politics

Caesarean Awareness Month

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Apparently April is not only National Poetry Month, but also Caesarean Awareness Month and blog posts (like this one) are popping up all over talking about why people believe in “non-intervention.” One thing I’ve noticed is that some of these posts refer to the idea that the World Health Organization (WHO) recommends a 15% c-section rate. The problem is, the World Health Organization doesn’t actually have any reason for that rate.

The introduction to this article in the WHO medical journal states:

There is no consensus on the “optimal” rate of caesarean delivery at the population level. Although values between 5% and 15% of live births have been suggested, the basis on which these thresholds have been proposed is not clear.

And the WHO handbook “Monitoring emergency obstetric care” from 2009 says:

Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15% (125), there is no empirical evidence for an optimum percentage or range of percentages, despite a growing body of research that shows a negative effect of high rates (126-128). It should be noted that the proposed upper limit of 15% is not a target to be achieved but rather a threshold not to be exceeded. Nevertheless, the rates in most developed countries and in many urban areas of lesser-developed countries are above that threshold. Ultimately, what matters most is that all women who need caesarean sections actually receive them.

That sounds to me like the WHO is waffling on the whole topic and maybe bloggers need to stop throwing the whole 15% number around. Tell me again why keeping a low c-section rate is more important than a baby's safety?

Of course bloggers and natural birth fanatics also say that they aren’t against necessary c-sections, only the unnecessary ones. But how do you tell if a c-section was really necessary? Do you wait until it is so late in the stage that the baby is one step from death and may have already started to suffer brain damage? A properly timed necessary c-section will result in a healthy baby and a mother who may well go home and think she had an “unnecessarian.”

The idea that a particular c-section was unnecessary will be reinforced by random bloggers and internet friends who are busy trying to convince themselves that natural births are totally safe. When people want to believe something they’ll find the bloggers and authors who support their ideas. There are plenty of “communities” online where phrases like “cascade of intervention,” “babies aren’t library books, they don’t have due dates” and “you can’t grow a baby too big” are floated around like cult mantras. Occasional comments about the science get rejected and newcomers assume the lack of a different opinion is because there really is a consensus about this type of thing, rather than because of heavy censoring. Stories of deaths of babies that could have been saved by a timely c-section will be removed or brushed aside as trying to scare people.

Being a parent is hard. It always has been and always will but I write this post about caesarean rates in the hope that it can help remind women that they aren’t responsible for trying to lower the c-section rate and they don’t have to believe the mothering communities that would tell them they should have somehow managed without it. C-sections are not something to be ashamed of. They are not a sign of failing. They are not because you did not “trust birth” enough. You are the envy of thousands of years worth of mothers who lost their babies due to what is inherently a dangerous process. You had access to medical assistance and accepted it.

 

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2 Comments

  • Beth

    God bless you. I have never experience labor because it was all my fragile uterus could to stretch for the babies. The first birth went okay, but the second one tore it and I lost nearly 7 pints of blood before they were all agreed that re-entering the surgical site was necessary. After that, my OB said no more children. The first c-section revealed the issues that were theoretical to that point. Had I gone into labor my uterus would have slowly shredded itself with each contraction. And yet, natural birth activists think I made a mistake not trying a VBAC. As my doctor said, better a living mother and a living baby than losing both,

  • Shad

    My mom was a midwife, so when I was a kid in the 80’s I heard her talk about Caesareans fairly often. My understanding from back then is that much of the anti-Caesarean sentiment (at least among midwives) started as a reaction to doctors’ choosing Caesareans for progressively smaller risks and making the decision progressively longer before labor, and to increasing rates of expectant mothers choosing Caesareans for no medical reason at all (usually to have control of their schedule). The perception seemed to be that as Caesarean deliveries became safer they shifted from being a last resort used only when there is a high risk of loss of life, to a precaution taken when there is any unusual risk, and then to an option chosen for convenience. The objection seemed to be essentially based on a disagreement about the relative risks of a planned Caesarean and the potential complications of a vaginal birth in cases where there were some indications of increased risk but only slightly increased risk. The argument against the increased use of Caesarean sections was that the risks and necessary trauma involved in a Caesarean section exceeded the risks and expected trauma associated with the weaker risk factors (or inconvenience) that were becoming used as indicators to plan a Caesarean.

    I would expect the recommended c-section rate to match the rate of all risk factors or complications which indicate a c-section. Since there still doesn’t seem to be good agreement about what those are, I would expect either some sort of range or a list of rates for different choices of criteria. I’m not sure what to make of the WHO’s upper limit, especially since the rates in the U.S. are roughly twice that limit. Are there that many women in the U.S. choosing Caesarean for convenience? Are doctors in the U.S. expecting a c-section to be less traumatic than the WHO expects? Are c-sections in the U.S. actually lower risk than in other parts of the world? Is giving birth in the U.S. so much higher risk than in other parts of the world that c-sections should be happening more often here?

    Regardless of what the risks are within some population, I would think decisions should be made based on the risks in each particular case. It’s unfortunate that anyone is bullied into making medical decisions based on some perception of an undesirable pattern.

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