Women struggle to avoid serial C-sections

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Gina Crosley-Corcoran could feel the ghost of a knife slice her lower abdomen as she gave birth to her first child by cesarean section. Even the healthy birth of her oldest son, Jonas, couldn't erase that haunting memory.

“[It] ... was a very traumatic experience,” ... "So when we decided to get pregnant again, I knew that I wanted to have a vaginal birth.”

Crosley-Corcoran’s feelings aren’t uncommon among women whose doctors say they need to have emergency C-sections, often after hours of labor. C-sections account for 31.8 percent of births in the United States and the rate has risen more than 50 percent in the past 11 years.

Our caesarean rate here in Australia is the same ...

That contrasts sharply with the World Health Organization’s recommendation that C-sections should account for no more than 15 percent of births in low-risk women. The numbers can be disheartening for women who know C-sections are major abdominal surgeries that come with all the risks of any major surgery – and they’re being performed for reasons that have nothing to do with a disease or medical condition.

Only about 11 percent of women in the United States had VBACs in 2003 ...

Again, similar figures for Australia.

In response to the heightening conflict, the National Institutes of Health held a VBAC consensus conference this week. Many women hoping to avoid repeat cesarean sections are being deprived of the choice, the conference panel announced late Wednesday. The independent panel of health care providers and policy makers emerged from the conference with new recommendations aiming to correct the complex medical, legal, economic, social and research issues at the root of the debate ... despite three days of meetings and speeches, the recommendations are still largely left open to interpretation.

The issue remains a subject of a hot debate between women who don’t feel they should be forced into surgery and doctors and hospitals that say the risks of VBACs – including uterine scar rupture during labor – outweigh those of repeat C-sections.

“We certainly support the concept of people having choice and are happy to have people undergo a trial of labor, but I think also we want to convey to them what the risks and benefits are in their individual circumstances,” ...

Yet critics argue ... the high success birth rates of VBACs ... between 60 and 80 percent ... [and] the extremely low risk of uterine scar rupture, which ... occurs in less than 1 percent of women.

Some health care professionals believe key risks involve legal as well as medical issues.

“It has to start with tort reform, that’s the bottom line. Until that happens, I will recommend every doctor not to do vaginal birth after cesarean, only because it’s going to put them in more jeopardy [of being sued if it goes badly],” said Dr. Mayer Eisenstein, a physician and home birth doctor in Rolling Meadows. “In our society today, there’s no tolerance. If something bad happens, someone has to pay for it.”

A CLASH OF VALUES

... “[My doctor] wasn’t going to support ... my VBAC,” she said. “I saw myself going back down this road where I was just going to end up with another C-section and I knew that I had to get myself informed and get myself a really good support system.”

... Crosley-Corcoran ... hoped to give birth at home to avoid unnecessary hostilities at the hospital. But when her contractions started ... she ... took a taxi to ... hospital.

“The minute I got there it was kind of a battle,” she said. “... a lot of doctors don’t get why birth is important to women.” ...

Crosley-Corcoran said she fought throughout her 38-hour labor with doctors and nurses who said she needed another C-section.

... “To me, the most inappropriate behavior was the scare tactics.”

COMMON PRACTICE

Dr. Melissa Dugan-Kim, an OB-GYN ... said in the last five years she has done nearly 300 C-sections and 200 vaginal deliveries.

“Our practice always offers the option [of repeat elective C-sections], and a lot of women choose to have another one,” she said. “They like the idea that it’s scheduled. They go in and know what’s happening, avoiding any chance of an emergency.”

Language! "Avoiding the chance of an emergency" ... when we focus on these emergency situations, of course women will feel fearful and opt for an elective caesarean. But if we put the numbers into perspective: the risk of a uterine rupture (0.5%) versus the risk of everything that can (and does) ngo wrong with caesarean: increased blood loss, infection, blood clots, increased use of medication, complications from epidurals and so on, not to mention the risks for future pregnancies, VBAC is by far the safer option.

Dugan-Kim, who also does VBACs, attributed the rising number of C-sections to an increase in assisted reproductive technology ... which leads to a consequent increase in twins and multiples who need to be delivered via C-section to be born safely.

Twins can be born vaginally, safely!

“But no one thinks about the bad [consequences of C-sections],” Dugan-Kim said. “Everyone thinks they’re going to get pregnant, have an easy pregnancy and take home a healthy baby. That’s not always the case.”

Jamie Grumet knew having a baby would be painful and even stressful. But she didn’t realize how hard it would really be ...

... Grumet arrived ... Hospital ... Things were slow to progress. A nurse had to break her water early the next morning and it wasn’t until mid-day when Grumet’s doctor gave her the go-ahead to push.

