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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Follow-up to TODAY show guest post: childbirth resources


If you are visiting from the TODAY show blog, welcome and thank you for visiting. :) If you haven’t yet read my guest post on the TODAY show, you can read it here: Viewer: Learn more about cesarean births. I’d love it if you would like to contribute to the discussion and leave a comment over there.

Because there was only so much information I could include in my guest post, I’ve put together some additional resources here for those of you who are interested in learning more about c-sections, VBAC, giving birth vaginally to larger babies, and more. I believe in informed consent. Knowledge is power.

Information about Cesarean Sections and VBAC:

  • International Cesarean Awareness Network – “The International Cesarean Awareness Network is a non-profit advocacy and support group whose mission is to improve maternal and child health by preventing unnecessary cesareans through education, provide support for cesarean recovery, and promote vaginal birth after cesarean (VBAC).”
  • Childbirth Connection’s Cesarean Section Resources
  • The Reality of C-Sections by A Mama’s Blog – Heather writes about the many things about c-sections that she didn’t know and wished she had been told before she had her own c-section, as well as includes pictures of actual c-sections (something we didn’t get to see on the TODAY show).
  • VBAC Facts – Jennifer, teacher of The Truth about VBAC classes, deeply believes that women, after educating themselves on the risks and benefits, should be the ultimate decision makers on their medical care – not OBs or insurance companies.
  • Maternal Death Rates Rise, C-sections Now Considered a Factor – another post by Heather from A Mama’s Blog
  • The Unnecesarean – The Unnecesarean provides information about preventing an unnecessary cesarean and resources for making fully-informed decisions about childbirth while offering an irreverent take on the maternity care crisis in the United States and beyond.

Giving Birth Vaginally to Large (Macrosomic) Babies – Information & Birth Stories:
Although your doctor may suspect that you might have a larger baby, that does not mean you should automatically schedule an induction or a c-section. Ultrasound exams are notoriously inaccurate for predicting the weight of a baby and can be off by a pound or more in either direction. There’s no way to know how much a baby will actually weigh until it is born and weighed. If you are told you are going to have a large baby, weigh the risks and benefits of any intervention and make the choice that is right for you and your baby.

  • Big Baby Bull****
  • Baby Julian – My son (pictured above) was born at home and was a surprise footling breech. He weighed in at 9 lbs. 8 oz., and was 22 inches long.
  • Baby Lazlo – Justine gave birth to her 11 lb., 23-inch son at home
  • Baby “D-Man” – Kat’s son weighed in at 11 lbs., 3 oz.
  • Baby “Muski” – Kate’s son was a VBAC and weighed 10 lbs., 3 oz.
  • Baby Peggy – Annette‘s daughter was 9 lbs., 6 oz.
  • Baby Jaxon – Jaclyn’s son weighed 9 lbs., 4.4 oz.
  • Baby Iris – Sybil‘s daughter was 9 lbs., 14 oz.
  • Baby Mikko – Lauren’s son was 11 lbs., 13 oz.
  • Baby Emma – Jessica’s daughter was 9 lbs., 2 oz.
  • Baby “Boychick” – Arwyn‘s son was 10 lbs., 6 oz. and born at home
  • Baby Julian and Baby Emma – Annie‘s two kiddos (not twins) were 9 lbs. and 9 lbs. 8 oz.
  • Baby “Junior” – Candace’s son was 10 lbs., 4 oz. and sunny side up
  • Baby “M” – Jennifer’s son was 9 lbs., 10 oz. – a home birth after cesarean (HBAC)

Additional Childbirth Resources:

  • Business Of Being Born – A documentary that “interlaces intimate birth stories with surprising historical, political and scientific insights and shocking statistics about the current maternity care system.”
  • Pushed Birth a book by Jennifer Block – “The painful truth about childbirth and modern maternity care”
  • Ina May Gaskin – Author of Ina May’s Guide to Childbirth. “Discover the proven wisdom that has guided thousands of women through childbirth with more confidence, less pain, and little or no medical intervention.”
  • Doulas of North America – A doula is “a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period. Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.”
  • Considering an induction? Use the Bishop’s Score for Labor Success – “This tool measures certain components with regard to the mother’s cervix and baby’s position to evaluate her readiness for an induction and ultimately increase the chance of having a vaginal birth. This scoring system can also be used to determine the likelihood of spontaneous labor.”
  • Post-Partum Crotch Care 101 – A humorous, but very practical list. This is one of those things that nobody ever talks about, but is good information to have.

