Unnecesareans

The WHO recently released results of a survey in which they found that nearly half of all births in China are surgical. China's c-section rate is 46%. I hate to get over-dramatic, but this is appalling. Not because I'm so ideologically attached to vaginal birth, but because this is actually really, really dangerous. The WHO recommends that a nation's cesarean rate should be no higher than 10-15%. Above 15%, the risks of cesarean surgery outweigh the advantages to moms' and babies' health. Looking at it from another perspective, that means that, under ideal maternity care conditions, only 10-15% of labors will truly necessitate surgical intervention in the form of a c-section, and 85-90% of labors will progress normally and safely.

So, to explain why, when the cesarean rate is above 15%, the risks of c-section surgery outweigh the benefits to mom and baby. These risks exist with any c-section, but when the life of the mom or the baby depends on immediate delivery, these benefits of saving the lives of the mom and her baby outweigh the risks of the surgery alone.

But when a c-section is done on woman whose labor falls into the 85-90% that are normal and healthy, mom and baby are exposed to these pretty scary risks completely unnecessarily. Immediate risks to the mom include: infection, surgical injury, blood clots and stroke, emergency hysterectomy, less early contact with baby, depression and psychological trauma . Long term risks to the mom include: chronic pelvic pain, difficulty passing bowel movements, increased likelihood to be injured during future surgeries, future infertility, depression and psychological trauma, and maternal death. Short and long-term effects on the baby include: surgical cuts, breathing problems, difficulty breastfeeding, and asthma throughout childhood and beyond. And if the mom wants (and is able, despite the risk of fertility problems) to become pregnant and deliver again, here are the risks to both her and her baby: ectopic pregnancy, placenta previa, placenta accreta, placental absorption, uterine rupture, stillbirth or death shortly after birth, low birth weight, preterm birth, fetal malformation, and central nervous system injury to the baby. (all above found here)

Now, China's rate is pretty scary, but how does our country fare? In 2007 (most recent data available, from Choices in Childbirth's New York Guide to a Healthy Birth), 31.8% of births were done by c-section. In New York state, it was 33.7%. Rates in the New York city metro area vary, but no hospital has a rate below 15%. The lowest is 18.5% at North Central Bronx Hospital (whose maternity ward is staffed entirely by midwives, by the way). The highest is 52.7% at Lawrence Hospital-Bronxville in Westchester.

It was not always this high. Let's compare cesarean rates to maternal mortality, if we want to see a quick correlation between c-section and maternal health. In 1987, the year many of my peers were born, the US c-section rate was 24.4% and the mortality rate was 7.2 deaths per 100,000. We have to use 2003 now for the most recent data. In 2003, our c-section rate was higher, 27.6%. Guess what was also higher? Our maternal mortality rate: 12.1 deaths per 100,000. I'm not saying that this absolutely means that c-sections cause more maternal deaths, because that is beyond my powers of statistics to prove. I am saying that the conventional wisdom of c-sections allowing birth to be safer is completely false, and that most people hold this conventional wisdom is very dangerous for women's and babies' lives.

Why why why why why why why why??????????

Reasons are hard to quantify. This one is a myth though: that women are choosing c-sections as a matter of convenience. When women say they chose the c-section, they also say that they didn't get to that decision on their own, but from pressure from their doctors about time and convenience, and inadequate and biased information given about the risks. Other reasons include a general lack of faith in vaginal birth and "low priority of enhancing women's abilities to give birth," "side effects of common interventions" (a common cascade: epidural, epidural slows labor, pitocin to speed labor, pitocin stresses the uterus and the baby, baby is stressed and uterus isn't working right, c-section), casual attitudes about surgery and c-section in particular, limited access to information and awareness of the risks, and again, providers fear of malpractice claims and lawsuits (a bit plagiarized from Childbirth Connection- they just say it so good!)

I'm sick of talking and thinking about this. My solution: midwives. They specialize in protecting safe, vaginal births. Obstetricians are great surgeons and indispensable for the 10-15% of births that require c-section. But for the 85-90% of births that don't, let's save women's and babies' lives by letting midwives take care of them. A funny parallel is this: OBs are SUVs that you only need in conditions you'll find yourself in 10-15% time. Midwives are regular cars that do the trick the rest of the time, quite well.

On that note, I'm out. With my phone attached to me at the hip for when one of my clients needs some doula love.

PS: I didn't come up with the awesome title of this post, it comes from the title of a really good blog, http://www.theunnecesarean.com/blog/).