Wednesday, May 28th, 2014
Is it possible to be awake, lucid, and able to make your own medical decisions—and still have surgery against your will? Apparently so. A New York woman is suing the hospital at which she delivered her baby, according to the New York Times, alleging that her doctor forced her to have a C-section that she did not want and did not consent to. The case is disturbing in and of itself but is also indicative of a much larger, extremely prevalent problem: the extraordinarily high rates of cesarean births overall.
Rachel Dray knew what having a C-section is like, as she’d had two of them previously. For her third baby, she wanted to have a VBAC—“vaginal birth after cesarean”—but after several hours of labor, and what must have been many vehement arguments with her doctors, she was given the C-section. “I have decided to override her refusal to have a C-section,” one of the doctors reportedly wrote in a note explaining the situation.
The right to decide whether to have another human being cut open your body seems like a fundamental choice that a person should be able to make for herself. Of course, the health and welfare of the baby is a concern, and perhaps there are extreme circumstances where a hospital needs to overrule a mother’s decision in order to save the life of a baby, but it’s hard to imagine that actually happening in reality rather than just in hypotheticals.
Ultimately, Dray’s whole situation may have been avoided if our hospitals were not so quick to move laboring women to the operating room in the first place. Labor can take a look time, and that’s not inherently a sign of distress. So let’s let it take a long time, if it needs to.
Thankfully, new guidelines issued in February by the American College of Obstetricians and Gynecologists aim to decrease the number of C-sections by having doctors allow healthy women to spend more time laboring. While I don’t know if these guidelines could have saved Rinat Dray from any of her three C-sections, I hope hospitals turn these suggestions into policy quickly.
Women in labor are too often shepherded into the operating room for no reason other than that they’ve been in the hospital too long. When you are admitted to the hospital in labor, the clock starts ticking—labor too long, and you’ll be told you must have a C-section. Partly because of this artificial deadline, nearly one third of all American babies are born via C-section, resulting in longer recovery times and other risks for those women.
In Cut It Out: The C-Section Epidemic in America, Theresa Morris calls for the C-section rate in America to be “publicly recognized as an epidemic threatening the well-being of women, babies, and families.” Morris, a sociologist at Trinity College in Hartford, Conn., details why C-sections have become so prevalent, and her focus is on the structural, organizational reasons. For the most part, it’s not individual mothers or doctors who are choosing this route. Rather, it’s a combination of hospital rules, fears of litigation, and the like that are conspiring to lead so many laboring women to the operating room.
Doing a C-section has become a way so that everyone involved in the birth did everything they could to deliver a healthy baby. “Hospital administrators, ACOG [the American Congress of Obstetricians and Gynecologists ], courts, malpractice insurers, and reinsurers have defined C-sections as the best practice to protect themselves and maternity providers from blame in the case of a bad outcome”, Morris writes.
There is nothing inevitable about a C-section rate of over 30%. My wife delivered our first baby via a C-section that we believe could have been avoided with more effort by our nurses and doctors. For our second baby, she switched to a practice that advertises a VBAC success rate of over 90%. She went on to have two healthy vaginal births, the first of which took more than 24 hours and involved a huge dose of patience alongside some creative interventions—the right dose of the right medicine at the right time, a variety of labor positions, massage by our doula, etc. (Our third was born moments after we entered the hospital.)
To truly reduce the C-section rate and return more decision-making power to women and their doctors, both the rules and the culture in hospitals will need to change. Too often, women are treated as selfish for wanting to avoid a C-section, with nurses condescendingly “reminding” women—as if they needed any reminder—that giving birth to a healthy child is the most important thing. But a C-section is major surgery done at a time when women need their strength and stamina to care for their soon-to-be newborn. There is no shame in trying to avoid it, if possible.
Of course, not all C-sections are frivolous, and plenty of them save lives, of the baby and/or the mother. Let’s not lose sight of that or vilify doctors or hospitals for focusing on the high success rates and low rate of complications C-sections carry. But that doesn’t mean the status quo is acceptable, either.
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Image: Pregnant woman in delivery room via Shutterstock
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Thursday, January 2nd, 2014
My wife jokes that we’ve now experienced the labor-and-delivery trifecta: One C-section (unplanned), one vaginal delivery with epidural (a planned VBAC, which I almost missed), and one unmedicated birth (very much unplanned). This is the story of that last experience and what it says about our medical system when it comes to hospitals and labor.
Stephanie’s contractions began in the middle of the night on Nov. 5 and were still far apart—about 10 minutes—when we called the doctor. She suggested we come to her office first thing in the morning, rather than heading straight to the hospital. Hours later, the contractions had not increased in intensity or frequency, and so we went to the doctor’s office. Her doc confirmed that everything seemed fine and healthy and said she’d normally suggest we return home. But we live about a 45-minute drive from the hospital, and she said, with a third baby like ours, things can change very quickly from slow to fast. Oh, how right she was.
