor)!

4 - do not be induced unless you have a clear medical reason that makes waiting more dangerous than being induced. Induction has a slew of risks, one of the biggest being c-section. If the induction fails, c-section. If the induction is too painful (and inductions are considerably more painful than natural labor), you'll probably need pain medications, which increase your chance of a c-section. Induction tethers you to the bed because induction makes you high-risk... being tethered to the bed, as I said before, means you're more likely to have baby get stuck, and more likely to have a c-section.

5 - plan on using natural methods of pain relief and if you do want an epidural, waiting until AT LEAST 5 cm dilation. Better yet, plan on not having any pain medication unless your labor is extremely long (longer than 24 hours) or unnaturally painful. Epidurals cause you to stop moving, making it a lot more likely for baby to get stuck. Epidurals make it more likely for you to have a c-section in general. Epidurals make baby more likely to get stuck because your body cannot respond as it normally would to the cues that arise when baby needs you to move or take action. You can't feel, so you can't act.

All of these things are true, regardless of your size and your baby's size.

I also wanted to mention that only about a third of c-sections are necessary, let alone "emergencies." With over 30% of live births being delivered by c-section, it is important for ALL expectant mothers to take an active role in their care and their births. If you have a doctor or midwife with a low c-section rate, you are already in good hands. If your doctor's or midwife's rate is high (more than 25%), then you know you're already setting up for a cesarean section, regardless of your size, and you might want to think about changing to a provider who believes in the female body's ability to birth babies.

Studies have shown that planning a c-section because the baby is suspected to be "too big" is dangerous for mother and baby and does not improve outcomes versus allowing things to go on their natural course.

Trust your body and your baby. They know what they're doing. If you allow your body and your baby to do what they need to do without interfering unnecessarily, you will be amazed at what they can do.

Source(s):
Gonen Ron, Bader David, Ajami Maha. Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery. American Journal of Obstetrics & Gynecology. 183(5):1296-1300, November 2000.Klaus, Kennel, and Klaus. Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier, Healthier Birth. 1993.International Cesarean Awareness Network - http://www.ican-online.org

(My quick response to a woman on Yahoo Answers asking when her doctor would be able to tell if she would need a c-section because of her size.)

Cesareans (10/12/07)

The cesarean section rate in the U.S. is 30.1%. W.H.O. guidelines state they should never rise above 10% for developed countries. This means that 2/3 of all U.S. cesareans are unnecessary. W.H.O.'s guidelines are based on when the risks begin to outweigh the benefits of this major abdominal surgery. This means that babies and especially women are actually being unnecessarily harmed by this cultural practice.

Why no outcry? Why no laws being made against unnecessary cesareans? Why no required guidelines for hospitals and maternity healthcare providers to follow to reduce their cesarean rates?

I joined the ICAN (International Cesarean Awareness Network) Yahoo group and read experience after experience of women who felt robbed, raped, devastated, devalued, lied to, and more because they had a cesarean that they later found was unnecessary. I read stories of doctors and nurses presenting vulnerable, laboring women and their spouses with the "option" of cesarean, or worse yet, tossing the "dead baby" card on the table when there was no reason to believe the baby was in danger. After months of physical recovery and years of emotional anguish, postpartum depression, and cases of post-traumatic stress disorder, these women go over their medical reports, talk with other medical professionals, talk with other women, and learn that their cesareans weren't necessary. They learn, three children later, that the repeat cesareans they were "offered" during pregnancy were not also not necessary, but because their doctors presented it like the first option, they took it. Doctors say, "You can have another cesarean," and refer to a VBAC as a "trial of labor," instead of telling women, "There is good reason to have a VBAC, in your case." When a woman wants to have a "trial of labor," they're not only given the consent form, but they're also given the lecture of all the risks of the "trial," whereas mothers who choose to schedule a repeat cesarean are not usually told of the risks of thier second (or third or fourth) cesarean when they sign the consent form. It's not until they've had three or four cesareans that their doctors get a little worried and tell them that they shouldn't get pregnant again because another cesarean would be risky, and they won't attend a VBAC after a woman has had that many cesareans because it would be risky... so a woman is told not to have any more children. TOLD. Who is this person who plays God over you as a woman? Who thinks you should just get a hysterectomy with your next cesarean? What angers me the most this is that these women wouldn't be "at risk" with subsequent cesareans or VBACs if their doctors hadn't suggested they take the second cesarean, and better yet, if they hadn't had an unnecessary cesarean in the first place.

Yes, I'm getting carried away on a scenario where women have bad doctors or simply feel under-educated. Yes, cesarean sections are necessary and life-saving in some circumstances. It is utterly horrifying to me that the cesarean rate is what it is in the U.S. I cannot express the horror I feel at the idea that one in three live births delivered in the United States of America are removed from their mother's splayed abdomens while they lie behind sterile shields with their arms tied down and their spouses nowhere to be seen. It's the thing of horror novels to imagine women with their babies ripped from their bellies, and yet we do it. To me, it is equally horrifying when the surgery does not save lives and livelihoods. No, not all obstetricians are evil surgery-mongers who want to cut open every woman who comes through their practices. I've never been one to think it's okay being satisfied and passive because things are "okay" or because it's good more than it is bad.

The big questions are why are so many unnecessary cesareans being performed and how do we stop it?

The Healthy People 2000 objective of reducing the cesarean rate to no more than 12% for primary cesareans, no more than 65% for women with previous cesareans, and no more than 15% overall not only failed, but failed miserably. The rate didn't go down, but went up and continues to do so. So, making objectives to make people healthier doesn't work.
The Coalition for Improving Maternity Services created the Mother-Friendly Childbirth Initiative, which states that mother-friendly maternity services will have a cesarean rate of less than 10% for low risk and 15% for high risk women (http://www.motherfriendly.org) was established in 1996 and hasn't worked in reducing the cesarean rate overall.

This is just the beginning of my thoughts.

Christina