Saturday, March 22, 2008

Too Posh To Push? Not if You Care for Your Mite

The c-section rate in the USA is now 25% and climbing. This means that at least every fourth birth is being carried out in a hospital by a doctor who is cutting open a woman's womb to bring the baby out. And yet, it cannot be asserted by any specialist that a quarter of all births are complicated and require such a dire & invasive procedure to give birth.

A lot of factors have been suggested as being responsible for the growth in c-sections in this country. Some of these are: the older age at which women are giving birth; our busy lives and the need to control where and when the baby is born; the medicalization of a natural phenomenon for various reasons such as the convenience of the doctor, insurance providers and their desire to make money; women's fear of pain, fear of vaginal tearing, fear of incontinence; women who think childbirth will leave them loose & stretched & therefore unable to experience good sex again; the acceptance of c-sections as normal birth, the fact that many celebrities with access to the best health care are choosing it...

And where America leads the world follows- albeit slowly in some cases. C-section rates have increased the world over but some nations have also been taking steps to capture this rate and to look at birthing more carefully. Not the US however. It continues to forge ahead and blaze a trail inconsequential of the long-term affects of such a radical procedure on human society.

Do women know that giving birth naturally through the vaginal canal actually endows the infant with exposure to the good bacteria the mother has? For instance, in a German study comparing c-section and natural birth babies, it was found that the former were more prone to diarrhea in their first year as well as being much more sensitive to certain foods such as cow's milk at 1 year of age. All the babies were exclusively breastfed for at least the first four months in case one is wondering if that somehow endowed differential immunity on the babies. The reason for this difference, the German researchers think, is the exposure to the mother's good gut bacteria while the child is passing through the birth canal which helps populate the babies system and strengthen its immunity. The c-section baby on the other hand not only does not get exposed to the good flora, it actually gets exposed to the hospital germs first. (By the way, breast milk also passes maternal good bacteria to the baby, so those who give birth via c-section and then don't breastfeed their babies are delivering a double-whammy to the poor mite.) Some researchers even believe that baby girls are colonized by their mother's vaginal flora which stays with them for life and protects them from infections.

How can we continue down this path where we may be putting the health of the species at risk by stripping it of some of the advantages bestowed upon it by a natural delivery? We need to take control of our health and our birth. All those reasons listed above as contributing to the rise in c-section rates should be addressed individually. Women should be armed with knowledge.

There are special cases where medical intervention in the form of a c-section birth is warranted to save the life of the baby or the mother or both (such as a breech position where the baby might be in distress). But the reasons listed above in paragraph two are not one of them. Women can give birth naturally at an older age and without more trouble than younger women. We should not try to determine where and when the child is born. Don't be lead by the convenience of others into giving birth through a c-section. Vaginal tearing is not an inevitable consequence of natural deliveries, neither are loose and stretched muscles or incontinence- learn and practice pelvic floor exercises. C-sections are not a normal mode of birthing. They have their place but if you can experience a natural birth while at the same time giving your baby some immunity, do it!

April Says: Hey -

Wholeheartedly agree with the sentiment expressed here. I personally have decided that it isn't until women take back what they have allowed to be stolen from them - a safe, and sacred, birth experience for themselves and their children - will the growing cesarean rate stand a chance of dropping.

I agree that some of the problem is the availability of knowledge - but much more of it, in my opinion, is our willful lack of forethought. I would argue that there is a tremendous amount of information out there for those that are looking, but most apparently choose not to look. Moreover, I think in this realm, as in many others, medical or otherwise, we have abdicated our own responsibility for decision making. And we face the consequences.

I say this not in an attempt to blame the many victims, but to instead suggest that we need a call to action.

Just some corrections and additions: I think one problem we encounter is trying to identify the appropriate selection rate for c-sections. Some places in France routinely had the rates below %6, I think, and without any decrease in maternal or infant mortality or morbidity. Specifically with regard to potential complications - well, birth is just about as safe as life gets. Breech, for example, only became a problem when physicians began to meddle in the natural process. Breech is not inherently dangerous - it is just a variant of normal. Unfortunately, just as few OBs know what a normal, unmedicated, unmedicalized birth looks like, few have seen natural breech births.

Also, a woman's vaginal tissue is, to some degree, made to tear, and to heal. Much worse than a tear is a surgical cut, which tends to take a lot longer to heal. Sadly, gone the way of the direct entry midwife has seemingly gone a lot of the knowledge about how to prevent tearing during deliveries - many, unfortunately, happen because of the protocol that forces a woman into an often humiliating position on her back, where she cannot push her baby out with tearing.

I am glad we are giving this issue time - thank you! I hope we can do more of it in the future.

Radhika replies:

Ok, I see your point about variants of normal birth (breech being one of them). I guess by normal I meant the straightforward births where one pushes and out pops a baby with no permutations or complications. I suppose the point I was trying to make there (and admittedly not very well) was that c-sections as a medical intervention are not without merit in severe cases as life-savers. But they have no place being another variant of the "normal" birth.

I also hear what you are saying about tearing of vaginal tissue. But are you sure that all vaginas tear up during birth? I didn't see my friend's vagina tear or bleed during birth. Can you write more about the tearing and healing?

