Birth, The American Way

kitten102, I think the point of this article was to illustrate that c-sections are an EMERGENCY procedure. The situation you experienced was......wait for it.....an emergency. Since your doctors were quite aware of the complications of your pregnancy, this is why you delivered in a hospital. Please don't belittle healthy women who choose to give birth to their healthy children in a way other then abdomen-rending surgery. And for the record, the birth experience has quite a bit to do with the mother. Seeing how she has to do all that pushing and birthing and nursing and stuff.

My 3 year old son is here, alive and well, ONLY because of the miracle of modern medicine: the c-section. I experienced reduced fetal movement at 38 weeks, went to the hospital as advised by my doctor, and proceeded to fail nearly every test performed. The only positive was that the poor thing had a heartbeat. Induction was tried, in order to try for a vaginal birth, but soon all hell broke loose, and I ended up in an emergency c-section, delivering a baby that was limp, blue and hours away from death had I tried to push him out. Turns out there was a blood clot in his placenta, so he was not receiving much that he needed to survive in my body. Thank God he was removed from my failing uterus in time. I can't STAND women that make the birth experience all about them. Isn't the goal "healthy baby, healthy mom?" Well, my baby would've died without a c-section and I, for one, am forever grateful that he is here, alive and healthy - no matter which way he entered this world. Delivering naked in a bathtub isn't so pretty when the baby that eventually arrives is dead or forever disabled because of insufficient medical care.

please i would like to know the chances likeof amother having other babies after the first child being delivered through a C Section.thanks Berlyne

Susan, the first thing I would like to say is that your persistent use of the adjective MAJOR in front of the word surgery is unnecessary. It goes without saying that cesarean delivery is not equivalent to a more minor surgery such as removing a skin lesion for example.

Secondly, you say: You know for a fact, cesarean surgery has more risks to mom and baby than vaginal birth. I certainly do not know this for a fact, particularly when we are talking about a planned cesarean delivery at 39 weeks EGA for a healthy woman who is planning a small family. If, however, you are referring to all cesarean outcomes ??? including emergency surgery and surgery for medical reasons ??? and comparing them only with successful vaginal delivery outcomes, then that is different. Of course if that is the case, you are also not comparing apples with apples???

You then ask: So why do you feel it is ok for an OB to advise a woman home birth is dangerous, but it is ok for an OB to tell a woman major surgery (c-section) is safe? I don???t believe that OBGYNs in America are advising women that surgery is categorically safe, and furthermore, I think that by accusing them of this, you are at best underestimating, and at worst insulting their professional integrity. It has been my experience that OBGYNs see it as their unquestionable duty to make women aware of both the risks and benefits as they relate to their individual pregnancy health. In fact ironically, it is you making categorical statements on safety: Birth is safe, interference is risky.

I do understand the frustrations of many midwives who feel that there is too much intervention in hospitals, and I can appreciate why they want to be a voice for the women who are unhappy with their cesarean birth outcome. I simply ask that in delivering your argument, you are more careful to clarify the undeniable differences in outcomes between emergency and planned cesareans, and you resist the urge to criticize women who choose CDMR.

Finally, I was disappointed to see that you did not address my comments regarding Holland, obesity outcomes and measuring infant mortality in my previous post, but in any case, I???d like to offer one more thought on this topic. In the UK, where home birth is an option for all women (in fact the government is actively promoting it as a birth choice), the numbers of women who actively make that choice are: Wales 3.53%, England 2.69%, Scotland 1.36% and Northern Ireland 0.39%. The truth is that the vast majority of women choose to give birth in a hospital.

I think the one thing that we can agree on is that women are not homogeneous creatures. You would never choose a cesarean delivery and I would never choose a home birth. What is important going forward is for every pregnant woman???s choice to be supported where possible ??? and more than that - for it to be respected.

I I do not question the need for c-sections, nor do I question the fact that cesarean section is MAJOR SURGERY. I think it is amusing you say " that the rights of the unborn baby should be protected too (e.g. if medical professionals believe that a baby's health or even life will be placed at risk during a home birth due to particular health problems in the pregnancy)." YOU KNOW FOR A FACT, CESAREAN SURGERY HAS MORE RISKS TO MOM AND BABY THEN VAGINAL BIRTH, and yet, you support the womans right to choose inspite of the medical statistics. ACOG made the statement home birth is dangerous and should not be done. This statement is based on no reliable studies but women have trouble getting insurance to cover home birth because OB's say it is dangerous. So why DO YOU feel it is OK for and OB to advise a woman home birth is dangerous, but it is OK for an OB to tell a woman MAJOR SURGERY (c-section) is safe.

