It's Time to Reduce the C-Section Rate
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