Are there any childbirth resources YOU think should be on this list? Leave a comment and let me know. Thank you. :)

Disclaimer: The information included on this blog is not medical advice and should be used for educational purposes only. It should not be used as a substitute for the advice of a medical professional (doctor or midwife).

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Live c-section on the Today Show

Thanks to ICANtweets I learned that the Today Show aired a live Cesarean section from Beth Israel Deaconess Medical Center in Boston as part of the “Today Goes Inside the OR” series. A healthy 10 pound baby boy was born via scheduled c-section to Carrie and Josh Johnson. According the The Today Show’s Dr. Nancy Snyderman, they elected a c-section because babies “run big” in the parents’ families and Carrie was “past her due date.” Dr. Snyderman adds, “And those are two indications that a Cesarean section is a lot safer than having a vaginal delivery.”

A lot safer? Really? You might want to weigh the risks for yourself.

Photo courtesy: tifhermon (Flickr)
Photo courtesy: tifhermon (Flickr)

Here’s the link to watch the Today Show c-section video

I found it hard to watch how the baby was handled and the way mom seemed to be left out of the process. Why can’t they clean up the baby where mom can see?

I also found a few other things quite disturbing.

At one point in the video, the doctor doing the c-section comments to Dr. Nancy that one reason for having a c-section is if the mom has had a c-section before. Then when asked if this mom gets pregnant again and has a “normal size” baby if she can have a vaginal delivery? The doctor responds, “absolutely, absolutely.”

That sounds like she’s giving mixed signals to me. Not to mention that many doctors and hospitals no longer allow vaginal birth after cesarean (VBAC) due to insurance costs. I left a message with Beth Israel hospital to find out what their policy is re: VBACs. I’ll update if I hear back. Joy Szabo had to move 350 miles from home to have her VBAC. And some women are being denied insurance after having a c-section.

After the baby was weighed (10 lbs.), Today Show co-anchor Meredith Vieira commented: “They chose the right way to deliver that’s sure by section.”

Dr. Nancy Snyderman agreed: “They sure did.”

So having a larger baby vaginally is the wrong way to have a baby? I strongly disagree. I think so would Justine who had her 11 lb. son at home on Jan. 6. And Kara who gave birth to an almost 10 lb baby vaginally. And Cathy who describes herself as petite and said both of her boys weighed 9 lbs. 4 oz. at birth. And Arwyn who said, “At home in the water was the right way to “deliver” my 10lb 6oz baby!”

What did you think about all of this?
Email the Today Show your thoughts at: TODAY@nbcuni.com

Read more about my reaction to the live c-section.

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Joy Szabo Travels 350 Miles for Vaginal Birth

Joy Szabo recently drew nationwide attention when she refused to have a repeat cesarean section at her local Page, Arizona, hospital. Instead, Joy and her husband Jeff decided that Joy (alone) would move 350 miles from home to Phoenix where they could, according to CNN, get “the birth they wanted” – a vaginal birth after cesarean (VBAC). Many are calling Joy’s vaginal birth a victory, but Jenn at Knitted in the Womb acknowledges that while on one level getting the VBAC is a victory, on a larger scale she wonders was it really a victory?

Photo courtesy CNN
Photo courtesy CNN

Here’s a little history. While seven months pregnant with her fourth child, Joy Szabo was told by her local hospital that she would be required to have a repeat cesarean section rather than allow her to have the birth she wanted, a VBAC. It didn’t matter that she had already had one VBAC at this hospital, the policy had changed and VBACs were no longer permitted there.