I do acknowledge vaginal birth IN A HOSPITAL is becoming much more risky due to interventions. EVERY intervention ( ie, IV's, epidurals, prostaglandan's, pitocin) has associated risks. The bigest risk being an increased chance of needing a c-section! But women are not being told this when they enter the hospital and agree to interventions. If they question them, they are told it will be best for the baby. Do you think it is a coincidence more c-sections are done Monday to Friday between 9am and 5pm. The third leading cause of death in the US is hospital born infection. Who is more likely to develop an infection, someone with major surgery, or someone who has given birth vaginally? And better yet, someone who has given birth vaginally, at home.

Recently, in the news, we heard of two a perfectly healthy women going to the hospital for inductions, and ending up dead (there are many more that were not news worthy.) We also saw the woman in Florida who went in for a normal vaginal birth, and ended up with no arms or legs because she contracted flesh eating skin disease from another patient in the hospital. Hospitals are not the safe place many people believe. Birth is not an illness. It is a normal, physiological process that USUALLY does not need controlling. Birth is safe, interference is risky. Yes, I am thankful we have hospitals where we can take our clients who are having trouble at home and NEED intervention.

Judging from your title, I assume you are for elective c-sections. Well I guess so am I because I believe in a womans right to choose what she does with her body. AS LONG AS SCHEDULED C-SECTIONS ARE DONE ETHICALLY- AND WOMEN ARE GIVEN TRUE INFORMED CONCENT. Funny though, the risk of c-section for both mother and baby is MUCH higher then any potential risk home birth has but OB's push c-sections and say home birth is dangerous.
Susan Scott Gill
Licensed Midwife

Continued...

Finally, when measuring infant deaths, it is far more relevant (when measuring the risks and benefits associated with a specific delivery type) to look at perinatal* or neonatal** mortality rates (which measure deaths *from foetal viability (28 weeks gestation or 1,000g) until the end of 7th day after delivery, and **the first 4 weeks (or 27 days) of life) rather than infant mortality rates (which measure how many live newborns die in their first year of life). This is because infant mortality rates do not take incidences of stillbirth into account, and also there are social factors in the first year of life (that have nothing to do with the birth) which may play a role in the deaths.

Pauline McDonagh Hull
Editor, electivecesarean.com

Susan, we certainly agree that waiting until 39 weeks EGA (unless there is a pressing medical need for an earlier delivery) is the safest course of action for healthy women who choose to have a cesarean. We also agree that women should be allowed to make choices in childbirth (whatever that choice may be). I would only add one caveat: that the rights of the unborn baby should be protected too (e.g. if medical professionals believe that a baby???s health or even life will be placed at risk during a home birth due to particular health problems in the pregnancy).

However, with regards to some of the other points you make regarding mortality rates,
I???m afraid I must highlight some research that you may not be aware of. First of all, the situation in Holland is really not the nirvana of maternity care that many midwives in the U.S. seem to think it is. Just last month I highlighted this in my BLOG (http://www.electivecesarean.com/index.php?option=com_content&task=view&id=373&Itemid=553) citing (among others) the 2008 research paper ???New choices needed in the care of pregnant women, Visser et al, 2008???, which reveals that ???the unique Dutch midwife system is under pressure.??? The perinatal mortality is no longer among the lowest in Europe and the maternal mortality rate has risen in the last 20 years, with more than 50% of cases being due to substandard care. And the cesarean rate there? It???s quoted as 15%... The World Health Organization???s ???ideal rate???.

I also think you may want to consider other potential reasons for maternal mortality in the U.S. - besides cesarean delivery itself - and that is, the increasing rate of obesity here. Again, I???ve written about this extensively (this time in my online article); here is an extract from one of the pages: ???In 2004, a study looking at the UK's overall maternal mortality rate reported a risk of 0.01% (13.1 per 100,000 births), but of these women, ???35% were obese???; a prevalence ???50% more likely??? than the general population. (66, UK, 2004) A 2007 triennial update on the study confirmed this trend; deaths ???from cardiac causes, often linked to obesity, are now the commonest type.??? (531, UK, 2007) Morbidities have been found to be worse too. In North America, postpartum hospital confinement of obese women is ???significantly longer??? following a cesarean, (95, USA, 1994) (293, Canada, 2007) largely due to ???significantly increased??? risks for perioperative morbidity, (320, USA, 1994) (77, Canada, 2005) (96, USA, 1993) (113, UK, 1989) (293, Canada, 2007) such as antepartum venous thromboembolism, wound infection and anesthetic complications.
http://www.electivecesarean.com/index.php?option=com_content&task=view&id=404&Itemid=1

