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THE C-SECTION EPIDEMIC: "At Least You Had a Healthy Baby" Harms Mothers, Babies & Society

Thursday, 22 May 2014 11:08
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There is a global c-section epidemic. Both mothers and babies are suffering trauma and health risks. New research is emerging indicating that the health of society at large is being compromised as a result.

While the reasons for the epidemic are varied and complex, awareness is growing (thanks in large part to mothers, birth workers, and advocates using social media). Earlier this year, The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, jointly-issued the Obstetric Care Consensus, stating that allowing most women with low-risk pregnancies to spend more time in the first stage of labor may avoid unnecessary cesareans [1] (long understood in the world of midwifery). 

Despite the growing awareness, US C-section rates (approximately 1/3 of all births) remain far in excess of the WHO standard: “The estimated proportion of births by caesarean in the population is not less than 5% or more than 15%.”[2]  (Note that 15% is not the rate it “should be,” but the very high end of what could be expected.) 

Of course there are some hospitals and OBs with decreasing C-section rates, but the fact remains that, based on the WHO guideline, 55-85% of the C-sections performed in the US are in excess of what should be required.

Alarmingly, maternal mortality rate is higher in the US than in China[3] despite the fact that China has a dramatically higher C-section rate (47%).[4]  Worse, Abigail Higgins reports: “Eugene Declercq, of Boston University's School of Public Health, produced a short film named Birth by the Numbers discussing maternal mortality in the US. In a 2013 follow-up report, he noted that mortality rates in other industrialized nations had declined - while in the US, it increased by 30 percent in the first decade of the new millennium,”[5] partially due to C-sections. [6]

Not only are c-section rates climbing, but surgery is being forced on women against their will.  In April this year, a woman was “kidnapped” from her home by authorities in Brazil to make her comply with her doctor’s demand that she have a c-section.[7]

And just last week in what the Inquisitor said could be termed a violation of the most basic of feminine, or even human, rights, a woman in Staten Island was forced, against her will, to undergo a cesarean section.[8]

Are We Culpable in the C-Section Epidemic?

As the friends, family, and caretakers of the victims of C-section abuse, we are unwitting accomplices to the tolerance and acceptance as “normal” of C-section rates of 33% (US hospitals), and even of 90% (private hospital rates in Brazil) when, by contrast, the rate at The Farm from 1970-2000 was 1.4%[9] (lower than would be expected in any medical facility, but the statistic and their work (www.thefarmmidwives.org) merit consideration. See footnotes*)

 With one sentence—“At least you had a healthy baby”—we unconsciously endorse the system that has created the phenomenon of the “emergency birth,” and the perception that birth is dangerous enough to frequently require surgical intervention to “save” mom and/or baby.

There are dozens of reasons never to utter those words to a new mother after her C-section (all actually nuances of the single problem that it makes us accomplices). Here are the top seven. 

1.    No mother wants “the least” for herself or her newborn.

Though it may be defined differently by each of us, we all want something wonderful—the best possible.  It is never comforting to hear we got “the least.” 

2.    It implies that the baby is healthy because the mother underwent surgery.

There is tremendous and mounting evidence that the opposite is true.  Bypassing the natural birth process (in anything other than a truly life-threatening situation) compromises the mother and baby’s health in numerous known ways (emotionally and physically). Overtime we will undoubtedly discover many more ways in which the compromise to our mind/body compromises society as a whole.  

A new film called Microbirth produced by One World Birth and scheduled for release September 2014 will address this subject with grave and fascinating new evidence.

I contacted Toni Harman, Director and Producer of Microbirth, to ask about her film and the discoveries they’ve made in their research.  This is what she had to share:

     "Microbirth is a feature-length documentary that looks at how the way babies are born could have consequences for long-term health. Over the past eighteen months, we’ve been filming scientists working across many different fields who are starting to link C-section with increased risk of children developing certain chronic diseases later in life. These diseases include asthma, allergies, obesity, diabetes, auto-immune conditions, cardiovascular diseases, mental disorders and even some cancers.

The scientists are hypothesizing that this could be connected to the baby’s microbiome (its bacterial ecosystem) not being seeded properly with the mother’s own   bacteria at birth. With vaginal birth, the mother’s bacteria transfers to the baby inside the birth canal, then more is transferred via immediate skin-to-skin with the mother and breastfeeding. This bacteria innoculates the baby and helps train the baby’s immune system, helping it distinguish what is “friend” and what is “foe”.  This helps protect a baby from developing one of more chronic diseases later in life."[10]

She added that a baby’s microbiome is still seeded during c-Section, unfortunately by the operating theatre. 

