It’s Not About Being Anti-Cesarean, It’s About Supporting Informed Choice

pixabay - for cesarean awareness 1April is a month of renewal for me. Not only it is the first full month of spring and I can finally shed my winter wear, but April is also a time for me to reflect on each of my childbirth experiences, particularly my cesarean and my VBAC.

Cesarean Awareness Month is an observance of the International Cesarean Awareness Network (ICAN), an organization dedicated to improving maternal-child health by preventing unnecessary cesareans, providing support for cesarean recovery and promoting Vaginal Birth After Cesarean (VBAC).

The U.S. cesarean rate is now 32.2%, according to a recent article on Contemporary OB/GYN, just barely below the peak in 2009 of 32.9%.

That is 1 out of every 3 women giving birth. That’s a lot of moms at risk of complications like maternal hemorrhage, infection, even death, and risks to future pregnancies such as abnormal placentation that can lead to preterm delivery, the need for hysterectomy, maternal hemorrhage and stillbirth, as well as transient tachypnea and pulmonary hypertension in infants. If there is concern about maternal and child health outcomes due to cesarean, why would obstetricians continue to ignore their Hippocratic Oath by continuing to opt for cesareans over primary vaginal deliveries, regardless of their phobias over the rare complications of VBACs?

There are cases where a cesarean is medically necessary or where the benefits of a cesarean delivery outweigh the risks. The top medical reasons for a cesarean are:

  1. Failed progression of labor
  2. Abnormal fetal heart rate
  3. Malpresentation
  4. Multiples
  5. Suspected fetal macrosomia
  6. Herpes simplex virus.

Notice that I didn’t include prior cesarean as one of those reasons for a necessary cesarean, which most obstetricians would list, but that’s ignoring that VBACs can be viable options in many cases.

According to the Contemporary OB/GYN article, the medical community is zeroing in on #5 as a reason behind rising cesarean rates. Fetal macrosomia is a baby that is bigger than typical. What seems to be happening, according to those in the obstetric circles, is that newborns are bigger than they once were due to higher rates of maternal obesity and gestational weight gain, both of which are associated with higher rates of cesarean.

But medical reasons are not the only cause for rising cesarean rates. There are just more moms requesting elective cesareans. The Contemporary OB/GYN article reports an estimated rate for planned cesareans as 4% in the United States. There are other developed countries, including Brazil, Taiwan and Chile, that have much higher rates of planned cesareans, and comparatively, the vast majority of U.S. women prefer vaginal deliveries.

So that brings us to the biggest reason behind much of the U.S. cesarean rise: Doctors are choosing cesareans that may not be technically necessary, out of a fear of being sued. In the Contemporary OB/GYN article, studies show that doctors are more likely to perform a cesarean if they had been sued recently or frequently, and that cesarean rates are lower in states with a cap on possible damages awarded out of lawsuits.

This is disappointing in so many ways.

Cesarean awareness can take a lot of different angles, and I have experienced many of them. I have been pressured to choose a cesarean for a possible medical reason that never actually was, I had life-threatening complications from that cesarean, and I went on to have a successful VBAC. I am personally all for VBAC.

But above all that, I support informed choice for mothers regardless of elective cesarean, medically necessary cesarean, VBAC, medicated childbirth, unmedicated childbirth, whether in a hospital, birth center or at home. I support giving women informed choice.

If a woman is presented with all the information about each childbirth option, and she chooses an elective cesarean, I feel that is ethical for a doctor to then perform that cesarean. If a woman is in labor and runs into a legitimate complication that threatens her or her baby’s life, and the doctor chooses a medically necessary cesarean, I also consider that ethical.

But if a woman desires a vaginal birth or a VBAC, and is not given the informed choice — whether the doctor, the practice, or the hospital is against the choice before or during labor — this is unethical. It is unethical for hospitals that do not perform VBACs to then not refer patients interested in a VBAC to a hospital that does allow this childbirth choice. And it is unethical for a doctor to present information regarding childbirth options in a way that might sway a mother to choose an unnecessary cesarean, because that doctor is afraid of being sued.

It all comes down to whether the mother received balanced information on the pros and cons of each childbirth option, information where she can go if she chooses a childbirth option not provided by her doctor or hospital, and if she’s then allowed to make that choice…or if her choice was compromised by withholding of information by a medical professional or establishment. Every woman is entitled to her rights of informed choice, and that’s what cesarean awareness is about to me.

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