The largest, randomized controlled study performed by the top epidemiologists in their field was published by the British Medical Journal (none of the US Medical publications were interested) and concluded home birth is as safe as hospital birth, with less intervention and a higher satisfaction rate.
www.bmj.com/cgi/content/full/330/7505/1416

The Royal College of Obstetricians and Gynecologists recently published a statement supporting homebirth for low risk women, again sighting similar outcomes to hospital birth but a higher satisfaction rate. www.rcm.org.uk/info/docs/Home%20Births_Joint%20Statement_1.pdf

As the movie states, all other industrialized countries with better maternity outcomes then the USA, use midwives. In Holland, where the birth statistics are DRAMATICALLY better then the USA, 70% of women have home births.

No woman should be forced to have a home birth. This is for people who have done their homework and decide it is what they want to do. The problem is in some states, it is illegal for them to do so. In other states it is legal, but women, who choose to do it, but end up transporting to the hospital, get treated horribly by many of the hospital staff (doctors & nurses.) Some insurance companies cover out of hospital birth, but some don???t. This is a woman???s rights issue and we ALL need to pay attention.
Maybe homebirth isn???t for you, but do you believe in a woman???s right to choose?

By the way, did you know the maternal death rate just went up in the US? We spend more money then any other industrialized nation, and we lose more moms and babies.

Also, if any OB tells you it is perfectly safe and OK to schedule your c-section at 37 weeks, he/she is lying. Do your homework! As for celebrities discussing birth, I'm much more concerned when celebrities like Christina Aguilera are plastered on the front cover of People magazine discussing scheduling her d-section at 37 weeks because she didn't want to tear her vagina, and besides she was "done" being pregnant.

According to WebMD
Babies born by elective C-section before the 39th week of pregnancy have a three- to fourfold higher risk of breathing trouble than babies whose mothers have a normal vaginal delivery.
Elective C-section babies also have a fivefold higher risk of needing mechanical breathing assistance for serious respiratory trouble, find Anne Kirkeby Hansen, MD, and colleagues at Denmark's Aarhus University Hospital.

"Mothers who choose elective cesarean section should be aware that the risk of respiratory problems is four times raised at 37 weeks' gestation vs. full-term, intended vaginal delivery," Kirkeby Hansen tells WebMD. "The rate of respiratory problems is 10% for elective C-section at 37 weeks, but it is 2.8% for intended vaginal deliveries. That is why we say you should never do elective cesarean section at 37 weeks."
Susan Scott Gill
Licensed Midwife

towieur

cesarian is the goverments bigest social free heath enemy (higher cost than give a birth like a cow) , and newborns protecting angel (ask all those poor hipoxie paraplegics for THEIR opinion on the matter). if you are on a doubt ...She how most doctors wives give birth and do the same....... THEY KNOW WHY...NEWBORN HEALTH FIRST!!!!

cesarian is the goverments bigest social free heath enemy (higher cost than give a birth like a cow) , and newborns protecting angel (ask all those poor hipoxie paraplegics for THEIR opinion on the matter). if you are on a doubt ...She how most doctors wives give birth and do the same....... THEY KNOW WHY...NEWBORN HEALTH FIRST!!!!

I'm so happy to see this documentary! I think it should be all over the internet. On myspace, etc.
I am a Doula/Labor Coach & Midwifes Assistant.
And I've seen what happens to women in hospitals- whether they plan it carefully or not.
It's a completely different experience at home of a birth center! Es

