Advocacy

In the coming weeks, I'm hoping our local ICAN chapter will undertake a new venture. We will be peppering the Greater Victoria area with pamphlets about c-section and VBAC. Anywhere you find new moms or moms-to-be, you'll find our pamphlet. Community centres, OB/midwife offices, kiddie stores, coffee shops. You name it. We'll be there.

If I get permission from ICAN, I'll post a link to the pamphlets here so you can download and print them yourselves. Stay tuned.

The c-section rate at Victoria General hospital is nearing 40%. It's nearly that high in the rest of Canada and across North America. What will you do?

ICAN Birth

A video montage of women who had cesareans because their doctor told them their pelvises were too small - and their success in birthing subsequent children. CPD (cephalopelvic disproportion) is a very common misdiagnosis - one of the reasons the c-section rate is climbing ever higher in North America.

Five Beautiful Births!

1Remember this mama? She gave birth without medical intervention early last Sunday morning to a beautiful baby boy!

I'm waiting on news from several other friends:
- a mama having her second baby is at 38 weeks - the doctors are raising her hopes by saying "he's going to come any minute - he's right there!" Poor woman has been on pins and needles for the past 10 days. Why can't these doctors keep their mouths shut? Update 11/21/07 - Baby boy (!) was born this past Sunday at 41 weeks - no complications.

- A first time mama who is 41+ weeks. I'm thinking about writing her an email on the dangers on induction... Update 11/02/07 I sent her an email on the dangers of induction last night...at approximately the same time as her son was being born at home!!!

- Another first time mama in Israel where the c/s rate is quite low, I've heard. I'm not too worried about her. A baby boy born early Sunday morning, 11/4/07!!!!

- Yet another first time mama in Sweden - also low c/s rates Baby also born early Sunday morning 11/4/07!!!!

I'll keep you updated!

Thinking of Letter Writing

A friend gave birth the other day - it was a little scary and I'm glad I didn't know the story until well after the fact. The OB broke her water when the baby wasn't fully engaged resulting in, surprise, a cord prolapse. Luckily, this powerful mama pushed that baby out before she had a chance to think and everyone is fine. I got VERY made at the OB, initially, but my friend assures me that the situation was more complicated.

Still, it got me thinking about my son's birth... I haven't cried over my c-section in at least a month, but I found myself breaking down last night after reading my friends birth story.

I've already written to my midwives with very specific suggestions for what to do next time a mama PIH (pregnancy induced hypertension) goes for induction. One of the midwives was very respectful and promised that she'd look at future situations differently as a result of my letter and experience. The other midwife, well, I haven't heard from her, but she did tell me at my last appointment that I shouldn't dwell on the past - I should just move forward. So much for empathy.

I'm wondering now if I should extend my letter-writing to the OB who performed the surgery and the GP into whose care we were transfered when my blood pressure went out of range of the scope of the midwives' practice.

I respect both of these doctors and I don't believe they were being cavalier in their pronouncement that I needed a c-section, I just think they were following business-as-usual in a hospital where the c/s rate is 40%.

I'd like to tell them how I feel post c-section and what I wish they would've done to help me make an informed decision (my husband and I did, ultimately, consent to the c/s, but it's been a case of "if I knew then what I know now..." in the months since my son's birth).

I will probably write these letters since I can't think of a reason not to. Both doctors are reasonable and compassionate and I fully expect to hear back from the OB (who offered to provide his services for free when he found out I wasn't covered by the provincial health plan) and possibly the GP.

Anyone think it will make a difference?

Outrageous

OK, so this isn't about caesarians, but it is about babies. I received an email today from babycenter.com. The subject: 5 bizarre baby behaviours.

I must admit that my curiosity was peaked. While my 9 month old ds does things that I wouldn't expect a 10 year old to do, I take his behaviour in stride - assuming, for the most part, that it is developmental.

So, what did BabyCenter have to say about these "bizarre baby behaviours"? The one that stood out to me was head-banging. I thought, why the heck are they talking about this? Head-banging is something you saw neglected orphans in Romania doing because they were always left alone in their cribs.

Why would western children head-bang (something the article suggests 20% of children do)? Then it dawned on me. Ferber and cohorts. These babies who head-bang? They usually do it in their cribs "to comfort themselves", says the article. All these babies have without a doubt been "sleep trained" by one of the so-called experts. What are they experts in? Society and media sponsored child abuse.

Newsflash: BABIES SHOULDN'T HAVE TO RESORT TO HEAD-BANGING FOR COMFORT! That's why we became parents. If we didn't want the job of comforting baby, there are plenty of parents out there who would love to adopt and comfort your child.

