Improving Childbirth: It's a Cultural Thing

This week the New York Times published an article about the alarming cesarean rate in the United States (nearly 32%).

I started interviewing mothers in the early 2000's about their birth experiences when the c-section rate was 25% and rising and all I wanted at the time was to see an article like this written. I knocked on so many doors of so many editors I knew. I even got a NY Times Magazine editor so interested she nearly commissioned me to write a piece (I wrote a 10 page outline of the piece) until her boss killed the piece citing: "We've already covered childbirth." Okay, I thought, my idea to write about the appalling c-section rate and childbirth crisis was before it's time. So I wrote a play called "Birth."

Now the piece I was waiting for has arrived - nearly 10 years later - and as I was reading it I got this visceral feeling that I don't want it. Sure, it's important that the NY TImes is now acknowledging the c-section rate is too high, that mothers are being denied vaginal births after cesareans and this is wrong, but as I was reading the piece I kept thinking why are mothers not taking to the streets to protest the abusive practices on them? And why can't we find a way for them to team up with OBs so that, as the article states, 29 percent of OBs are not doing c-sections for fear of lawsuits?

THIS IS WOMAN'S BODIES WE'RE TALKING ABOUT HERE!

This whole situation is an injustice on so many levels.

I also thought as I read this piece how ironic it was that not one mother was quoted in the piece. Women's voices silenced again and the emotional affect of c-sections, denial of VBACs and more ignored.

We are a culture obsessed by numbers. With the c-section rate rising I'm wondering what number we're going to have to hit before we begins to take seriously the post traumatic stress mothers are experiencing due to a culture that has failed them.

I do think the stumbling block to improving childbirth today is that our culture is so masculine (busy, logical, etc) and prizes these values and this hurts women's chances of having or even wanting a powerful birth experience.

When I've talked with women it's often the women who have shunned dominant cultural norms, even a little, and have met a health provider who also shuns the norms where birth outcomes are most positive.

So while articles like the NY Times piece are important, more important to changing childbirth today might be to work on changing our culture. And here is where I see a ray of light. There are many growing modalities to help mothers get into their bodies and start knowing their bodies rock. From this place, I believe, good birth decisions will follow.

Paris!

Yesterday BOLD received an application from a woman in Paris who wants to produce the play this year. When asked why she wanted to produce the play this is what she wrote:

"I saw the play Birth in 2008 when it was performed in Paris, I was pregnant with my second child after having had a traumatic c-section for the birth of my first child, and I was really moved by the play. The play was one of the things that helped me get my way to my VBAC. In 2009 I participated in the BOLD event as an actress in the play. I think a play like Birth should be seen by every woman so that she can have information about what can happen during a birth and that she can feel the emotion and the beauty of a natural birth. That’s why I would like to be the organizer of the BOLD event in Paris this year."

Yes! This really made my day.

We've actually had many applications from mothers in France wanting to produce the play this year. When asked about the environment for mothers giving birth this is what they all seem to say:

"In France almost all the mothers give birth in hospitals (the birth centers do not exist here, and there is a very few number of midwives doing home births). Generally there are a lot of medical interventions during the birth (epidural, synthetic hormons, episiotomies, etc …), and the rate of cesarean sections is increasing. Despite the fact that the moms and babies are usually physically OK after the birth, there is a lack of supportive accompanying people during birth and often the women do not even know that they can ask for a more respectful way to be treated when they go to the hospital to give birth."

Sounds like it's time to Be BOLD in France me!

VBAC Statement Supports VBAC Trial

I spent last week attending the National Institutes of Health's VBAC (Vaginal Birth After Cesarean) Conference. With less than 10% of American moms having VBACs these days - from a high of nearly 30% in the mid-1990s - NIH was brave enough to ask the obvious question: why is the VBAC rate so low? And, more importantly to the panel, does the scientific evidence support such a low rate?

The panel's answer: no, there is no medical evidence that supports the decline of VBACs.

Mothers should not only be alarmed, we should be outraged.

Does this mean that every mother who had one cesarean and has been counseled by her health care provider that she would be better off having another cesarean for her next babies was lied to? For many mothers, yes. The medical evidence shows that "once a cesarean, always a cesarean" is not medically advisable for many mothers.

Here's a quote from the conference last week from an OB from Michigan whose hospital does not allow mothers to VBAC:

"I feel like I'm committing a crime every time I take a knife to a mother who I think has a good chance of VBAC."

VBAC denial in hospitals in the United States is a hot issue, brought on by guidelines from the American College of Obstetricians and Gynecologists (ACOG) that direct health care providers to only allow VBACs in medical facilities that have "immediately available" emergency staff and environment. This prompted many hospitals to claim they can't meet this standard and therefore must deny mothers VBACs.

But if you follow this argument beyond obstetrics - that hospitals cannot provide immediate emergency services to their patients - you begin to see the luancy of this guideline. And when you look at the medical science around VBAC, which the NIH panel did, you learn that uterine rupture is so rare for VBACs that in most cases emergency services are not necessary.

But wait, back to mothers. I encourage all of you moms to read the panel's statement, especially the conclusion, and let it help guide you to your personal birth choice. For too long mothers have been guided by fear.

While I would have liked more qualitative data like mother's stories to have had more input into NIH's statement, in the end medical evidence told enough of the story: VBAC is safe for most mothers. This is what mothers need to know.

Without fear anything is possible.



PS: To read about my sons' reactions to the VBAC issue see my blog at Mothering Magazine.

PPSS: check out NIH's statement and the NY Times and NPR piece on the conference statement

PPPSSS! And "Lessons at Indian Hospital About Births" is a great piece to read too!