Let me preface this post by saying that c-sections are an incredible medical advance and have saved many babies and mothers since its invention. There are definitely cases where c-section is the safest way to deliver a baby. Having said that, however, I'd also like to say that women, biologically speaking, are designed to bear offspring. Our bodies aren't just capable of it, they are built specifically for it. Leading women to believe that they are no longer capable of this most basic of abilities is one of the great crimes of modern medicine.
The statistics are terrifying. I grew up around midwives and homebirths, so I've never feared them, but I know that if something goes wrong, it's a very long ride to the hospital. I always assumed that with all of our modern medical advances, it was just preferable to give birth in a hospital nowadays. Wrong, wrong, wrong. The statistics speak for themselves. The US cesarean rate is 33% nationwide. A "normal" rate is somewhere around 10-15%. Birthing Centers and midwife practices regularly report rates of less than 10%, with no higher (and in most cases, lower) rates of infant and maternal mortality.
The rates of induction, epidural and episiotomy are higher and frightening. Studies have shown again and again that in a normal, low-risk pregnancy, natural labor and delivery on the baby's time are best for both mother and child. Speeding up that clock with drugs and surgery is detrimental to both. There are no long term studies (as yet) on the effects of Pitocin, epidural drugs, ultrasound and the like, which is cause for concern. There does seem to be some indication that babies born with "interventions" have a more difficult time breast feeding, have lower Apgar scores, and potential have developmental problems associated later in life. Mothers of these babies generally report having a harder time bonding with their new babies. The US is 32 out of 33 industrialised countries for infant mortality. We're 33rd for maternal mortality. (All stats quoted from "Pushed".) Like I said, terrifying.
So, as you know from my previous post, I'm having a hard time finding a midwife who will deliver at home, and the birthing center (and midwife practice) near me is full for February births. I really like my OB and I trust her, so I thought, "Well, if I have to deliver with her at a hospital, it wouldn't be so bad. I'd just need to lay down some ground rules." I'm still wary of that and would prefer not to have to go that route, but I decided some investigation into the local hospital system (Inova) was warranted.
I checked their website first, and as it turns out, there are several midwives who are licensed to practice in the Inova hospital system. That's a good sign, right? They don't work for the hospital, but they are affiliated with it. Then I made some phone calls...
First, it took me 4 transfers to even find someone who could tell me anything about the rates of c-section, episiotomy and induction. It turned out to be the charge nurse in the labor and delivery ward. She said that about 40% of women who come in get c-sections. "I don't know... A lot.", was her answer when I asked about inductions (Pitocin or Cervadil, specifically.) But she qualified it by saying that the majority of those were patient requested. She said "very few" episiotomies were cut. She also said that if any "interventions" were given (inductions, for example), fetal monitoring was required. Otherwise, fetal monitoring is "intermittent" - 20 minutes out of every hour. For the record, in my research I've found that fetal monitoring has done nothing to improve rates of birth defects caused by the birth itself, such as cerebral palsy (oxygen deprived to the baby during birth). Fetal monitoring, in my opinion, seems to be a placebo at best, and at worst a leveraging tool used to force women into unnecessary medical interventions. The nurse said that women can stay in the L&D ward as long as their insurance will cover - generally 2 days for a vaginal birth, 3-4 days for a c-section, but can leave in "as little as" 24 hours. She also claimed that women weren't confined to bed and could labor and push (deliver) in whatever position they wanted. The one bit of good news? Babies room in with their mothers rather than going to a nursery.
There are some troubling things about this information. First, why did she have to guess? Why aren't these numbers published somewhere for public access? Second, what, exactly, is "patient requested"? In my research, I've discovered that just agreeing to a procedure recommended by a doctor constitutes "patient requested". Third, I find the bit about being able to deliver in whatever position you want to be highly suspect. For starters, if you have any "interventions" you are hooked up to IVs and a fetal monitor, and you absolutely can't move around with those things attached. (Specifically the fetal monitor.) I have never seen or heard of a hospital that allows that. Any hospital I've ever seen makes you lay down on a bed and push flat on your back. Which is well demonstrated as the absolute worst position to try to deliver a baby. Maybe Inova is different, but somehow, I doubt it. Fourth, why does Inova have a 40% c-section rate? Are women in the DC metro area just incapable of giving birth on their own?
I think not.
After talking to the nurse at Inova, I started doing some Internet research and found a website called The Unnecesarean. This website publishes rates of c-section by state and by hospital within each state. Virginia is high on the whole, but the metro area of Northern Virginia has some of the highest rates in the state. The hospital closest to me reports a rate of 43.6%. Yikes. That percentage is indefensible in my opinion.
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| Graphic from theunnecesarean.com |
I again want to point out that c-sections and other advances in obstetrics have saved the lives of countless mothers and babies of the years. I know a few personally, in fact. I'm not anti-cesarean. I'm anti-cesarean when it is not medically necessary. I think most doctors would argue that the c-sections performed in hospitals today are almost always medically necessary (except the rare instances when women schedule them in advance for convenience), but the research shows that to be categorically false. C-sections become "necessary" when you have cascading interventions. The birth process requires no intervention in all but a few cases. I should also make it clear that I am not intending to engage in any behavior that will risk either my life of my child's. If it becomes necessary for me to have a c-section, I can guarantee that the midwives will drive me to the hospital (or call an ambulance). This is not about doing something dangerous to prove the system wrong. This is about doing something normal and natural, and showing that the "system" isn't always right. My goal when I started this research was to stay out of a hospital. After my phone calls to the local hospital, I think that goal is one of the most important of my entire pregnancy.
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