Radical Doula

Highlighting something that we all already knew, the research is finally starting to come down in our favor on this issue of vaginal births after c-section (VBAC). Despite the frightening number of hospitals entirely banning VBACs, and an alarming number of providers refusing to do them, the research is showing that VBACs are the safer, better option for most moms and babies.

From the LA Times:

The first paper summarizes the findings of a government consensus conference that took place in March at the National Institutes of Health. Researchers concluded that vaginal birth after cesarean is “a reasonable choice for the majority of women.” The paper is based on a large database of births and finds that although both elective repeat cesarean section and VBAC are highly safe, maternal death was higher for elective repeat Cesarean sections (0.013% versus 0.004% for a trial of labor). The rates of hysterectomy, hemorrhage and transfusions did not differ between the two groups. Uterine rupture — the complication that is usually given for discouraging VBACs — was rare but higher in the trial of labor group (0.47% compared with 0.03% in the repeat C-section group). Infant death was higher in the trial of labor group (0.13% compared with 0.05% in the repeat C-section group).

How long do we think it will take medical practice to catch up to the research?

Cross-posted from Feministing.com

This is a post I wrote for Feministing that I wanted to cross-post here. It’s a bit broader (and less political!) than what I write for Radical Doula because of the audience there.

Birth has been making national news lately because of the release of recent data indicating continuing upward trends in maternal mortality and c-section rates.

Jessica mentioned the recent California report that exposed the rise in maternal morality in the state. But this problem isn’t just in CA, it’s national.

The New York Times reported this week that the US c-section rate has reached an all-time high of 32%. That’s more than 1 in 3 women giving birth via surgery. C-section has been the most common surgical procedure in US hospitals for a while now, and the increases don’t seem to be slowing down.

I often get flack for being anti-doctor when I write about birth politics here, but pretty much everyone can get behind a concern about this rate of surgical birth.

The increases — documented in a report published Tuesday — have caused debate and concern for years. When needed, a Caesarean can save the mother and her child from injury or death, but most experts doubt that one in three women need surgery to give birth. Critics say the operation is being performed too often, needlessly exposing women and babies to the risks of major surgery. The ideal rate is not known, but the World Health Organization and health agencies in the United States have suggested 15 percent.

The risks to c-sections are numerous. It’s major abdominal surgery, with it’s resulting possibilities for complications. It presents problems for subsequent pregnancies, and it can be really difficult to find a hospital that will allow you to try a vaginal birth after a c-section (VBAC), meaning once a c-section, always a c-section.

Amnesty International recently released a report entitled Deadly Delivery: The Maternal Health Care Crisis in the US. Amnesty, an organization often focused on highlighting the stark situation of countries around the world, found itself examining what is a crisis among maternal health in the US.

The report exposes the fact that the risk of dying during childbirth is greater here than in 40 other countries, putting us at the bottom of the developing world when it comes to maternal mortality.

Read the rest of this entry »

UPDATE (Jan 13): Via the ACLU’s blog posted at RH Reality Check and Feministing, the State of Florida yesterday argued that forcing Burton to bed rest was just maintaining the “status quo.” Ugh.

Via a press release from the ACLU (which I can’t find on their website), a woman who was forced via court order to hospital confinement during her pregnancy’s case was heard yesterday in a Florida court.

Samantha Burton who was confined to a hospital bed, against her will, after disagreeing with her doctor’s recommendations for treating pregnancy complications last year.

In March 2009, the Circuit Court of Leon County ordered Ms. Burton – a pregnant mother of two – to be indefinitely confined to Tallahassee Memorial Hospital and forced to undergo any and all medical treatments deemed necessary to save her fetus.  After three days of state-compelled hospitalization, Ms. Burton miscarried and was released from the hospital.

In August 2009, Ms. Burton asked the court to overturn the lower court’s decision to compel her to undergo medical treatment, stating that her rights had been violated.

It’s pretty scary stuff when a court can force you into hospitalization based on the idea that they are protecting your fetus.

Jill at Unnecessarean wrote about this case in August. In her post, she explains that Burton actually had a forced c-section during the time of her hospitalization, which is when they realized that she had miscarried. The statement above doesn’t include that fact, but it’s in the brief filed by the ACLU.

The language the court used is pretty damn scary:

At the State’s request, the Circuit Court, Leon County, ordered Ms. Burton to be indefinitely confined, which had her pregnancy gone to term would have been up to fifteen weeks, to Tallahassee Memorial Hospital and to submit, against her will, to any and all medical treatments, restrictions to bed rest, and other interventions, including cesarean section delivery, that in the words of the court, “the unborn child’s attending physician,” deemed necessary to “preserve the life and health of Samantha Burton’s unborn child.”

I’ll update when I hear about the results of the case.

Thanks to Lynn Paltrow for the heads up

I thought we’d start off 2010 on a good note.

Via Pushed Birth and CNN, the happy news that Joy Szabo gave birth vaginally to her fourth child on December 5th without incident.

Unfortunately she had to do quite a bit of fighting to have the birth she wanted. From Jennifer Block:

Joy Szabo of Page, Arizona, was told by her local hospital that she wouldn’t be allowed to give birth vaginally there. She even met with the hospital CEO to discuss their policy of forcing repeat C-sections — a policy she equated with physical assault — and the hospital responded by threatening to get a court order for the surgery. When the local paper headlined Szabo’s plight, the hospital backed off, but it still told her “No VBAC.” Instead of agreeing to the major surgery, Szabo pushed back. She found a willing hospital and provider in Phoenix, a six hour journey by car from her home, and made the decision to move there and await labor.

The birth was an easy one, with just a few hours of labor and one quick push. Congrats Joy!

Crazy. Choices in Childbirth and the New Space for Women’s Health have partnered in collecting this data and getting it out into the media.

You can see a video, including a graphic about c-section rates broken down by borough, at NY1.

Choices in Childbirth has a pdf with all the stats. Just as an example here are the stats for just two of the hospitals in Manhattan. Each percentage represents the rates as they increased each year beginning in 2000 going to 2006.  

New York Downtown Hospital 11.1 % 13.5 % 13.3 % 14.2 % 18.4 % 18.8 % 21.6 %

Bellevue Hospital 18.4 % 18.5 % 19.8 % 20.9 % 22.6 % 25.2 % 27.8 %

Just as a friendly reminder, the World Health Organization recommends that the cesarean section rate for industrialized nations should not exceed 15%.

This is why NYC needs things like the New Space for Women’s Health:

Friends of the Birth Center announces the launch of the New Space for Women’s Health, a project to create a center for birth and wellness in New York City. We’re beginning a fresh dialogue with women about changing birth and women’s health care in our city. Join us in this important conversation as we plan a new beginning, in Chelsea, 2010.

Thanks to Rebecca for the link