Lastly, I'm not sure that we can blame the 25%-&-rising rate of c-section on willful lack of forethought alone. I really think the reigning paradigm has incredible inertia and in this case it is gaining velocity. And the reigning paradigm here is one based on medical intervention. Choosing to look for the information you mention requires additional deliberative action. Many will pass by the birth chapter without having access to this information because the majority of information they receive comes from their doctor and mainstream childbirth/pregnancy books and others who have gone through similar birth experiences. With the base rate (of those giving birth medically) being high and growing, the probability that this information will just be out there when they happen to look is shrinking. This is why someone like Ricki Lake stepping up and airing the issue at this point in time is a good thing. At the moment many women, if they ever come across someone like us airing our opinions on the issue, dismiss the ideas as clique-ish and new-agey.

Btw, had you heard about the healthy exposure to birth canal flora before? Especially the one about the little girls getting mothers' vaginal flora and keeping it for life? I hadn't. Way cool, huh?!

To which April responds:

A breech baby can just "pop" out, too. No complications, just a different way of entering the world. There are good reasons why the baby's head usually comes out first - not sure if we want to get into them here, but, again, many much of the data suggest that problems with breech delivery are often caused by who's assisting, not with the inherent nature of breech babies. But, I do think we agree - something that should be an option of last resort, to legitimately save the life of a mother or baby or both, is being abused.

All women do not tear during childbirth - sorry if I implied that. My point was that lots of women do experience some tearing, and it should not be considered abnormal. Superficial tears often heal quickly, without any complications for the woman, sexual or otherwise. Our attempts to avoid tearing, by episiotomies, for example, cause a lot more problems for women, in part because flesh that is cut with a sharp knife doesn't heal nearly as well as flesh that has torn. How the physician stitches the woman back up is yet another problem.

Sure, sure, momentum is a factor; I didn't mean to discount that. It's just that I *do* expect women to take the additional deliberative action for the sake of their own health and the well being of the baby. And, again, I am trying to not blame the victims here, but, frankly, one should at least prepare to not be a victim. I haven't seen the Business of Birth, but have heard a lot of interviews with the producer. I would love to know what fraction of birthing women enter hospitals and receive pitocin, for example. My very poor scientific study of those who are filmed for the Discovery Health shows suggest that at least half, and probably more, get it. That alone increases your probability of getting a c-section.

Wow - I feel like to some extent a revolution is necessary :) Defying the current paradigm, finding an alternative path - does that define a revolution? Sadly I think the likelihood of it happening in a culture where a huge fraction of people don't even perceive delivery by c-section as a "problem" is pretty small.

Radhika says:

I am loving this conversation. To me it is so clear that the "additional deliberative action" would be so lost on most women. Choosing baby cribs, painting a special nursery room, getting all "essential" baby implements (like stroller, pacifier, baby monitor, bottles, breast pump...), buying some "classics" like What to expect when you are expecting, taking lamaze classes, etc. etc. would be the deliberative action they are thinking of and so they would respond to you- yes, of course, I am excited and happy and making lots of effort for the baby.

Imo, this is not about deliberative action so much as what is the environment like for these women. How is it that they are not even hearing about or realizing that you can give birth healthily without any overt medical intervention? Why is it that all non-hospital births are portrayed as "emergency" and "ambulatory" in our popular culture (watch any primetime TV show)? Why is there a perception of criminal negligence or uncaring parent when one doesn't leave one's care in the hands of an Ob-Gyn? Obviously, at some point in the past this wasn't so. So how come there aren't vestiges of that more innocent and, in many ways, healthier child birthing past left in our present day culture.

When I meet women now, I am as likely as not to ask if they gave birth naturally. I used to assume that more often than not I'd get a yes. Turns out, I get a yes almost every single time. But then we talk about how exactly they gave birth and it turns out natural can mean without pain killers, it can mean lying down in a hospital setting, in can mean with painkillers but through the vagina, it can even mean c-sections without complications! It seems our understanding of natural birth has diminished to the point that it means nothing to the everyday woman. Am I making this sound worse than it is? Am I being alarmist? I am going to finish Born in the U.S.A.(Marsden Wagner) and let you know.

Upon reading all this Molly Eness said:

I would recommend "Misconceptions" by Naomi Wolfe as another perspective on this topic. ( I think I am one of the women who you asked if I gave birth naturally.) I have a sister-in-law and a young cousin who are expecting their first child now and have been thinking about this topic a lot lately. While I completely agree that a natural childbirth is preferable, I also think that the pressure to have no intervention and the fear "chickening out" when the time comes are detrimental.

To which Radhika responded:

Molly, That is a really cool comment and one sure to generate even more debate. As someone who has gone through the experience, your perspective is valuable. I want to birth naturally (as and when I get pregnant). I totally get what you are saying. I'm afraid however, that the pressure is generally from the opposite direction. The jaws that drop and the askance looks are more common when I state I'd like to try a natural, unassisted (well assisted by friends, families and maybe midwife but not necessarily doctor) birth. I have not felt any pressure from the opposite side because I am not part of any natural birth group nor are these viewpoints commonly aired. Of course, I will not deny myself medical treatment should there be a genuine reason for it but I would hate to be on my back if I felt more like squatting, y'know. I suppose, in a way, I like the Swedish example where because of the low birth rate all births are legally required to be within the hospital but where the hospitals have birthing centers which cater to the desires for the various types of birth experience people would like. While the Swedish have mandated hospital presence because they cannot afford to lose a single child in childbirth, they have still not gone ahead and taken the control away from the mother (and father). In spirit, this is the attitude that should prevail about birth.

I'll check the book out. Thanks!

Click on "Pregnant Woman" to see details and credits.