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.

ACOG Anti-Home Birth Response

The American College of Obstetricians and Gynecologists, ACOG, released a press statement on Wednesday, February 6th, about it's stance on home birth (ACOG 2008). Their statement epitomizes the position of ACOG as representors of their members, not the rights or needs of the women their members provide care for. The statement is riddled with propaganda, including sentences like, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre," and "Choosing to deliver a baby at home is to place the process of giving birth over the goal of having a healthy baby." Allow me to paraphrase and address each paragraph in the statement.

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The first paragraph states that ACOG is opposed to home births, that childbirth is a normal process, that monitoring in a hospital or certified birth center is necessary due to the potential for quickly arising complications.

This seems like a reasonable enough set of statements, except that if a hospital is really the safest place for complications to be addressed, why is it that many hospitals across the country are not equipped to respond to an emergency in the 30 minutes commonly expressed as necessary for an emergency cesarean? Why are VBACs banned in many rural hospitals because of lack of adequate staff for an emergency cesarean when the chances of any other laboring woman needing an emergency cesarean are at similar rates? Why did the 2005 study of outcomes for planned, appropriately attended home births yield similar or better results for maternal and perinatal mortality than did hospital births in the same period (Johnson 2005)? Home births are just as safe or safer for low-risk women who are planning an attended home birth because an adequately trained home birth midwife is able to handle common health needs of childbirth and serves as a first-responder in true emergencies. Home birth midwives with adequate training can recognize the need for hospital transfer, usually long before any true emergency arises.

In Colorado, home births are required to occur within 30 minutes of a hospital. This would negate the worry of adequate access to hospital personnel and equipment, considering that in the event of an emergency transfer, an ambulance would be used and the hospital medical team would be informed of the incoming patient's needs. Hospitals typically take this long to prepare for an emergency anyhow. Considering this Colorado regulation, I fail to see the additional dangers associated with home births attended by trained midwives.

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ACOG "acknowledges" the rights of women to choose their health care providers, but does not support home birth providers or home birth advocates. ACOG also states that they only support midwives certified by ACNM or AMCB.

ACOG is blatently claiming that women should have limited rights to birth attendants and environments! What right have they to dictate what a woman can choose for the "normal physiological process that most women experience," as they state in their first paragraph? This statement should be drastically fought, considering its implied removal of a woman's rights to her body and to informed decisions. This statement might as well say, "Birth is only okay when We are in ultimate control of you. Don't listen to those crazy old granny-midwives. Only We know what is best for you."

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The next statement expresses ACOG's beliefs that home birth is a trend made popular by celebrities, that life-threatening complications can arise during birth, especially for VBACs, and that a woman puts herself and her child at unnecessary risk by giving birth anywhere except a hospital or accredited free-standing birth center. This paragraph contains the amazingly expressive sentence, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre."

Considering that only 1% of U.S. births are at home, how could one call this a "trend" at all? What this statement is referring to is Ricki Lake's recent film The Business of Being Born. Ricki Lake has brought home birth to the public eye unlike anything in the past decades, showing America and the world that home birth is not only an option, but a safe and desireable option. This is threatening to ACOG because it may be a cornerstone to a shift in birth philosophies of many Americans. To speak fairly, the movie also increases the likelihood of people choosing home birth when it may not be a good option for them. Instead of better educating the public and expressing the means of making home birth safe for appropriate people, ACOG chooses to blast home birth altogether, implying they are more interested in representing their members than the public good.

Another issue to take up with this statement is that ACOG doesn't put out damning press releases when celebrities glorify elective primary cesareans, even though they are drastically more dangerous (three times the neonatal mortality rate) than home births, when applied to the same low-risk category of women (McDorman et. al. 2006). A low-risk first-time mother electing for an unnecessary primary cesarean versus a low-risk first-time mother electing for a CPM-attended home birth within 30 minutes of a hospital: which would you say is more deserving of a press release of condemnation? It seems the health of mothers and babies is not the only thing of concern to ACOG.

