Cesarean Awareness Month: Why is it so hard to get a vaginal birth?

April is Cesarean Awareness Month. You may wonder why an entire month needs to be devoted for raising awareness about c-sections. Here’s why. The c-section rate in the United States is on the rise at an alarming rate. It’s estimated that in 2008 over 1.3 million babies in the US were born by c-section, accounting for 32.3% of all births. It also marks the 12th consecutive year the Cesarean birth rate has risen, despite a number of medical organizations — including The World Health Organization (WHO) and American Congress of Obstetricians and Gynecologists (ACOG) — urging medical care providers to work on lowering the Cesarean birth rates and increase access to Vaginal Birth after Cesarean (VBAC).

Cesarean Awareness Month - April

My Gentle Birthing Blog discusses that while VBAC is often suggested as an option to a woman who has had a c-section, in reality, VBACs are hard to come by due to the fact that many hospitals no longer allow them.

According to the National Center for Health Statistics, the C-section rate in the United States has risen 53% since 1996. Cesarean birth is being overused, and VBAC (Vaginal Birth After Cesarean) is being grossly underused, at about 8%, because many hospitals are outlawing VBACs. Because of bans on VBACs, women have been denied access in over 40% of hospitals in the United States. The National Institutes of Health has found that VBACs are reasonably safe for women who had a previous cesarean birth and are low risk for uterine rupture.

Andrea Owen says, “Fighting for my own VBAC has changed my life. I don’t use that term very often, only when I truly mean it. It opened my eyes up to the world of American obstetrics, and how far we’ve come away from birth as a natural process. In my opinion, we’ve shoved a big, fat middle finger in Mother Nature’s face.”

And in the sometimes the truth is stranger than fiction category, the Keyboard Revolutionary wants to know how it is that “a woman can waltz in off the street, say she’s pregnant and wants a Cesarean, and everyone leaps to her command….yet a woman who IS pregnant has to jump through hoops and fight tooth and nail just to give birth vaginally?” Yep, in 2008 in Fayetteville, NC, a woman who was NOT even pregnant was given a c-section.

So how can a woman avoid a c-section in the first place? Knowledge is power. Here is a list of Five Essential Questions to ask your care provider. My Gentle Birthing Blog also has a list of the risks with cesarean birth as well as a list that might help you avoid having your first c-section.

On Live Your Ideal Life guest blogger Pamela Candelaria who writes over at Natural Birth for Normal Women discusses the risks of a c-section as described on a typical consent form and says, “what isn’t on the form may be surprising.”

Heather of A Mama’s Blog provides a lot of information about The Reality of C-sections.

And Breastfeeding Moms Unite posted What to Expect of Your Body after a C-section.

Bellies and Babies has a great round up of posts in honor of Cesarean Awareness Month.

There is one victory worth celebrating regarding Cesarean birth and women’s health in general. Thanks to the Health Care Reform, c-sections, giving birth and domestic violence can no longer be considered pre-existing conditions and used to deny insurance coverage. It’s a step in the right direction, but so much more needs to be done to lower the c-section rates and allow women access to VBACs, so that they don’t have to travel 350 miles just to have a vaginal birth. And that’s why an entire month is needed to raise awareness about cesarean sections.

Additional resources:

Photo credit: Flickr – Grendellion

Cross-posted on BlogHer

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An evening with Ina May

Ina MayAs I set out driving Friday night to hear Ina May Gaskin – called “the mother of authentic midwifery” by Midwifery Today – speak, I was filled with nervous excitement. When I was about 10 minutes out from the church in Lafayette where the event was taking place, a friend of mine called me to say she was saving some seats for me and other friends of ours and she was able to get pretty close to the front. I felt like a teenager going to a rock concert. Third row seats! We got third row seats to see Ina May! :)

As I pulled into the parking lot, I saw moms with their children in baby slings or carriers, groups of women without children, as well as some couples all making their way towards the entrance. I pulled in a spot, got Julian from the backseat and into the Ergo carrier when I overheard a woman a few cars down from me say, “I’m so glad I remembered to bring my book for her to sign.” D’oh! I never even thought to bring my copy of “Ina May’s Guide to Childbirth.” Some groupie I am, eh?

With only five minutes to spare before the talk was supposed to begin, Julian and I hightailed it into the building, quickly saying hello as we passed a couple of women I know from our AP group on the way. I couldn’t wait to get inside.