VBACs carry a less-than-1-percent increased risk of a uterine rupture, which could cause brain damage in the baby or even death, according to the American College of Obstetrics and Gynecologists.”

According to CNN:

After their discussion with their doctor, the Szabos made an appointment to speak with Page Hospital’s CEO, Sandy Haryasz. When the couple told her about their desire for a vaginal birth, they say Haryasz would not budge, even telling them she would get a court order if necessary to ensure Joy delivered via C-section.

The Szabos thought that seemed extreme and rather than succumb to the hospital’s new policy, a few weeks before her due date Joy moved into a Phoenix apartment 350 miles away from her husband and three children while she waited to go into labor. At the Phoenix hospital Joy gave birth to her fourth son Marcus Anthony in an “uncomplicated vaginal delivery.”

Emily from Laundry and Lullabies said, “Joy, you’re an inspiration. Thank you for standing up for yourself, for bringing attention to the state of maternity care in America, and for making it just a bit easier for other women to follow your example.”

Danielle who blogs at Birth, Babies & Everything In Between believes VBAC is much safer for healthy, low risk women than elective repeat cesareans. She likes to use the example of Michelle Duggar to demonstrate the safety of VBAC. Michelle has had four c-sections and 13 VBACs and recommends the organization International Cesarean Awareness Network (ICAN) for those wishing to gain information about VBAC.

On the Duggar’s website, Michelle describes how things have changed from her first pregnancy to her 18th.

I would say the greatest change that I have seen in the field of obstetrics, and I might add that it is very troubling to me, is the idea that once you’ve had a C-section you must have a C-section for any other pregnancy. It is much healthier for mom and baby to avoid major surgery and all the complications that go along with a C-section if possible. Granted, there are health situations that would warrant such, but for years obstetrics encouraged TOL (Trial Of Labor after previous C-section) with many successful healthy vaginal births. It was quite alarming to be told that I could no longer have a vaginal birth due to hospital or insurance companies regulations. It appears that what is best for the patient is not the priority with this decision. I feel our health care is being jeopardized by this unhealthy approach. Doctors are having to tell their patients that they no longer offer VBAC assistance due to hospital regulations and some might even state to the patient that they are not safe so as to avoid confrontation. Statistics prove much differently. For the many women that find themselves in this situation, ICAN is an organization that is very helpful in gaining more information on this topic.

Jenn at Knitted in the Womb, who I mentioned above and questions the “victory” aspect, says:

I am glad that Joy got a vaginal birth, and on that level the birth was a victory. But on the larger scale level…the extreme hoops she had to go through make it less than that. The “victory” that I see missing is an acknowledgment by the Page Hospital administration that A) VBAC is safe and B) even if they disagree with “A,” they have no right to force a person to have surgery. For a woman who does not have the financial means to do what Joy did – move away from her home for over a month – surgery is still a forced situation.

…this could easily be used by hospital administrators as “precedent.” “You want a VBAC? So sorry, we don’t offer that here. Do what Ms. Szabo did, go move to be near ‘hospital X.’”

I agree with Jenn in that the CNN article headline, “Mom fights, gets the delivery she wants” is misleading. When I first read it, I expected that Joy Szabo had fought the Page hospital and had her VBAC there. I wasn’t expecting that she had to move six hours from her home, leaving her children and husband, to get a VBAC at another hospital.

Yes, the fact that she got a vaginal birth is a victory, but this story also shows that birth advocates still have a lot of work ahead of them. As more hospitals ban VBACs, there will be more and more cases of women who are forced to make difficult choices.

The fact that this situation got the national attention that it did, that CNN covered it and posted “some tips for what to ask your doctor (or midwife) in the delivery room if the suggestion is made that it’s time to give up on a vaginal birth and head to the operating room” is a step in the right direction. It might not be the big victory that many of us are hoping for, but it’s a small victory and that counts too.

Related posts:

Cross-posted on BlogHer.

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