The Epidemic of Unnecessary C-Sections

In my last post here at Mothering Outside the Lines I wrote about an amazing mom who decided to have a home birth to avoid a fourth C-section.

I emailed Aneka’s story to my friend Denise who still has angry, unresolved feelings about a second C-section. Denise was fully dilated and pushing when the doctor told her there was “no way” the baby would be able to slip under her pubic bone.

Any birthing woman is incredibly vulnerable. Her senses are heightened. She looks to those around her for support and love and encouragement.

What if that doctor had told Denise she was doing a good job? What if that doctor had offered her something to eat or suggested she sleep between contractions? (In her book, Ina May Gaskin’s Guide to Childbirth, Gaskin observes that women sometimes need to rest, even sleep, after transition to renew their energy to push the baby out. She also notes that food eaten at the right moment during labor can be the fuel a woman needs to rally.) What if that doctor suggested laboring on all fours? What if that doctor had just said and done nothing but stayed with Denise in an attitude of encouragement?

When your body’s working as hard as it knows how to birth a baby it can be devastating if a doctor or a nurse or a midwife tells you you aren’t doing a good enough job. Or even suggests as much with an impatient or unkind attitude.

When I was more than 15 hours into labor with my first child I was only at four centimeters dilated. Instead of encouraging me the doctor on call–the only man in the practice and the only doctor I had never met previously–told me I was being selfish and making my family suffer unnecessarily (my mom and my husband were there) and that I should think of other people and get an epideral and pitocin.

For Denise just trying for a VBAC had already been a fight. But how could that doctor have known that Denise’s baby couldn’t be born vaginally? Was the doctor subconsciously (or consciously) punishing her for having the hubris to try to do it her way? Or was the doctor just impatient for the baby to be born?

We have a C-section rate in this country that is so high that Amnesty International has issued a call to President Obama to address what they call the systemic failures in the maternal health care system in America.

Augustine Colebrook, a midwife and mother of three who has just founded a birthing center in Medford, Oregon, recently taught a childbirth class for six couples.

Three couples were planning home births.

Three were planning hospital births.

The three moms who chose to birth at home had healthy babies and no complications.

The three who chose to birth in the hospital? They all ended up having C-sections.

As Tiffany, a labor and delivery nurse, pointed out in a comment on my last post, Cesarean birth can be a life-saving intervention. It is a wonderful operation, a medical miracle that can save the life of an infant and a mom when used in a real emergency.

An impatient doctor is not an emergency.

A hospital that profits from billable hours for the operating room is not an emergency.

A previous C-section is not an emergency.

A breech baby is not an emergency. (Babies turn during labor. Vaginal breech birth done correctly, which usually means with as little intervention as possible, has been shown to be safer than major abdominal surgery for most women.)

Twins are not an emergency.

Most people don’t realize that the skyrocketing C-section rate in America has devastating ramifications.

The United States lags behind 40 countries in maternal death rates.

It’s safer to have a baby in Bosnia and Herzegovina, a country recovering from civil war, than it is to have a baby in America.

Katelyn couldn’t lift her baby for weeks after having an unplanned C-section. Her son was born 11 years ago. The operation gave her terrible gastrointestinal problems that continue to this day.

Nora’s scheduled C-section ended in weeks of anxiety. One of her baby’s lungs collapsed and he had to be helicoptered to a hospital with a NICU. “I think the doctors got the dates wrong,” she mused afterwards. A doctor herself, she hadn’t realized that the risk of not letting her body go into spontaneous labor includes premature birth.

This major abdominal surgery has many other risks: hemorrhage, infection, organ damage, scar tissue adhesions (including placental accreta, placenta increta, and placenta percreta), delayed interaction between the baby and the mom which can lead to bonding problems and breastfeeding difficulties, a longer and more painful recovery time, post surgery stress disorders, higher chance of rehospitalization, higher chance of complications in subsequent pregnancies, higher risk of respiratory problems for your baby, and more.

