Pregnant women read the writing on the wall
A few years ago I noticed a sign on the wall at a local women’s clinic. It stated “Our doctors will no longer perform VBAC.”
The sign made me laugh. VBAC stands for vaginal birth after cesarean. Since the doctors in that practice were males, it was difficult to imagine them performing a vaginal birth. Doctors do not perform vaginal births. Pregnant women do.
For women with past c-sections, the sign is not funny at all. This prohibition jettisons women’s rights back to the 1950’s when the mantra was “Once a cesarean, always a cesarean.” Women are being robbed of a fundamental childbirth choice, even though studies confirm the safety of VBAC for most women.
Healthy People 2010 urges doctors to cut the cesarean rate in half, from over 30% down to 15% by 2010. According to Dr. Marsden Wagner, former director of women’s and children’s health for the World Health Organization, international studies show that the optimal cesarean rate for a country is 10-15%. “If the rate is below 10 percent, maternal mortality goes up,” he said. “If it’s over 15 percent, maternal mortality goes up.”
In fact, a study published in the February 13, 2007 issue of the Canadian Medical Association journal reported that women undergoing planned c-sections are three times more likely to die. Cesarean section is major abdominal surgery. It exposes the mother to increased risks of infection, hemorrhage, anesthesia complication, organ damage, scar tissue, secondary infertility, postpartum depression, maternal-infant bonding complications, breastfeeding difficulties and death. Is it any wonder maternal deaths are on the rise here in the US?
Cesarean section subjects infants to increased risk as well. In November, the British Medical Journal published a study showing that the risk of neonatal death was 70% higher for surgically delivered babies than for normal deliveries.
The International Cesarean Network (ICAN) advises pregnant women that they have the right to refuse any medical treatment, including cesarean section. But how can a woman with a previous c-section refuse surgery when no physician around will attend a VBAC?
Obstetricians have pushed pregnant women into a corner. Some women are weighing their options: Unnecessary surgery vs. homebirth. Homebirth is relatively rare these days. In 1900, 95% of babies were born at home. Since 1955, that number has hovered somewhere around 1%. Yet the practice persists, not only among VBAC-seekers, but also among women who were unhappy with previous vaginal birth experiences in the hospital, and even among some first-time mothers.
Homebirth is gaining recognition within the mainstream as the result of Ricki Lake’s highly acclaimed documentary “The Business of Being Born.” The movie focuses on the profiteering that goes on in the birth industry at the expense of mothers and babies, and offers a look at how empowering and thrilling natural birth can be.
The American College of Obstetricians and Gynecologists (ACOG) is striking back. On February 6, 2008, ACOG published a press release condemning homebirth. What the statement leaves unwritten is that every homebirth represents an economic loss of thousands of dollars for doctors and hospitals. After all, ACOG is essentially a trade union for the OBGYN industry. An anti-homebirth statement from ACOG is like an anti-tap water statement from Pierrer.
Taking a swipe at Ricki Lake, ACOG says, “Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre.” Calling homebirth “fashionable” or “trendy” is laughable. Hospital birth is the recent historical trend. Babies have been born in homes for thousands of years. Women birthed them, and women caught them, and women nursed them.
In fact, if ACOG members would cast their myopic gaze across the Atlantic, they would find that European births are primarily attended by midwives. One third of Dutch babies are born in their own homes. Or if they peered across the Pacific, they would find that 70% of Japanese births are attended by midwifes, often in dedicated birth houses or in private homes.
The CIA states that babies are more likely to survive in 41 other countries than in the United States. Babies fare better in South Korea and Cuba than here. The safest places to be born are Singapore, Sweden, Japan and Hong Kong, followed by a long list of European countries.
Are US newborn deaths the result of over-medicated birth, c-section, or lack of health care? Take your pick. Countries where babies are less likely to die typically offer universal healthcare and home midwifery.
ACOG seems more concerned with evoking emotion than delivering facts. Consider this statement: “Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.” Translation: Homebirthers are selfish mothers who put their babies at risk. Does ACOG at least support their contention with scientific data? Perhaps a study actually showing that hospital birth is safer? Not a chance.
The studies, in fact, offer the opposite conclusion: Uncomplicated pregnancies end just as well at home. In fact, US hospitals aren’t doing so well. Our country has the highest rate of cesarean sections, and the second worse newborn death rate in the developed world.
According to the 2007 State of the World’s Mothers report, “The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn [death] rate is higher than any of those countries.”
All ACOG can say about studies is: “It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous.” In other words, the studies do not support ACOG’s contention that hospital birth is safer – which makes it completely irresponsible for them to assert that homebirthers have misplaced their priorities.
ACOG has apparently done enough market research to determine one of the factors drawing some women to homebirth: America’s soaring cesarean rate. The obstetricians have a response to this, too: “Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.”
Translation: “The only reason we’re cutting 1/3 of American mothers is because they’re old, they’re fat, they’re lazy and they want to be cut.” These doctors refuse to take responsibility for America’s outlandish c-section rate, even though the rate varies widely between practices and is lower in natural (drug-fee) labors where women are allowed to eat, drink, and move around.
The ACOG statement even addresses VBAC, stating that women with cesarean scars are more prone to uterine rupture and thus VBAC should always take place in a hospital, never in a home. Anyone smell a rat? It’s dishonest to say VBAC should be hospital-bound and obstetrician-supervised, when obstetricians and hospitals refuse to participate.
Whoever penned the ACOG statement needs a crash-course in marketing. Obstetricians will find they are unable to shame homebirthing women back into the maternity ward. Given a choice between fat & lazy vs. selfish, we prefer to selfishly protect the precious lives of our little ones.
-- Jeannie Babb Taylor