‘The Cesarean Catastrophe’

I was reading over some medical journals, and this article popped out to me. It is a reader question article and the I became intrigued.

“I believe the contribution to this high cesarean level is general lack of concern, elective cesarean scheduling, and hospitals designing units to accommodate the 50% cesarean rate. How can we help stop this?”

Just the question got me thinking. This reader summarized the cesarean reasons in one sentence. I had never thought it could be put so simply, but it can!

The answer to this question was pretty long, so I am just going to summarize parts of it in my own way.

1. Lack of risk awareness:
In 2003, the only cesarean risk study was conducted and published in What Every Pregnant Woman Needs to Know About Cesarean Section. This is the only study that has EVER been conducted and that was 6 years ago!
Cesarean sections have a lot of risks if they aren’t medically necessary. They increase the short term risks for mothers by: infection, surgical injury, severe and lasting pain, poor functioning, rare but fatal blood clots, stroke and emergency hysterectomy.
The ongoing harm of cesarean sections are also something to consider. They are: pelvic pain, future infertility, ectopic pregnancy, placenta previa, placenta accreta, and placental abruption.
In future pregnancies, a cesarean section can also have some impact, including: increased risk of stillbirth and increase in low birth weight babies.
The one thing people don’t realize is that cesarean sections also can harm the babies, by: surgical injury, increase in respiratory problems, and increase in asthma later in life.
Those risks are enough to scare me away from an unnecessary surgery!!

2. Lax surgical attitude:
Surgery has gotten increasingly safer, so we are comfortable with all surgery. Plastic surgery which is completely unnecessary, elective cesareans to keep your vaginal form, and other surgeries done only for convenience.
I blame Hollywood haha.

3. Vaginal birth is harmful:
The one thing every one worries about with a vaginal birth is being ‘stretched’. Sex won’t be the same, I won’t be able to hold in my pee, I won’t be able to control my stools, and that is not something anyone wants. What a lot of women don’t realize is that you are made to stretch. Your vagina and birth canal are made of layers of skin that unfold during birth so that the baby can fit while at the same time everything pops right back after the birth with regular exercise (kegels) of it. The other part is that interventions such as vacuum extraction, forceps, and episiotomy actually increase your risk of incontinance.

4. Failure to support normal birth:
Our country is ‘intervention-intensive’ in labor and delivery.
In the Listening to Mothers survey in 2002:
44% were induced
71% didn’t move freely
93% had continuous EFM
86% had IVs
74% gave birth on their backs
This is enough to show that we truly don’t believe in normal birth. Everything is medicalized, even when it doesn’t need to be. There is NO WAY that 44% of women that year needed to be induced. No freaking way.

5. Fear of lawsuits
This is a huge one. Maternity care in our country is one based on fear instead of evidence. No one sues you if you do a section. It is the ‘last possible option’ and no one is going to say you did a bad job, even if the baby died.
Cesareans in this country are growing every year. As are the reasons for a cesarean, including: breech, previous cesarean, continuous EFM, movement restrictions, labor support restrictions, routine interventions, and so many more I can’t even name. I am terried that we will eventually become a cesarean society.

6. Elective cesareans:
What is not to like about this? You choose your babies birthday, you choose when you want to stop being pregnant, you choose everything about your birth, and you don’t have to feel labor! What could be wrong with that?
Everything is wrong with that! Again, it is MAJOR ABDOMINAL SURGERY. Not a face lift, not a tummy tuck, MAJOR SURGERY.
Research over the last couple years has actually found that it isn’t the patients that are choosing the section. The doctors propose the cesarean and offer reasons such as CPD, Fetal Macrosomia, and others, and the patients accept because they don’t see anything wrong with it.
This is definitely not evidence based care, this is convenience based care.

The second part of the question asked ways we can help stop this dilemma. Considering this piece was written in 2003, it obviously isn’t helping since the rate has gone up over 4% in the last 6 years, but I think it is something we need to know anyway, just in case one person can truly stop this pandemic.

1. Encourage the choice of supportive caregivers and place of birth:
“The choice of care provider and place of birth powerfully influences how labor will progress, including risks of having a cesarean”. When you are choosing your caregiver, don’t ask your friends if they have a doctor they would recommend. Just because your friend loved them, doesn’t mean you will. They could be intervention and cesaren happy for all you know. Ask childbirth educators, doulas, and other people that work in the medical field about people that follow the normal process of childbirth. And then don’t forget to interview and don’t settle!

2. Share evidence based information:
“Birth is too important — and cesarean birth without medical indication is too harmful for women and their babies — for society to sit back and continue to watch the cesarean rate skyrocket.” How many women and babies die every year from unnecessary surgery? How many more have to die before people get the picture?

***

I truly hope that in my lifetime the cesarean rate will go down to 10-15%. I doubt it will ever happen, but it is a nice thing to hope for.

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