3.    It assumes that something was “wrong” with mom and baby in the first place.  

We know statistically that, when we allow birth to happen at its natural pace in a peaceful, uninterrupted, supported environment, the vast majority of mothers without pre-existing conditions can successfully birth their babies without medical intervention. We also know without question that—far too often— the procedures in the hospital are actually creating the “emergency” situations that lead to C-sections. In an article called “The Cascade of Interventions,” Theresa** puts it this way:

     “We are lucky to live in the time of modern medicine, however medical interventions such as labour induction, pain relief, and cesareans—measures that have saved many lives—have been overused. In a hospital setting where your care providers are actively managing your labour, once you have one intervention it makes more interventions more likely to be needed in order to remedy the effects of the previous ones.”[11]

What was “wrong” with mom and baby is that they weren’t given the circumstances in which birth has a decent chance of occurring without surgery. 

4.    It minimizes what the mother lost in the experience.

Even when baby is healthier or saved by a C-section (again, in a small percentage of cases this is accurate), “at least you had a healthy baby” disregards the emotional and physical loss and trauma the mother experienced.  She had a dream for her birth . . .and that dream was taken away (excluding cases of elective surgery). She is experiencing loss, and is in recovery. She has the right to mourn and work through her valid emotions without having them discounted or ignored.

I contacted Lindsay Lipton Gerszt, a documentary filmmaker whose latest work is a film on postpartum depression called When the Bough Breaks, to discuss this aspect of the issue.  She said:

     “According to the National Center for Health Statistics, the C-section rate has climbed more than 50% since 1996.  Whether the C-section was medically necessary or a personal choice, many women who have had it experience postpartum depression. Although the reasons may be many and varied, one reason why women feel depressed after having a C-section may be due to the stigma surrounding it. Many are made to feel guilty for not giving birth naturally.”[12]

In a Catch-22 scenario, by not wanting to contribute to the pain these mothers are experiencing, we try to minimize it with the infamous line, “At least you had a healthy baby.”  I conducted an informal poll online with mothers of C-section, asking how they felt when hearing that statement.  One woman’s response clearly shows the complexity of the emotions mothers of C-section experience:

     "There was such a flurry of emotion. I felt angry because I knew I would have had a healthy baby without the section. I felt guilty because I knew many women who pray for the opportunity to simply have a baby . . .any way. I felt like a failure for not doing a better job of standing up for my rights and my baby's. I felt hurt from the insensitivity of that statement."

Indeed, women of C-section are not to be made to feel as if they failed or guilty for having had a C-section. Either it was truly medically indicated or they’re victims. In either instance, the mother should be supported. There is a better way to support them than pretending (in the cases where it could have been avoided) that their child was “healthier” or “saved” by the surgery. 

I believe we unwittingly perpetuate the problem and dishonor mothers and babies when we try to gloss over the serious risk and pain they endured with what we believe is the kind thing to say, but is—in fact—a benevolent, yet pernicious untruth.

I asked Theresa Morris, PhD, author of Cut It Out: The C-Section Epidemic, for her thoughts. She said,

     “Normative structures of mothering are strong, and when a woman gives birth to a healthy baby by C-section, it becomes difficult for her to question whether the C-section was necessary. Yet, we should always ask, “Would the baby and the mom have been just as healthy (or healthier) if the baby had been born vaginally?” The answer to this question, according to the World Health Organization, is yes for all but about 15 percent of women who give birth in any country in a given year.”[13]

5.    It minimizes what the baby lost in the experience.

The baby. The co-birther. This aware participant who is too often treated—at best—as an incapable, unaware “patient,” and at worst as “an object to be removed.”

Ask any birth worker who has witnessed hundreds of births, natural and surgical, “What are babies like after each kind of birth? How does their behavior differ after the different types of birth?” They will tell you that babies born naturally are generally calm and alert, while babies born of surgery—because they are drugged and shocked—are often disoriented and even difficult to rouse.

We must not allow ourselves to skirt the subject of how babies are traumatized by surgical birth in the name of protecting the feelings of new-mothers-of-c-section. It is for them and because of their experience that we must speak about this subject honestly, and protect other mothers and babies from c-section abuse.

Babies of surgical birth are traumatized. All they are programmed by nature to expect, to be ready for and capable of, is voided in birth by c-section. 

6.    It implies that the doctor has done something that was necessary—was a “savior.”  

There is enormous research indicating that a great percentage of mothers who birthed by C-section felt “pressured” to do so because they were “failing to progress” (meaning in many cases, just “taking too long” for hospital efficiency standards) and would not have chosen surgery otherwise.

In instances of multiple births and breech, many OBs simply won’t consider varying factors, “forcing” the mother to accept C-section as her only option. One mother said:

     "I was cornered into an unneeded and unwanted C-section because the obstetrician that I had didn't have the experience to catch her."[14]

7.    It encourages other mothers (and society at large) to believe that surgery is safe and often necessary to save their baby, when for the majority it’s a dangerous option involving more risk and suffering. 

     "There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so," said Dr. Lalonde.[15]

Then What Can We Do and What Can We Say? 

What can we do about this C-section epidemic?  In an article published in The Atlantic titled “Once a C-Section, Always a C-Section?,” Whitney Pinger, Director of Midwifery Services at George Washington University, said of the situation:

     "You can’t pin it on one thing. There’s no one thing to blame, there’s no one person to blame . . .we’re all in this together; we got ourselves into it as a society."[16]

Yep, we did. And it’s high time to get ourselves out of it.  Starting with the very simple first step of never saying, “At least you had a healthy baby.”