Hail Riki pt 2 of 2
The ones who 'know' how to take care of mothers and babies in birth are the homebirth midwives. They have knowledge and wisdom that has been passed down through countless generations since the beginning of time; Knowledge that we are now only beginning to understand through science. Birth is not a medical condition, yes there is blood and it hurts a bit but it is a normal process of life and should not need medical assistance. We don???t go to the hospital every month when we menstruate do we? Why should we go there to give birth? Each month we have a mini birth without a baby... the womb expels its contents and then heals up and grows a new lining. Nature knows how to do it perfectly. But what about complications and emergencies that arise during birth? The truth of the matter is??? MOST MEDICAL EMERGENCIES AND COMPLICATIONS THAT ARISE DURING HOSPITAL BIRTH ARE CAUSED BY THE HOSPITAL IN THE FIRST PLACE FROM ALL THE INTERVENTIONS. BIRTH IS A DELICATE FINE PROCESS THAT SHOULD NOT BE INTERFERED WITH. Yes we have a lower infant mortality rate than that of the 1900???s but it???s not so much due to more medicalised births than to improvements in general health, living standards, better hygiene etc. I advise all women to educate themselves, do their own research. Not in medical journals; you wont find it there (medical journals protect the medical industry). There are plenty of studies which prove the harmful effects of birth interventions, seek and you shall find. Watch Ricki Lake???s documentary, read Sheila Kitzinger, Michel Odent, Ina May Gaskin, to name but a few 'real' Birth Experts. To make a long story a little bit shorter... I had my second child in hospital three years later wearing an invisible suit of armor and with a 'do not touch me' sign etched on my forehead in invisible ink. They got the message... the experience was a little better. My third child was born at home three more years later. It was probably the most exhilarating, incredible and beautiful experience of my life. She is now 10yrs old, happy, healthy and full of self confidence, a quality I put down to the way she began her life, with a beautiful birth. The whole family still reflects with great affection the day she arrived into our world. I pray that in the future all women will have the opportunity to birth their babies their own way from the inside out, with the right kind of knowledge and support and with no interference.

Hail Ricki pt. 1 of 2
A documentary like this one is long overdue. It's about time the whole business of exploiting women at a most vulnerable time in their lives for profit and gain by the medical birthing industry is exposed. The best, most beautiful birth experience for any woman is not her obstetricians first priority, if it truly was, then they would be familiar with and recommending home birth. Getting the baby out, mother and baby still breathing and with all four limbs still attached along with doing everything they can to protect their reputation and make sure they are not sued is their priority, everything else is frills. Any great Doctors with impeccable integrity out there will not be offended by this because they know that in general it is true; That???s what birth has come to in this country. So, if a woman is satisfied with that then fine. But most women don???t know the difference (and most doctors don???t either). I have done both hospital and home birth and believe me they are incomparable. My first child was born in hospital and the experience was horrific. It took me years to get over it. I think I could liken it to rape actually, one of those date rapes where you've been drugged and you wake up next day having a vague recollection of what happened and you try to piece it together.. my body had been through one of the most incredible experiences available to us as humans and I was only allowed to be a passive spectator while someone took control and my body was used and 'done to'. I was young and vulnerable and had handed myself over to the people I thought knew how to best take care of me and my baby through birth. How wrong I was! The ones who 'know' how best to take care of mothers and babies during birth are a dying breed, they are being squeezed out by the medical industry through policies and politics in order to keep their giant share of that lucrative pie that the birthing industry is.

I think that C-sections are something that are becoming an issue. I think that they should be done only when necessary and should not be able to be scheduled ahead of time unless the mother has health conditions that require her to have a baby normally. However, if the mother is healthy and wants to schedule it just because she thinks that she does not have any other time to have it because she is working should not be allowed. By doing this, she is risking her health and the health of her baby. I think that hospitals should not allow this to happen because if the mother is truly to busy to have a baby to have to schedule the birth then she should be having a baby anyways. How is she going to take care of it if she has to even schedule it???s birth even if it is going to be premature. I think that this should be stopped. That is only my opinion though.

Thank you for an insightful article on this informative documentary. There are always two sides to every coin and each side will obviously think it is right; otherwise why would we do it?
Each woman deserves the right to choose her course for birth, unfortunately some women are being denied that right. In Missouri, most women do not have the option of a Midwife attended home birth. We are being forced to deliver our babies in hospitals or ask the Midwife to commit a felony. For those of us who would like the option of having our babies at home with a legal, trained professional in attendance, this issue is not about saying other women are wrong for having their babies in hospitals, it's about having our right to choose the best possible birth attendant for our family. Home birth is not for everyone, just as hospital birth is not for everyone. Research has shown that planned home birth with a Midwife is as safe, if not safer, than a hospital birth and therefore this should be a viable option for those who want the Midwife Model of Care.