Let’s follow Aneka’s lead and stop the C-section epidemic in America. Isn’t it time for American women to be empowered to give birth on their own terms without unnecessary, even life-threatening, intervention?

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17 thoughts on “The Epidemic of Unnecessary C-Sections”

  1. I’ve had two c-secs. I wish I had had other advice. It’s a tough thing because at the time you are in what feels like a moment of crisis, so you listen to the person you trust – your Dr – to give you good advice. You’re scared and you want to do the right thing to protect your baby. I don’t think there’s anything wrong with listening to advice from a professional. Moms who have Cs are not at fault (and I know you agree). I think the medical profession has got to make changes.

  2. I couldn’t agree with you more, Brette. When I first thought about my first hospital birth, I convinced myself that it had ALL HAPPENED FOR A REASON, and that the doctors had given me good advice and that my husband and I were right in following it.

    It’s taken me years to realize that what happened was not in my best interests or my baby’s. I was lucky that I didn’t end up with a C-section but I very easily could have.

    Instead of realizing that what happened was part of a cascade effect of being in the hospital where intervention gets piled upon intervention, I beat myself up about how we could have done it differently. Why did I go to the hospital after my water broke? Why didn’t I read more about labor and delivery (and read the right books)? Why didn’t I talk to the mom in Atlanta who my friend knew who had had a home birth? Why did I let my husband’s fear and our lack of money get in the way of making a better choice about where and how to give birth?

    But as easy as it is for us to blame ourselves, women in any stage of labor are not at fault. If you had a C-section (or two or three or four) it doesn’t mean you’re less of mom or that you’ve done something wrong or failed in some way (though I know I feel like I failed in my first birth.)

    Our system is so broken right now, doctors are rushing to operate on women who absolutely do not need to be cut open, that women’s choices and women’s rights are being violated.

    As you write so eloquently in your comment, the medical profession has got to make changes.
    .-= Jennifer Margulis´s last blog ..What Did I Learn From Being Robbed =-.

  3. Hrmmm. Not having had children, I find it tough to have an opinion on this topic, but I feel like a midwife would infinitely more supportive than a doctor and far more likely to make an unbiased decision based on the circumstances at hand. But this is probably old news. 🙂

  4. I didn’t have a C-section with any of my children so I was never faced with that pressure. But I will say that my most relaxed, enjoyable birth experience was when my medical provider (a midwife) told me that she had until Tuesday (it was Sunday) for my baby to be born so I should go ahead and take my time. Of my three births–one with an epidural, another with pitocin, my last was my shortest. And I was the least farthest along when I got to the hospital. Having my provider support me and encourage me definitely made the difference. I didn’t require and intervention and when we did disagree (I knew I should push and she said I wasn’t far enough along) she told me to go ahead and afterwards she even told me I had been right to listen to my body. It all felt so validating and empowering.

  5. I ended up have a c-section for my first and only child. My doctor really pressured me to have it, and to have it on a specific day (a Friday). He was talking about his golf game while he was slicing me open. My baby was breech and just would not turn. I tried all of the usual turning methods. But I could not find a doc in my area who was willing to deliver a breech, and I didn’t feel confident or brave enough to deliver at home or with someone who didn’t have experience delivering breech babies. It seems the medical profession has both over medicalized birth as well as removed any choice from moms. It’s sad.
    .-= Alisa Bowman´s last blog ..What Would Miss Abigail Do =-.

  6. I’ve never been pregnant or given birth, so I can’t give an opinion based on experience, but I’m appalled by your doctor’s comment about you being selfish, Jennifer. Seriously?! Your family was there to support you. I’m sure they would have waited as long as it took. It’s not like you were preventing them from being part of some Big Event, because actually you giving birth WAS the Big Event.

