Saturday, October 25, 2008


There was a screening of "The Business of Being Born" in the Dallas/Ft. Worth area in February, followed by a panel taking questions. The vast majority of questions and dialogue were addressing VBACs, or Vaginal Birth After Cesareans. Why so many questions? Like I've said before, in this area of the state, the c-section rate is 50%. No matter where you live, it's probably hovering around 30% -- some more, some a little less. We all know women who have had a c-section. This affects us all, even if you have never had one. Let me explain.

There are so many reasons for the high c-section rate. I am not aiming to explain those in this post, although I will touch on a few.

The phrase that gets me is: "I had to have a c-section because..." If women were not induced or did not have pain medications, they would most likely not have a c-section. Only about 3% of women TRULY need a c-section because of a true medical condition, such as placenta previa, cord prolapse, etc. The World Health Organization has recommended that the c-section rate not be above 10-15%.

And yet, every now and then, a student of mine will map out their labor that ended in a c-section, and I am stumped. I don't know what could have been done differently. More often than not, however, I can tell exactly where labor took a turn that headed down that path -- often introducing pitocin or pain medications.

I had a woman in class a couple of years ago who was attempting a VBAC. She was tiny. Less than 100 pounds and less than 5 feet tall. The first c-section was unavoidable -- cord prolapse -- but she was determined to have a vaginal birth the second time around. She hired a doula and labored beautifully for many hours. She loved labor, in fact. She was so prepared for the birth, physically and mentally. She never dilated past 9 cm. and the baby was not descending. They tried all sorts of positions and movements. She never had any interventions at all. After several hours at a 9, she said she would do it for one more hour. If there were no changes, she would have another c-section. The hour passed, there were no changes, and she had a c-section. She had no regrets though. She gave it her all, loved labor (which was so beneficial for both baby and mom), and ultimately, despite the 2nd c-section, is an advocate for natural labor and birth. She was a wonderful example of taking an active role in her health care and doing her part.

Lately, the biggest reason I am seeing for c-sections is, simply, the time clock. You've been in the hospital too long. They are not going to let you hang out to labor for more than a day. Even a day is extremely generous. Usually, we are talking more like 12 hours. You are taking up space. They can "section" you, make twice as much money, and move you out, on to the next one. Will they tell you that is why you are having a c-section? Of course not. They will call it other things: failure to progress (in their time frame), CPD, or cephalopelvic disproportion, meaning the baby's head is bigger than the pelvic outlet (extremely rare, but very common reason for a c-section), or fetal distress. If any of these things are true emergencies, they will put you under with general anesthesia and do a c-section in a matter of minutes, or less. If they take their time, it's not an emergency. Fetal distress is rarely a diagnosis is natural labors. It usually begins to show up after the introduction of interventions, such as pitocin or pain medications, even continuous monitoring that prohibits mom from moving around.

Plus, if they can get you on the c-section path, as opposed to birthing vaginally, now you will likely (thanks to ACOG, again!) be having all of your babies by c-section. Of course, you can have a vaginal birth after a c-section, but it's very hard to find someone to do them, at least in the DFW area. Subsequent pregnancies become more and more dangerous to babies, as well as moms, who continue having c-sections. It's not just about the birth, but the actual pregnancy. The more c-sections you have, the more likely your baby is to have problems. It is not a good idea. Please, seek out birth attendants who do VBACs.

There are many reasons given for c-sections -- some are legitimate and some are not. I believe that if a woman will educate herself, stay healthy and low risk, trust in her body to start labor on its own, and not have medication to numb her labor and birth, it is highly unlikely that she will have a c-section. If she has done these things and then has a c-section, she can at least know that she did her part to try to not have one, like the woman in the story above. It all comes back to taking responsibility for ourselves and our health care. And ultimately, our babies.


Sarah said...

Once again, a great post! I like how you brought up a good example of a "necessary" c-section. They aren't all bad--just most!

It is a grief to see that so many people needlessly experience this life-altering/halting (and let's not forget life-threatening!) MAJOR SURGERY!

Keep posting, Donna! Such thought-provoking information!

Kate's mommy said...

Great post Donna, keep writing!

Christina Pond said...

I think a lot of times it is NAP that gets people. That coupled with drugs and the distress it creates in the baby...

It breaks my heart. Especially for my friends who have had them, one of my girlfriends cries over it all the time, and she is 5 months PP. She relives the moment over in her head again and again, and feels so cheated.

How dare OB's not spend a little extra time with the laboring woman and help her avoid a C-section.

OB's need some training in empathy, and sensitivity. Birth is the most important moment in a woman's life. What happens at that moment is life changing.


Christina Pond said...

I have a friend, whose friend's baby just died of an overdose of pitocin used to induce labor.

I can not imagine the pain she must be feeling... Don't ever let anyone say the drugs don't make it to the baby!

Donna Ryan said...

I am sorry to hear about your friend's baby, Christina. That really is devastating, especially when you know it was preventable. Again, just goes to show how dangerous these drugs can be. Forcing the uterus to contract has the potential to hurt, or even kill, a baby. This is why we hear of fetal distress in labor so often -- the majority of women have pitocin in their bloodstream, forcing the uterus to contract because the epidural has put an end to normal uterine activity. But, thank goodness for the c-section that saves this baby! (Said with only the slightest degree of sarcasm.) Women need to be given confidence, instead of drugs, in labor and birth.

Donna Ryan said...

As far as the NAP comment earlier, for those of you who don't know what that is: It's a Bradley term that stands for Natural Alignment Plateau. This is a common occurrence in labor, when the cervix stops dilating for a time, possibly hours. Other things are taking place; such as, alignment of the baby with the pelvis, production of colostrum, softening of ligaments, etc. This NAP is often diagnosed as Failure to Progress (don't get me started!) because she's not dilating "one centimeter per hour." Don't ever do labor math! It is your enemy and leads to unnecessary c-sections.

Summer said...

When I was having my baby in the hospital I was "not progressing" fast enough for the doctors. They allowed me to use a natural method of induction (nipple stimulation)for several hours and I was actually dilating (howbeit very slowly, but what do you expect when your body is not ready to give birth and the baby is obviously not ready to be born?). They started me on the Pitocin. Then when they decided it wasn't "working fast enough" they kept asking me if they could break my water. I didn't want to do that because my mom (a midwife) kept telling me that I would have only 24 hours to give birth after breaking my water before they would do a c-section. Not too long later the doctor came back and said (this was a medical school as well, I think you should know) "There are some specialist who want to be here when the baby is born and they would rather it be in the day time." CAN YOU BELIEVE THAT???? These people's schedules are more important than my health and the health of my baby!! She said "I'm going to check you again and if you aren't progressing still, we will have to break your water." I said okay. I was thinking she would check me then we would talk about breaking my water. However, she checked me, said I wasn't progressing and BROKE MY WATER WITHOUT MY PERMISSION! I was an emotional mess. Thankfully, I got through this ordeal without a c-section (prayer works). Oh, and later when I was about to push the baby on out, they made me lay down so they could put the monitor on me. I keep thinking it would have been much easier if I had been in a squatting position like I wanted to be.

Sorry for the rant but your post brought back all these memories! I'm reading through all your posts and they are awesome. I love the bradley method.