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