  7. Well, it’s me, the Denise in the first part of this wonderful (and, I think, appropriately angry) post. When I wrote the piece Jennifer links to for, I got a lot of supportive comments, on and off babble’s site, and a LOT of negative comments. The negative ones I could ignore if they seemed to reflect a total lack of reading comprehension (which happens a lot — people ascribing to you things you did not say/write). But ones I could not ignore easily were from folks who thought I SHOULD NOT BE ANGRY ANY LONGER, or at least SHOULD BE OVER THIS BY NOW (my younger child is 6). I’m sorry, but I don’t feel I should, or need to, get over it. If not enough of us are angry, then we are all complicit in the appalling rate of unnecessary C-sections in this country.

    Jennifer nailed it when she suggests that my doctor could have done any number of things when I was at that crazed moment with my second son, when I’d careened into the hospital at 4am, already at 10 cm and feeling that overwhelming urge to push. Those negative commenters said things like, “well, why didn’t you speak up to your doctor? Aren’t you complicit, too?” I’ve been angry at myself about that for 6 years — imagining myself doing or trying other things. But remember this: She, the doctor, was in the position of authority. I was the woman in panic and pain, with a panicked husband beside me. There was no one else to advocate for me.

    I go back in time in my head frequently, only this time I hire a doula or find a midwife friendly to VBAC patients. This doctor was one of a handful in a new practice I’d found after my first set of doctors scheduled my C without telling me. The head doc, a late-middle-aged male doctor who had delivered my nephew, a VBAC, in 1992 (when my sister would have had to fight to get surgery, as it happens!), might have done more for or with me, who knows. At the very least, he was the only one who didn’t tell me, either outright or by implication, that I was crazy to try. Crazy, silly, stupid, selfish: pregnant women who have a brain their heads, thoughts of their own, and ideas of how they want their birth go are often told these things.

    I, for one, am sick and tired of it.

    Thanks, Jennifer.

    .-= Denise ´s last blog ..What Is

  8. I had vaginal births both times, and it’s hard for me to predict how I would have reacted had I been told I needed a c-section. For me, the important thing is for there to be a trusting relationship between the woman and her health provider. And women are in such a vulnerable position when they’re about to give birth that they need to put their trust to someone else. But what I object to is the doc who insists on a C-section for the sake of their own schedule or the profit motives of the hospital. I find it so sad that we as women cannot trust completely in a medical decision that has been wrought with so much controversy.
    .-= Sheryl´s last blog ..Catch Up on Five Important Health Stories =-.

  9. I had my three babies in France. The first labor was incredibly long, and I can see how an American doctor might have decided to facilitate things with a C-Section. I think that it’s outrageous that obstetricians, in this country, are opting for the procedure more frequently than ever for reasons that do not involve the health of the mom or the baby.
    .-= Alexandra´s last blog ..What Tide Do You Prefer =-.

  10. I had two C-Sections many years ago. The second C-Section could probably have been a natural birth in today’s world. But my first child was a frank breech and weighed almost 9lbs and I have a small pelvis. I have never regretted having her by C-Section. I know too many children with learning problems who were breech and birthed naturally. Although, I do agree that there are too many C-Sections in this country, there is also a down side to insisting on a natural birth when conditions are iffy.
    .-= Donna Hull´s last blog ..Discovering Ronda =-.

  11. I had a c-section for my first baby and the diagnosis was CPD. But in fact, they had me pushing lying down, plus my baby got stuck in my pelvis for lack of room to move around. I was really surprised that they insisted I have a c/s for several reasons : when I went for my first pre-natal exam, I was told by the midwife (yes I was with an in-hospital midwife practice!) that I had plenty of room; when pushing on my back was not doing anything, no one suggested I get upright instead. So when I was pregnant again, I decided to take charge of the birth of my baby. I told the same midwife practice that I wanted a VBAC and asked what it took to do it. They were specific that they would accept if I met 2 conditions : 1- monitor me and baby at all times and 2- that if I get stuck at the same place my 1st baby was stuck, I had 1 hour to unstick it otherwise I would go for a c/s again. So I talked to my baby and uterus and told them the whole time I was pregnant that we would do it and show everyone (my dad is an old-school ob, so is his ob nurse wife, my mil is a nurse and my sil is a social worker – all four thought I would end up in anothre c/s !). And when the time came, I followed 2 rules : 1- do not push until you feel the urge, and not necessarily when I was 10 cm dilated (which there was a delay of about 30 min in between the two) and 2- I would labor and push as vertically as I could. I labored on my knees, and the last 30 min I was standing up next to the bed, holding my husbands’ hand and leaning against the bed with the other. I pushed 2 hours for this baby to come out, and he was born mom-med free! And I want to add that when I initially went for an evaluation of my chances of having a successful VBAC, I was told it was 13% ! The head midwife was very supportive, and the two midwifes with me at labor and delivery were super supportive. The midwife with whom I ended up with a c/s the first time came to see me after my VBAC and called me a hero !

