Soapbox

I had to do a research paper and a presentation for my English class this semester and I decided to write about cesarean sections. A couple of years ago I read an article about the rise in cesarean rates and it seemed to be a good fit for this paper since it was a topic I was interested in and something that I could find good, scholarly sources for.

So I'm gonna get on my soapbox now and share what I've learned in this process:

(trust me, this is the least disturbing photo of a cesarean one can find!)

There are too many cesareans being done in this country. There are many legitimate reasons for needing one, but the rate has risen dramatically in recent years- 1 in 3 women (31.1%) now are having a cesarean. We have set a new record each year since the year 2000. Keep in mind that the WHO has gathered a lot of info and stated that a cesarean rate of 5-15% of babies born is preferred. If the cesarean rate is below 5%, more women die. And if the cesarean rate is above 15% (and that number is a little high) more women die.

A cesarean is major surgery with a lot of recovery time- weeks compared to days. The surgeon has to slice through five layers to reach the baby!

There's multiple reasons for the rise- there are more older moms, obese moms (obesity doubles your chance of needing a cesarean) and multiple births then there were, all of which raises the need for cesareans, but doctors and hospitals play a role as well. More births are being induced then in years past, and inducement is linked to cesareans. Inducement leads to pain which leads to an epidural which leads to "failure to progress" which leads to a cesarean. Many hospital practices (and I could go on about this) lead to cesareans, from poor birthing positions to continuous fetal monitoring.

Doctors of course are going to prefer a scheduled, predictable birth to one that could happen anytime. A study shows that more cesareans occur during Mon-Fri, 9-5 hours instead of being more spread around as they should be for an emergency. Since WWII, obstetricians have replaced general practitioners for attending births and of course a surgeon is more likely to use surgery to solve a problem. Many doctors today are afraid of litigation and are more likely to do cesareans if they are afraid overall of being sued. Many doctors get paid more if they perform a cesarean, so there's a financial incentive too.

And yes, the rate of requested cesareans has increased too. Many women think they're "Too Posh to Push." Or they're more concerned over vaginal tone. Or they're influenced by celebrities who get scheduled cesareans. Who knows.

As expected, there's a lot of risks to women. Birth has its risks, but cesareans are far riskier. You are 2-7 times more likely to die than a woman having vaginal birth. And there's all the risks associated with surgery: increased blood loss, reaction to anesthesia, complications, infection, damage to internal organs, etc. A woman having a cesarean is much more likely to have to be re-hospitalized. Not to mention you are having to recover from major surgery while caring for a newborn!

Women who have had a cesarean are at a greater risk of problems down the road: involuntary infertility, ectopic pregnancies, etc and their future babies are more likely to be of low birth weight and have other issues.

So yes, we know that surgery is bad, but here's the kicker- when you have a cesarean, bonding with your baby is interrupted. When a woman gives vaginal birth, she releases oxytocin, which is a powerful bonding hormone that helps bond with her baby. Cesareans don't produce that same effect and it can be harder to bond with your baby. Babies born vaginally get endorphins that help them to be alert and ready to feed, cesarean babies don't get those endorphins. Between that and the delay in which the mom can attempt to breastfeed (it takes time to be sewn back up and be awake enough to hold your baby), many cesarean babies don't breastfeed or don't breastfeed very well.

Of course there are risks for the baby: risk of being born premature (it's still hard to determine exactly how old a baby is in utero), risk of being cut during the procedure, high risk of breathing problems (and breathing problems are a leading factor in infant deaths) because fluids aren't being squished out during labor, and cesarean babies are twice as likely to get asthma.

Another reason to cut down on cesareans is the cost. Cesareans cost much more than a vaginal birth and costs even more if there are complications. Cesarean section is the most common surgical procedure performed on women. It's the 2nd highest procedure billed to Medicaid and the 4th highest procedure billed to private insurances. Presumably if we lowered the number of unnecessary cesareans, health care might not be so expensive. Other countries have a system of using midwives for most births (much less expensive) and using surgeons when needed, which not only saves money but lives. The US spends by far the most on birth, but we're not seeing good results. It's rather embarrassing how many other countries have better infant and maternal mortality rates than we do. We're not getting what we pay for.

So cesareans are necessary and lifesaving, but more needs to be done to educate women about their options when giving birth. Reducing the rate of cesareans would be beneficial to mothers, babies, families, and us all. I think this topic naturally leads into other topics in childbirth. Overall, I think that women and doctors need to have faith restored in what a woman's body can do.

For my own unofficial data, I have a midwife friend who births a lot of babies- and no more than 3% of her babies need to be born by cesarean. I also have a friend who is a nurse working Labor & Delivery in a hospital and she says that she has to constantly fight against doctors pushing cesareans on women. Since writing this paper, I have realized that a really large percentage of my child-bearing friends have had a cesarean (reasons unknown) which fits with the data.

My young friend in class read my paper and said she was scared to have kids, (but hey, there are a lot of kids needing adoption)which is not the goal of my paper. The goal was to inform and empower women with some knowledge. I'm sure it's kindof odd to be so interested in this topic when I've never given birth, but I think it's good stuff to know.

Two sources I recommend:

The book Born in the USA: How a Broken Maternity System Must be Fixed to put Women and Children First by Marsden Wagner

and the documentary The Business of Being Born (really great and touching)

I'll get off my soapbox now (steps down).