Tuesday, February 12, 2008

Et tu, Brute?

If you don’t believe that “normal birth” and birth options in this country are at risk, watch this:

1. In 2006, the cesarean rate in the United States was 31.1%. That is approximately 1 in 3 babies being surgically removed from their mothers' bodies.

2. So, now we have hundreds of thousands of childbearing women with scars on their uteri. What are their choices for subsequent births?

3. (a) hospital repeat cesarean
(b) hospital vbac
(c) home vbac (with midwife)
(d) birth center vbac (with midwife)
(e) UC (unassisted childbirth, though I’m including in this category births attended at home by unlicensed or “illegal” midwives)

5. Looking at the list, it would seem that there are many birth options in the United States for women with a previous cesarean surgery. However, the American College of Obstetricians and Gynecologists (ACOG) released a statement this month that condemns home birth as a safe and viable option for any childbearing mother, let alone mothers with a history of cesarean surgery. So, this is going to lead to an increase in obstetricians who are unwilling to provide back-up services to homebirth midwives. In many states, a homebirth midwife cannot accept a vbac client unless she has a back-up obstetrician. We can scratch (c) off the list.

6. Also this month, the American Association of Birth Centers (AABC) released a statement saying that because of the minute risks involved in vbac, they can no longer support vbacs being attended in birth centers. We can scratch (d) off the list.

7. All across this country, hospitals are “banning” vbacs and obstetricians are refusing to attend vbacs. As this trend gains popularity (meaning: if women don’t fight against it), there will eventually be no hospital or obstetrician in this country who supports vbac. We can scratch (b) off the list.

8. Now, mothers with cesarean scars have two choices: undergo a repeat cesarean surgery at a hospital or have an unattended birth at home. Cesarean surgery presents the mother with many of the same risks as vaginal childbirth and compounds those risks with the added risks of major abdominal surgery.

I do not mean here to portray UC as a dangerous or reckless choice for the childbearing woman. To the contrary, it can be a safe, fulfilling and joyous experience for a woman who chooses UC. However, if a mother is stripped of all her other rights and choices and is forced into a UC (or otherwise face unnecessary surgery), this is not the mother’s choice. Just because UC may not be “right” for a woman doesn’t mean that another cesarean is right for her.

So, it would seem as if we don’t have as many options as we think we do.
What are you going to do about it?


AtYourCervix said...

I've posted a very interesting VBAC success article on my blog. Check it out, if you haven't already.