Majority of Caesareans Are Done Before Labor [UPDATED]

From an article in the NY Times (surprise, surprise):

A new study suggests several reasons for the nation’s rising Caesarean section rate, including the increased use of drugs to induce labor, the tendency to give up on labor too soon and deliver babies surgically instead of waiting for nature to take its course, and the failure to allow women with previous Caesareans to try to give birth vaginally. […]

The concern arises because Caesareans pose a risk of surgical complications and research has found that they are more likely than normal births to cause problems that can put the mother back in the hospital and the infant in intensive care. Risks to the mother also increase with each subsequent Caesarean, because it raises the odds that the uterus will rupture in the next pregnancy, which can seriously harm both the mother and the baby.

Here’s where it gets bad:

Dr. Zhang said one thing that surprised him about the study was that a third of first-time mothers were having Caesareans. Although it was known that the overall Caesarean rate was 32 percent, some of that was thought to be due to repeat Caesareans.

The main reason for a Caesarean was a prior Caesarean. But in women who have not had Caesareans before, one factor that may increase the risk is the use of drugs to induce labor. The practice has been increasing, and the study found that induced labor, compared with spontaneous labor, was twice as likely to result in a Caesarean.

In the study, 44 percent of the women who were trying vaginal delivery had their labor induced. When Caesareans were done after induction, half were performed before the woman’s cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role,” the authors wrote. Full dilation is 10 centimeters, and a Caesarean before six centimeters may be too soon, the researchers said.

Like other studies, this one found that few women were offered a chance to try vaginal birth after Caesarean.

“Physicians and patients may be less committed” to the vaginal births, the authors said.

44%! Nearly half the women who intended on having a vaginal birth were induced.  That to me is completely insane.  I understand that some women will need to be induced for whatever reasons.  But nearly 50% of them have medical reasons that they can’t wait for their labors to begin naturally?  That doesn’t even make sense.

Here’s my thing about all of this.  I feel like there is a medical system that has completely taken over birthing.  And that system expects women and their labor to conform to some cookie cutter experience (birth will begin on this date, will progress at this speed, will take this long, will require these drugs, etc.).  Any deviation from said experience leads to panic of the part of the medical staff and the patients relying on their expertise, and so often ends up in surgery.  The other options aren’t even presented.  And if you ask about them, you are often made to feel idiotic, silly, not possibly able to do give birth in any other way than the way your doctor expects you to.  At least, that was my experience with the medical establishment. To have the birth I wanted, I felt like we fought all the way.  And then I did have my birth and everything was fine.

I would feel better about these c-section numbers if I felt like women were choosing surgery because they had been given all the options, had weighed their possibilities, and then decided this was the best course of action for them.  But I’m not sure that doctors are having conversations with women about doulas (get one!), the different types of drug interventions (including none at all), the fact that IVs don’t have to stay in your arm the whole time you are laboring, that your due date isn’t some sure date, that inductions have ties to c-sections, etc.  If you want to know these things, you have to search all of this out on your own.  You have to have the time, the resources.  To have anything other than a doctor-deemed “normal” medical version of birth, you have to have levels of privilege.  That is what these numbers mean to me.

————————————————–

UPDATE:

As if it was meant to be, Arwyn at Raising My Boychick tweeted yesterday a post that she had written a year ago titled, “Just Like Athletics: Exploring a Childbirth Analogy“.  The entire thing is GREAT in explaining the roadblocks that pregnant women in labor receive from the medical community (and culture at large) as compared to the support that amateur marathoners are given when they are trying to complete that physical feat.

It is a MUST READ, but here is a favorite part:

Rather, I am saying that kyriarchy’s construction of labor and birth as unbearably painful, as unworthy (as opposed to war games or athletics), and women as either too weak or too “advanced” to tolerate it, is inherently misogynistic. Whether an individual woman follows the biological default and has (or pursues) unhindered birth, or elects to make use of the medical interventions available to most of us in developed nations, does not reflect on her moral standing, any more than participating in, or not participating in, athletic events does. But the current cultural construction of birth must change: not by moving backward to a time when women had no options in childbirth, and were expected — even encouraged — to suffer, and in which there were no medical interventions for when they were truly needed; but forward, to a time when our bodies are valued, our spirits are supported, and the work of birth is seen as hard, yes, and even sometimes painful, but within reach of most of us, and oh so worth it: just like athletics.

And also, I just want to point out how the media plays a roll in downplaying the chemically-induced labor and c-sections connection.  When MSNBC reported on the same study as the NY Times (see below) here was their paragraph about what may be causing higher c-section rates in the last two decades:

Explaining the increase in C-sections is no simple matter. The study found a variety of reasons, some related, including heavier moms and babies, women giving birth later in life, an increase the number of twins and multiple births, and evidence that doctors may be opting for a cesarean if women encounter difficulties in the early stages of labor.

Moms are fat!  Moms are old!  People who opt for IVF are making it harder!  Oh, and doctors may opt for c-section in early stages of labor.  Whose opting for c-sections?  The laboring mom?  Nope.

According to MSNBC, moms only matter in the decision to move to c-sections if they came into L&D fat, old, or with multiples in their bellies.  When it comes down to determining c-sections because of those “difficulties” in EARLY labor, its the doctor’s option.  Blah.  I can’t believe (though I can) how this is presented by MSNBC.  The NY Times doesn’t blame mothers because of their weight, age, or how many children they are carrying.

Businessweek (!) also managed to report on the studying without shaming women.  Amazing.

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5 thoughts on “Majority of Caesareans Are Done Before Labor [UPDATED]

  1. Thanks for analyzing this — you couldn’t be more on the mark.

    I wasn’t even overdue before my OB started pushing induction. I refused because two of my girlfriends before me had Cs due to induction. Lucky for me we were only 3 days overdue. Even then, I’m pretty sure one of the nurses stripped my membranes without asking, and they pushed to break my water.

  2. Thanks for reading and commenting.

    I’m sorry that your OB and the nurses acted that way. My son was born 4 days after his due date and it was a fight to push it that long. But there were no actual reasons that my son needed to be born sooner than he was. My OB pushed to schedule an induction before we even reached my due date (at least the induction was supposed to be 8 days after my due date), even though I made it very clear multiple times over that I would not be induced until I was 14 days overdue. She couldn’t get that it was more important for me to attempt a non-intervention birth than it was for me to have her as my doctor the night my son was born.

    And during labor I was told that they were probably going to break my water. Luckily, it’s like my body and my son heard and within ten minutes it happened naturally. It’s amazing how consistent the fight is the whole time you are laboring. That is why I am a HUGE, HUGE, HUGE fans of doulas because they are there to fight that fight for you and they are experienced at it.

    Okay – stopping now. I could go on and on and on. Thanks again.

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