Do women need the permission of their doctor to push? In natural labour, women feel the sensations to push just as people feel the sensation to defecate or urinate. We do not have people by our side in the bathroom directing us on having a bowel motion. Bithing is the same. When women tune into their body's signals, the urge to push will usually come at the right time and will result in the birth of a baby ... no cheer squads required! Of course, if women opt out of vaginal examinations in labour, the whole business of breaking waters and being told when and how to push can be avoided.

“I was all excited,” she said. “My husband, Josh, was on one leg and the nurse was on the other. They were telling me I was doing a great job, but I was pushing for about an hour and [the baby] was still really high up.”

I'm not surprised! Are you? Pushing on her back, with her legs in human stirrups, is the most unphysiological position to birth a baby in. Didn;t anyone think to move her to a good birthing position such as kneeling or all fours??

Grumet’s doctor attempted to manually re-position the baby for a vaginal delivery but failed. She told Grumet she needed an emergency C-section because, if she continued to push, she could risk breaking her narrow pelvis.

This is highly unlikely ... scare tactics again! Repositioning this woman was never thought of, just caesarean. It's cheap and safe to change positions. When we stay still in labour, we are not helping our bodies and our babies through birth. Birth requires movement and we need to move to enable this process to occur.

“That 20 minutes between the time they prep you for the C-section and you actually go into surgery was probably the worst, scariest, awful 20 minutes of my life,” she said. “I knew I was in good hands. It’s just that I was so alone and they lay your arms out on the table literally like Jesus on a cross.”

Just 20 minutes after she was wheeled into surgery, baby Ellie was born. Although Grumet understands her C-section was necessary, she said her birthing experience didn’t go as she had hoped.

Her caesarean was not necessarily "necessary". As it reads, this woman was not offered all that was on offer to ensure a vaginal birth.

... Grumet’s doctor said any subsequent deliveries must be via C-section.

Of course! And this plants the seed for the next time this woman gets pregnant. She will approach her new careprovider saying, "my last doctor said I have to have caesareans from now on" and if her new careprovider simply goes along with this, this woman will always have caesareans. How different things would have been if her doctor had explained why she performed the caesarean, and had told her the facts: that she has around an 80%-90% chance of having a sussessful VBAC if she books with a private midwife and avoids obstetric care.

C-sections have become such a common practice that 90 percent of women who give birth that way once will do so again ...

“My doctor said, for the next baby, it’ll be a lot different because I’m having an elective, scheduled C-section. You can have your Starbucks in the morning and have your baby in the afternoon,” she said. “I think I would be mentally prepared, knowing I was going into surgery, so I’d be ok with it.”

We read how they make an elective caesarean seem like no big deal, and certainly better than an emergency caesarean. But the obstetricians will be heard to say, "I discussed the options with this woman and she chose a caesarean. Women seem to prefer them these days. They like the ability to schedule the birth" and so it goes.

More than 24 hours into Crosley-Corcoran’s VBAC, her doctor became more insistant that she needed a C-section.

“He said that my uterus ... ‘just might not work,’ so I needed to have a C-section,” ... “He said I’d had enough time and my ‘trial of labor’ had failed. He said it was a case of ‘failure to progress,’ at which point I shot back, ‘No! It’s a failure to WAIT.’”

Crosley-Corcoran continued to resist.

A TANGLED WEB

Situations like Crosley-Corcoran’s stem from a complex web of causes.

“I think it speaks to the many different pressures in our health care system,” ... “It has to do with regionalization of health care. It has to do with, probably, to some degree, the professional liability climate. It has to do with societal attitudes toward cesarean and vaginal delivery.”

... “It’s not that those hospitals are being mean, per say, but they’re constrained by guidelines and circumstances. In that sense it’s not really necessarily their fault,” he said. “It’s really system-wide change that people need to make … if people feel this is an important thing.”

... “Unfortunately, lawyers have characterized doctors as just out to hurt people and do bad things,” said Eisenstein, who also has a law degree. “I don’t buy that for a second. I’m as big a critic of medicine and doctors as can be, but I can tell you, left unconstrained, doctors will do the right thing 999 times out of 1,000.”

PLAYING THE CARD THAT’S DEALT

... Crosley-Corcoran’s experience turned out differently. She said eventually her doctor told her Jules’ heart rate was fine and she could continue to labor. Crosley-Corcoran took responsibility for whatever happened. For her, the struggle was completely worth it.

... “Getting my VBAC and knowing that I did it … it’s just the most miraculous and powerful, unbelievable feeling.”

Melissa Maimann, Essential Birth Consulting 0400 418 448