It's no secret that in the U.S. today, approximately 1 in 3 women will have a c-section; that's just over 30%. (In some parts of the world, that rate is upwards to 90%! YIKES!!) Prior to the use of obstetricians as primary birth attendants, the cesarean rates in the U.S. were a mere 6%. As teams of doctors, researchers and other medical workers came together to explore how they can continue to improve their care of birthing women and babies, they came up with a slew of creative ideas. More drugs, more tools, more procedures, more surgeries... always MORE. And, as more intervention led to more complications, they circled back to square one. (More). This is the revolving door of medicine.
Admist all of these developments was the introduction of electric fetal monitoring, a variation of ultrasound technology that, in most cases, keep women confined to a hospital bed for monitoring her baby's heartbeat. Between the confinement and consistant disruption of the physical body and the inconsistent accuracy of the external technology, there was an increase of intervention related to perceived fetal distress that led to (drumroll please...) MORE C-SECTIONS!
Now, it's easy to assume that of course there was an increase of cesareans-- an increase of lives saved due to the newly found way to detect distressed babies. I encourage you to consider this: the cesarean rate continued to climb, not plateau, and with it climbed maternal mortality rates. The doctors and researchers, as good-hearted as i'm sure they were, looked for a solution to improve this, but did not turning to trusting women and undisturbed birth, but instead turned to increasing inductions of labor, of intrauterine monitors, of forcep-assisted deliveries, and of episiotomies.
Can you guess what happened next?
The maternal mortality rate did not improve and those revolving doors in labor & delivery units all over the country continued to spin.
As the integral system of medicine has evolved, the standards of care, titles and duties of the various staff members, and availability of resources have evolved too. Our modern medical model is a complictated systematic network between the patient, provider, hospital, and insurances. In the center of well-intended medical assistance and tangled ever-so tightly within the restraints of profit, liability, and false senses of authority, lie 98% of American birthing women. They, who have conceived and grown their babies are withheld information and denied autonomy, as they are measured, analyzed and predicted to either progress in alignment with a hypothetical clock or be subject to procedures deemed necessary by the system. The trust and respect given to women as they enter the world of industrial birth is becoming obselete at the expense of confident, autonomous, and well-bonded women and mothers.
Lets take a moment to consider the reasons for c-sections.
The most common reasons for C-sections are generally rooted in the misuse of and overtrust in technology.
Despite evidence-based advisories against and proven inaccuracies of ultrasound technology, most women receive visual ultrasonic screenings more than twice during pregnancy as well as fetal heart rate monitoring via handheld doppler or continuous monitoring throughout pregnancy and labor. In some cases, this technology can provide valuable insight, but it is also misused and overtrusted to diagnose perceived complications and prescribe induction and surgical birth.
Diagnoses often made by ultrasound include:
Perceived Big Baby
Perceived Low Amniotic Fluid Volume
Estimated Gestational Age of 40+ Weeks
Indication of Fetal Distress via Electronic Monitoring
Multiple Pregnancy (twins, triplets, etc)
Perceived Fetal Malposition (breech or transverse presentation)
Predicted Cephalopelvic Disproportion- baby's head is incompatable with mother's pelvis
Placental Compications such as previa or accreta
I encourage you to research about which of these diagnoses warrant surgeries, and which are likely to be inaccurate assumptions.
Of course, things arise in pregnancy and labor that are diagnosed without ultrasound. Some of these include perceived "failure to progress" (labor that is not moving at a speed that meets staff is comfortable with), perceived shoulder dystocia, cord or placenta issues such as insufficient blood flow or placental abruption (where the placenta detaches prematurely from the uterine wall), cord prolapse, and maternal or fetal complications of various natures, to name a few.
SAFER surgery does not equal SAFE surgery.
Back when the cesarean rate was hovering 6%, cesareans were deemed appropriate only when absolutely needed due to their highly invasive nature and the lack of assisting technologies that accompany today's surgical practice. Today the maternal outcome post-cesarean is much higher than it was, but having safer surgery does not justify using assisting technologies without extreme consideration.
Of the 33% of women who have a primary cesarean section, 90% will go on to have cesareans for their future birth. Let me pause here and state that, like many other things that happen in modern maternity care, it's not evidence based practice. This is not to say that C-sections are "bad," or even "wrong." My intention here is to shine light on the many cases in which cesarean sections and other risk-intensifying procedures are irresponsibly, neglectfully, or otherwise used in ways that do not serve the birthing mamababy.
Cesareans do not come without risk. Last year, we launched the #Hearher campaign in response to Cesarean Awareness Month, where we shared women's stories of their c-section experiences on our Instagram page. This year, we held the #morevbacplease campaign to share the power and joy of healing VBACs. Women's stories are a wealth of knowledge. It is worth listening to the ways in which birth affects our bodies, minds, spirits and the way we interact with the people and world around us.
Cesareans are correlated with higher maternal mortality rates than vaginal birth, decreased rates and duration of breastfeeding, and increased separation of mother and baby in the delicate immediate postpartum period, all of which have short and long term effects on maternal and infant health. Although not unique to surgery, many mothers who have had c-sections also report decreased confidence in their selves and their bodies, and exhibit signs and expressions of birth trauma physically and emotionally.
There is better. Women deserve better.
IMPROVING BIRTH OUTCOMES FOR YOU AND YOUR BABY
Know what increases your risks of intervention,and what each intervention is indicated for. Research the intervention cascade and physiologic birth.
Sit with what you have control of and surrender to the process of birth.
Recognize red flags for misuse of medicine & commit to steering away from them- provider abuse really happens, whether it intentional or not.
Encourage primary vaginal births and vaginal births after c-sections! There are countless benefits of vaginal birth for mothers and babies.
Step outside of the medical paradigm (or use it wisely) & tune into what you and your baby really need for a healthy pregnancy and birth.
As we carry ourselves forward, I invite you to hold compassion for every woman who births and has birthed. We each hold our own perceptions of our experiences, regardless of how needed, wanted or helpful potential interventions were. I invite you to move forth with an open mind about how each woman interacts within these revolving doors of medicine, and to recognize that ultimately, BIRTH BELONGS TO US.
Here's a few of our favorite maternity care resources to get you started:
Gentle Birth, Gentle Mothering by Sarah Buckley
Pushed by Jennifer Block
International Cesarean Awareness Network (ICAN)
You can check the reported cesarean rates in your state here.