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ACOG applauds themselves for issuing a task force to analyze cesarean rates of physicians and hospitals and to assist said institutions in lowering their rates, if they deem it necessary. They go on to cite obesity, gestational diabetes, and maternal choice as important factors in the rising cesarean section rate, and state that it is impossible to determine a goal for cesarean rates.

I want to point out the irony of this: ACOG supports maternal choice in the cesarean epidemic, but not in home birth, which, as was previously mentioned, is safer than elective cesarean. The reasoning for this discrepancy is obvious: cesareans support ACOG's members, home birth does not. It is also appalling that ACOG would point blame at these groups of women for the cesarean rate, avoiding any statements inplying that their own practices might contrbute to said problems.

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ACOG next states that OB/GYN's may save lives and lower the chances of "bad outcomes" in emergency situations. They also say that they believe the safest place for labor, delivery, and postpartum are hospitals, accredited free-standing birth centers, or birth centers in hospital complexes.

All statements in this paragraph have previously been addressed in this essay.

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The next paragraph states, "studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous." Then ACOG states that midwives cannot perform cesareans or other procedures that would be best for mother and child.

As is obvious from my essay thus far, adequate studies have indeed occurred and have certainly been rigorous enough for change to be made and informed opinions to form. Home birth is at least as safe, if not safer, than hospital birth for low-risk women attended by adequately trained midwives.

It is obvious that midwives, as well as family practitioners and other non-OB attendants, are not able to perform cesareans, but this statement also implies that such medical procedures, which only obstetricians can perform, are necessarily the best for mother and baby. One need only spend a few days on the ICAN email forum to realize that an inexcusable number of women and infants are the victims of unnecessary obstetrical procedures, performed for the "safeguarding" of obstetricians, not of mothers and children. Stories abound of women who were sectioned because their obstetricians had a social obligation, because nobody told them they could try something different, because a cesarean was presented as their only option, because they had a cesarean with the last baby, because the baby was getting "too big," because labor was taking "too long." This list goes on.

If this second statement were to be taken seriously, all hospitals without in-house obstetricians and anesthesiologists available 24-hours a day would have to shut down their maternity wards. This statement basically says that such hospitals are unsafe for labor, childbirth, and postpartum.

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ACOG summarizes their statement by supporting prenatal care and birth plans, hospital or birth center births, and CNMs working with physicians. They also state, "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby."

This statement, which implies that women do not care for the health of their babies if they choose to birth at home, is ludicrous and false. It also explicitly shows that ACOG does not care at all about the mother, the mother's health, the mother's desires, or what is best for mother and child. Even if the health of the baby were the only goal of ACOG, home births would be the method of choice for many babies.

ACOG is not interested in the health of mothers or babies, however. ACOG is interested in "representing over 52,000 members who provide health care for women." ACOG represents it's members by lying to the public, by attempting to bully people into choosing the more dangerous options, by putting mothers and babies at risk who would not otherwise be there, by allowing their members to perform unnecessary primary cesareans thus endangering the lives of mothers and babies, and by pushing propaganda instead of informing the public of scientifically based risks and benefits. ACOG is obviously not interested in providing health care for women, ACOG is interested in providing under-educated patients for their members to make money from.

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References

ACOG (2008) "ACOG Statement on Home Births" February 6, 2008. Washington, DC. <http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm>.

Johnson, Kenneth C and Betty-Anne Daviss (2005) "Outcomes of planned home births with certified professional midwives: large prospective study in North America" British Medical Journal. 18 June 2005 330:1416. <http://www.bmj.com/cgi/content/abstract/330/7505/1416>.

McDorman, Marian F. PhD, Eugene Declercq PhD, Fay Menacker DrPHCPNP, Michael H. Malloy MDMS (2006) "Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with 'No Indicated Risk,'" United States, 1998-2001 Birth Cohorts. Birth 33 (3), 175–182. <http://www.blackwell-synergy.com/doi/full/10.1111/j.1523-536X.2006.00102.x>.

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