The doctor suggested we stay close by–her office is just blocks from the hospital–and so we spent the morning having a lovely time on Manhattan’s Upper East Side, just Stephanie, me, and our doula. We went out for a luxurious brunch and took a walk. I was the one who was most agitated, feeling like we should be settled in the hospital, but contractions remained eight to 10 minutes apart and Stephanie was feeling OK. She, her doctor, and our doula all agreed that we had plenty of time.
We eventually made our way back to the doctor’s office, where she put Stephanie on a fetal monitor and we continued waiting, a surreal day getting stranger.
At one point, we went out for another walk, but things were clearly starting to progress. Still, nothing seemed imminent. The doctor said she’d do a quick exam, and then we’d head to the hospital. Stephanie, however, said it was time to go—NOW.
Then her water broke.
The baby was coming. Fast.
Our doula ran out to hail a taxi. (She later told us she put all our bags in the trunk before telling the driver that a woman in active labor was coming. Smart woman.) The doc and I escorted Stephanie, slowly and carefully, to the waiting car. I later found out that the OB had grabbed gloves and an emergency receiving blanket. You know, just in case of a street-side NYC taxicab delivery.
We were off, eager to go the very few blocks between the office and the hospital. However, this being New York, nothing is quick, and the streets were clogged with bumper-to-bumper traffic the entire way. Our driver did his best to weave and dodge, but with nowhere to go, we inched along as the doc called ahead to let the hospital know to be prepared. I started to feel weak and nauseous and just kept thinking: All that planning, and we’re going to have this baby in a cab. I didn’t sign up for this.
Finally, we turned the corner to the final block of our trip, and traffic remained at a stand-still. The OB got out to literally negotiate with the cars in front of us to move over just a few inches so we could get by, but then I noticed a school bus half a block ahead—and suddenly, its red lights turned on. No one was passing until those lights went off. It felt like a ridiculous movie, where the director piles on a hopelessly implausible set of challenges and obstacles.
Our doctor called ahead once again, and suddenly our taxi was swarming with nurses. They helped Stephanie into a wheelchair, and we ran full force the half block to the hospital. The doctor and I ran just ahead, gesticulating for people to move and screaming like maniacs, “Out of the way! Out of the way!”
We finally made it inside. The nurses shooed everyone away from the elevators and used their powers to summon an emergency elevator. Once in a delivery room, they got a gown on Stephanie, and told her to start pushing. She asked, repeatedly, for the anesthesiologist, for her epidural, but there was no time. Just a few pushes, and I saw the head; in about 10 minutes, our baby was born. Little Sophia made quite the entrance. It was 3:11 p.m.; I’d made a phone call to my parents at about 2:20 telling them that Stephanie’s labor was just starting to speed up and that we’d be going to the hospital soon. That’s how fast this happened.
It was not the birth we planned for, for sure. But there were benefits, besides a great story. No need for an IV, for one thing: Immediately after Sophia came out, the nurses were about to put in an IV port—because that’s what they do for all women in labor—but our doctor stopped them. What purpose would it serve, now that the delivery was over? And despite the pain, Stephanie said she had fewer lingering side effects after, and the baby seemed more alert at birth.
It can often seem like labor is a battle. You go in with a plan and a set of expectations (hopes, really) and try to stick to it, even as circumstances dictate otherwise. We were prepared to navigate the rules of the hospital–issues such as whether the fetal monitor is worn constantly or intermittently and how long someone can labor before a C-section is warranted–and, of course, to follow the advice of Stephanie’s doctors.
But we also knew from experience that these rules are sometimes constraining. For instance, a fetal monitor can inhibit the someone from laboring in certain positions, which in turn can make labor longer and more painful, which in turn can lead to additional, potentially avoidable interventions, including a possible C-section.
So we decided to stay away from the hospital as long as we felt we could. In the end, the extraordinary speed with which Stephanie’s labor turned from slow to baby-coming-now, not to mention the challenges of New York traffic, conspired to make this birth dramatic. Perhaps that could have been avoided if we felt like the hospital experience would be more collaborative and supportive, in which case we may have gone in earlier. Instead, however unintentionally, we were able to experience a completely unconstrained labor–Stephanie was able to walk, eat, and drink, whatever was most comfortable for her–which resulted in a successful vaginal delivery with no complications. But obviously, we’d rather not have had the last-minute scare. If only we could have the benefits of an unconstrained labor and the support for the laboring mother’s needs and choices in the safety and comfort of the hospital.
After it was over, we asked the nurses how often this sort of thing happens. They told us that a baby was born in an ambulance on the way just that morning. I’m grateful that Sophia made her debut in the hospital, and of course, that everyone is safe and healthy. Our doctor gave me the blanket she’d taken along in the taxi as a memento. Happily, it’s still wrapped in its packaging.
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