We made our way to the front of the registration line and we were greeted by my midwife K with a big hug. I wanted to stay and chat with her, but there wasn’t time and she had a lot more participants to check in, so we agreed to try to meet up after Ina May’s talk to chat. My excitement and anticipation grew.

Once inside the church, I spotted my friends waving me down in, yes, the third(!) row, right in front of the podium. I may have skipped a little as I made my way towards them and settled down in my seat with Julian.

We chatted for a good 10 to 15 minutes before Karen Robinson, the president of the Colorado Midwives Association (CMA), came out to welcome everyone to the event, speak a bit about the CMA, and then, the moment we were all waiting for, introduce Ina May Gaskin.

The applause began immediately and Ina May walked in to a standing ovation.

She began her talk with a bit of history both about herself and about the history of birth and obstetrics in the United States. While I have read and heard before about how women used to be treated in hospitals (drugged to the point of being unconscious while their babies were extracted from their bodies using forceps, etc.), it gives me the heebie-jeebies every time. She told us how her first birth was in a hospital, where, despite her belief that she could’ve given birth naturally and without pain medication, she was drugged and her baby was taken out using forceps.

She spoke about the path that lead her to become a midwife, as she began attending births while traveling across the country (on hippie buses) with hundreds of others who were following Stephen Gaskin on a five-month-long speaking tour across the United States. 11 babies were born on the buses during the Caravan. She has attended more than 1200 births to date.

She talked about Sphincter Law which is described in detail in her book “Ina May’s Guide to Childbirth.”

“The Sphincter Law recognizes the cervix as a sphincter along with the other excretory sphincters. These sphincters function best, Gaskin points out, in an atmosphere of privacy and familiarity.” —Midwifery: the Revival an Old Profession

So it is difficult for a woman to give birth in a hospital with nurses and doctors shouting “PUSH!” or making threats of “you’d better get that baby out soon or you’ll have a c-section” etc. Just as it would not be easy for any of us to shit (yes, she said shit! and ass too for that matter) on command. If you are sitting on the toilet, trying to take a crap and someone walks in on you – what happens? You stop crapping until you feel safe and no longer vulnerable. Same thing can also happen with birthing a baby.

She also talked about the mind/body connection, though I don’t know if she used that term. She described how she has witnessed a woman get stuck at 7 cm (or whatever) for hours on end with no apparent physical reason, only to later discover that this women’s mother died in childbirth, so this woman was afraid she would die too. Once the “secret” was out, however, the woman was able to dilate to completion and have her baby. She ran into something similar in another situation as well. But (and this is my own rambling here) had something like that happened in a hospital, how many doctors would stop to wonder what could be causing this woman’s labor to stall or would they threaten the woman that if she didn’t dilate by such and such time, she would need a c-section? Yes, I believe things need to change in the obstetrical world.

She talked a little bit about Ricki Lake’s new movie, “The Business of Being Born,” as she is interviewed in it. She mentioned that it received a standing ovation at the Tribeca Film Festival and that Ricki had recently been interviewed about it on “The View.” Someone asked how can we see the film and she recommended we start calling our local movie theaters to ask them when they will be getting it. Let them know there’s a demand for it.

At the end of her talk, she took questions from the audience. Questions were asked about VBACs (vaginal birth after cesarean), breastfeeding, circumcision, vaccinations and breech births. I don’t recall all that was said since we were going on two hours of Julian being a happy camper in my lap and he was starting to get squirmy.

I know she said that she believes breastfeeding should continue as long as it’s mutually satisfying to both the child AND the mother. If mom isn’t enjoying the breastfeeding relationship anymore, she doesn’t believe in continuing to nurse out of guilt. She is currently in the process of writing a book about breastfeeding.

She doesn’t believe in routine circumcision, but has seen many circumcised boys in her years as a midwife, and even acted as a mohel for a while.

I didn’t get to hear a lot of what she said about vaccinations, since it was about that time that I decided Julian and I needed to move from our third(!) row seat and stand in the back, where I could sway with him and keep him contented. I recall her saying that she felt some vaccinations were OK, but she believes in starting them later than the recommended age. And that there were others (like chicken pox) that she wouldn’t recommend.

After I had Julian tucked back into the Ergo and we were swaying at the back of the room, someone asked a question about her thoughts on breech births (i.e. should they be automatic c-sections?). This, as some of you who have read