    I want to say to all of you c/s moms, take charge of the births of your babies, and don’t let the drs tell you what to do. Surround yourselves with mothers who have had babies as a support system. Women need to listen to personal experiences, but mostly to their own bodies. Yes c/s are need in emergencies, but not when things are not progressing “fast enough” (and for whom anyway !)

  12. This is the hardest part of being a doula! You see a mom work so hard and you are encouraging her the whole way and one doctor walks in the room says something negative and takes all that moms confidence away!! Many time the damage is so great that i can’t even get the mom back on track!! My one peice of advice for women birthing in the hospital is don’t be afraid to question athority!!! Also have a labor suprt team that will look our for not only your physical saftey but your emotional well being!!

    Jennifer i love your work you are great!!! A true inspiration sad that the one birth we attended together ended in a c-section;-(

  13. This continues to be a fascinating topic to learn about. I have never given birth and never had an idea of what an epidemic c-sections had become. I know there there is a place for them, but to hear of their use for no good reason is jaw dropping.

  14. Thank you very much for all the love and support. You can contact me on facebook Anekas Hbac Again Thank you very much.

  15. Oh, boy, do I agree with you!

    Long ago, when I had my first child I was in labor for nearly 24 hours. Although it was a new concept, I had insisted on preparing for a natural birth as nearly as possible. My doctor was sympathetic and delivered

    lectures to all the nurses, etc in the hospital. He told me later that

    my preparation helped avoid having a C-section.

    Of course, I also had the advantage of giving birth back when family

    doctors delivered babies, and their concern was the FAMILY not just

    pleasing the woman and keeping her pain free so she’d tell all her

    friends to come see HER OB-GYN.

    I see more young women today who just want the birth to be convenient for them. I don’t know how you break through that culture

    of “Make it easy for me” and substitute a sense of pride at creating a

    new life.

    That attitude boggles my mind because I felt such a sense of

    accomplishment each time I gave birth. This is NOT like having your

    appendix out, kids! Even on the third, when he got stuck in the birth

    canal for a while and I was cursing at the doctor and the marine-

    sargent type nurse was saying–“LOOK! We got these mirrors so you

    could watch!!” there was still a sense of awe at seeing a new life

    emerge form my body.

    Thanks for giving me the opportunity to vent about this.
    .-= Vera Marie Badertscher´s last blog ..12 Gifts for Your Holiday Reading =-.

  16. Most OBs, like most humans, are very subject to the culture of their community, and not very critical of it nor very active in changing it. So it drifts toward convenience, toward intervention without necessity, toward systematizing the experience of birth. But I do know a couple of OBs who are very supportive of homebirth and of natural birth generally, and they lament that OBs today are losing the skills of assisting a vaginal delivery when the baby is breech. OBs used to be expert in that; but it is no longer taught, and no longer practiced in most hospitals, so the professional knowledge is disappearing. That insures that OBs who haven’t sought out that expertise will do all breeches–or even deliveries in which the baby doesn’t quickly progress while the mother is lying supine–by C-section. It’s a self-fulfilling practice. But confidence in natural birth, on the other hand, will allow all sorts of ‘impossible’ births to happen as they evolved to happen.

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