What then do we say to mothers recovering from c-section?

We want to support all mothers after birth—and mothers who experienced any kind of trauma need particular care emotionally and physically. Again I went to a group of thousands of mothers online and asked them what they wanted to hear.  Kayla Dar, founder of Baby’s Breastie and mother of four, provided what is the simplest yet likely the perfect response: 

     "After listening to what she has to say about her birth, ask the mother:  

     How are you? How can I help?"

 

_______________________________________________

Note about C-section statistics quoted in this article and in general: In my research I found varying numbers for C-section rates by State (in the US) and by country. For example, rates in Brazil in general appear between 40-50% while there are statistics indicating that 90% of births in Brazil private hospitals are by C-section.  Further, even WHO documents and reports explain their range (generally quoted of 5-15%) differently. In one report, a nuance of the minimum range was explained this way:

“The recommended minimum necessary c-section rate at population level to avoid death and severe morbidity in the mother lies between 1-5%[17]

To further complicate matters for those wanting precise numbers, consider this nuance explained by Right Diagnosis:

“The word 'prevalence' of Caesarian Section usually means the estimated population of people who are managing Caesarian Section at any given time (i.e. people with Caesarian Section). The term 'incidence' of Caesarian Section means the annual diagnosis rate, or the number of new cases of Caesarian Section diagnosed each year (i.e. getting Caesarian Section). Hence, these two statistics types can differ.”[18] 

For purposes of this article, I’d like to suggest that the precise numbers, whether 31% or 33% or 35% for the US for example, is not of primary importance. The fact that we know close approximations—that are far too high—is the point.

[1] http://www.acog.org/About_ACOG/News_Room/News_Releases/2014/Nations_Ob-Gyns_Take_Aim_at_Preventing_Cesareans?IsMobileSet=false February 19, 2014

[2] http://www.scienceandsensibility.org/?p=483 Oct 30, 2009

[3] http://www.vox.com/2014/5/5/5680964/americans-are-likelier-to-die-in-childbirth-than-russians-or-chinese  May 5, 2014 

[4] http://usa.chinadaily.com.cn/epaper/2013-09/04/content_16943528.htm Sept 4, 2013

[5] http://m.aljazeera.com/story/201438161633539780

[6] Ibid.

[7] http://www.telegraph.co.uk/women/mother-tongue/10767161/Kidnapped-by-the-authorities-meet-the-woman-forced-to-have-a-caesarean.html  April 17, 2014

[8] http://www.inquisitr.com/1250257/mother-forced-to-have-cesarean-section-and-now-shes-suing/#UXXEWJoTczECB1Ls. 

[9] http://www.naturalbirthandbabycare.com/farm-statistics/ 

*The Farm does not serve women with preexisting conditions that make them high risk and has had varying policies over the decades about working with women with breech presentation and other situations or variations of normal.  However, the enormous difference in their statistics compared to the national average—especially given the duration of the performance—demands the comparison.

[10] Email exchange with Toni Harman, April 30 and May 14, 2014  http://oneworldbirth.net/microbirth

[11] http://thebirthingsite.com/labour/item/612-the-cascade-of-interventions.html Feb 9, 2013

[12] Email exchange with Lindsay Lipton Gerszt  April 21 and April 25, 2014.

[13] Email exchange with Theresa Morris, April 15 and April 21, 2014

[14] http://m.theglobeandmail.com/life/parenting/pregnancy/delivery/c-section-not-best-option-for-breech-birth/article1186104/?service=mobile  IL

[15]http://m.theglobeandmail.com/life/parenting/pregnancy/delivery/c-section-not-best-option-for-breech-birth/article1186104/?service=mobile  IL

[16] http://www.theatlantic.com/health/archive/2014/05/once-a-c-section-always-a-c-section/362088/ May 20, 2014

[17] http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf

[18] http://www.rightdiagnosis.com/c/caesarian_section/stats-country.htm#extrapwarning  April 18, 2014

**author’s full name as posted in the article

Read 10360 times Last modified on Friday, 23 May 2014 18:40

ALLIE CHEE has studied Asian martial and healing arts since 1989, earning a 2nd degree black belt and certification in TCM nutrition; she is a 42-year-old home birth mom; and author of NEW MOTHER: Using a Doula, Midwife, Postpartum Doula, Maid, Cook, or Nanny to Support Healing, Bonding and Growth; and FREE LOVE: Everyday Ideas for Joyful Living.

Her articles have appeared in: 

  • Midwifery Today
  • The Well Being Journal
  • The Birthing Site
  • The Holistic Networker
  • Kindred Community
  • Natural Mother Magazine

With 85% of US births considered traumatic for mother and child, how can we plan the gentle birth & loving postpartum we all want? View: The New Mother video...

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Website: www.alliechee.com

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