The V-birth vs. the C-birth: NIH faceoff!

Posted at 1:00 PM Mar 17, 2010

By Andrea Grimes

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Last week, Amnesty International released a report on the atrocious maternity death rate here in the United States, which we mentioned here on HD. According to the report, inaccessible and overpriced medical care are responsible, as well as the over-use (over-prescription?) of cesarean section births. And, indeed, the same week the Amnesty International report came out, the National Institutes of Health held a "census development" conference on the use of C-sections--determining eventually that doctors are too quick to rule out vaginal labor. Vaginas: 1, medicalization of birth: 0, at least in this round.

The deal is this: once women have had a C-section and are pregnant a second time, they are far more likely to be ushered into another C-section, rather than given a chance to deliver vaginally, ostensibly for health reasons. But, it turns out, VBAC (vaginal birth after cesarean) carries risks comparable to various fetal tests routinely given to most pregnant women. As in, it's actually not particularly risky.

Per the Our Bodies Ourselves blog:

One important topic included perceptions of the risk of trial of labor; a speaker who reviewed factors associated with uterine rupture and other adverse outcomes stated that "there is a major misperception that trial of labor is extremely risky," calling the risks to women comparable to other common medical procedures. Amy Romano provides additional commentary on uterine rupture risk at Science & Sensibility, noting that "we heard a rather consistent message that uterine rupture itself is not the issue."
And then there's the issue of whether or not women have the actual right to refuse a C-section birth.

Day three generated perhaps the most heated discussion, in which a panelist stated that it is not a settled matter that women have a right to refuse a cesarean, reminding us of the need to continue to advocate for choices and rights for childbearing women. The relevant audience question comes up at 1:47:20 and comes from Shannon Mitchell of BirthAction. She raises the concern that there is nothing in the draft document that says that women have the right of refusal of a cesarean, an issue of concern given reports of court-ordered cesareans.
Court-ordered ceseareans!? Christ, what is this, an episode of Grey's Special Victims Hospital? Check out The Unnecesarean for horrifying sentences like "a woman being operated on against her will."

Remind me again why anything about pregnancy seems awesome? Lordamercy.

Comments

Theda said:

Because you get nifty drugs that makes it so you don't feel a thing for about 15 hours.

Michelle said:

It's frustrating that, despite decisions like this and other studies that relate the safety of home birth and the dangers/non-necessity of many common interventions, the US childbirth system continues to be broken. It's good to see some hospitals moving toward evidence-based maternal care (Baylor Dallas is a good example), and I hope that more will embrace a less fear-mongering view of pregnancy and childbirth.

JenX said:

I ran into this very same discussion the other day at my doctor's office. My 'birth plan' is "No C-Section unless I'm ABSOLUTELY going to die without one". He loves it, and is totally behind me, saying that not only do too many doctors opt for the cesarean, but women are *voluntarily* going for them.
Then, the issue came up...I am wasting my, and my insurance company's, money going to visits every 2 weeks from here until the end of my pregnancy. I'm not high risk. The baby is perfectly healthy (a little TOO healthy for my taste, at the rate he's growing :P). There are no factors with me *needing* to be there. His reason? "Both you and I would appear neglectful of your baby, as this is the standard of practice." So, because it's the SOP, I have to go in every 2 weeks. Had I, from the beginning, opted for a completely at-home birth (and I would have, if we had a decent place to do so) with a midwife and a doula instead of an OB, this wouldn't be happening. But, because I felt the need to make sure that my baby was healthy (I was born with a hole in my heart, my oldest son was born a "Proportional Dwarf"), or to be prepared for other instances...I follow the SOP. Which is ridiculous. I've been through this before, I've been through at least a dozen other pregnancies as a bystander...yet I'm not allowed to trust my body and my instincts. It's stupid.
Women have been giving birth since, well, the dawn of man. Female animals give birth all the time, normally without aide of a vet. Yet, I have a team of doctors making me question my ability to do the first great act of motherhood without their intervention...

Seminymous Coward said:

JenX-
You realize that you don't actually have to go, right? The standard of care for pregnant women is borderline paranoia (which is good), but there's nothing making you go but you. You are complaining about excellent medical care.

Elaine said:

As a woman and a physician, I'm opting for a repeat C-section. Just like I support other reproductive choice, I support this as a choice. I don't want to try to go through labor again, and I'm overjoyed at the opportunity to have a section. I do respect that women would want and should be able to have VBACs if they so chose.

I get sad when people get down on modern medicine. Yeah, women have been having children without doctors for millions of years, but the reality of that is that maternal fatality was one in a hundred (I don't even know the fetal fatality rates). Now it's closer to 1 in 1,ooo. (If I remember correctly from OB/GYN) I know if I'd delivered without the aid of modern medicine, I might have died. My baby would likely have died, too. /overshare

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