When will we all wake up form this surreal existence we call Modern Society where it's considered best for a mom to be sliced open to deliver her baby and for that baby then to be placed in a crib to cry himself to sleep?

Stop the train, I want off.

Cautiously Optimistic

On a personal note, Yom Kippur is approaching. It is a day for atonement and reflection.

The day after Yom Kippur is the date DH and I set for beginning to TTC bebe #2... VBAC, anyone?

Kitzinger

For my doula training I have to read The Complete Guide to Pregnancy and Childbirth by Sheila Kitzinger.

I got an older copy out of the library (published in 1996) and in it she says that 20% of women will have CPD (cephalopelvic disproportion). Now, I'm no scientist, but my gut says that this is absolute bullshit. Historically, 20% of women didn't die in childbirth because the baby wouldn't come out. In fact, Childinfo.org reports the rate in Afghanistan (we can probably agree that birthing conditions are primitive here) is 1,900 per 100,000 births - a maternal mortality rate of 1.9%. Where is all the CPD in Afghanistan?

I have to assume that this part has been edited in current editions. Anyone know?

Maddening

I know a woman who is due in a few months. She's young (early 20s) and she's only been married a year. She's petite in build and her husband isn't. He has a big head. The doctor took one look at them and said (wait for it...), "you might have to have a c-section because the baby's head will be too big."

Arrrrgggghhhh!!!!!

She's naive. She's religious, so she's reluctant to read any groovy birthing books (even though there's no prohibition to do so). She's "thinking about" taking some sort of childbirth education class.

I live 4000 miles from her and am not close to her. I'm being updated on the story by a friend.

I just emailed my friend and advised that this woman should hire an experienced doula to be with her. I also said that, as her due date approaches, she should spend time on all fours with her bum in the air to encourage baby to wiggle his head into just the right position.

What else can I do? I know she intends to have a big family and I cringe when I think of her having 6 or more c/s. She isn't the type who would stand up for a VBAC. Oy, I can't stop thinking about her.

Ghosts

I just finished reading Peggy Vincent's The Baby Catcher.

Every home birth she described in the book I imagined taking place in my own home. It's early in the morning here - the time when the edges blur around truth and dreams. My son is curled next to me with one hand resting on my leg. His father's snores temporarily silent on the other side of the bed.

My house is full of ghosts. There's the ghost of me labouring in the bathtub, on the toilet. Another ghost cleans out my kitchen cabinets while laughing companionably with the midwives. A third ghost rests her elbows on the edge of the futon, squatting to push the baby into the world.

Nights like this are hard. I look at my son and thank G-d for every cell of his being, no matter how he came into this world. Then, I grieve for what we both lost.

I can only pray for his continued good health, and for me, a chance to try again - to replace those ghosts with my physical being.

Becoming a Doula

I decided shortly after my son was born that I would like to become a doula. I don't want any more women to have an unnecessary caesarean due to lack of information. I dream of whispering in the labouring mother's ear - reminding her to demand that her doctor give her all the information before she consents to or declines a particular intervention.

Tonight I began my training by attending the first of a 6-week prenatal class - a requirement for attending doula training this winter.

It was amazing. I had taken my own prenatal classes there. I don't know if I ignored what they said (can't imagine I did), if I was distracted, or if I'm looking through a different lens this time, but I heard things I'd never heard before.

The knee-chest position can help an asynclitic baby reposition. Doing lunges while pushing can help move a sticky shoulder past the pubic bone.

Good stuff.

It was traumatic in a way, too. I remembered vividly being in that room with my husband and my belly. I felt the hope of all the families there. I felt renewed pain for the labour and birth I did not experience. I cried more than once and felt silly - I was just supposed to observe. I didn't think I would feel it so deeply.

At times I question my motivation and it seems selfish. Is it wrong to avenge the wrong done to me by helping other women avoid intervention? I think I'm looking at the role of a doula too narrowly. We're supposed to be whatever the mom needs, right? I worry that I won't know.



Oh well, it was only the first day.

They did it!!

Not only did they publish my letter, but check out the headline they gave it:

MDs responsible for rise in caesareans

Times Colonist

Thursday, August 02, 2007

Re: "Canada's caesarean capital," July 29.

How dare the doctors quoted in the article blame the high caesarean rate on women without taking any responsibility themselves.

I, too, underwent what I believe was an unnecessary caesarean at VGH. At no time was I realistically given other options and at no time were the risks of caesarean surgery explained to me.

Labouring mothers in the maternity ward at VGH are very much on their own when it comes to obtaining information. If you as a labouring mom don't ask the right questions, no one will volunteer the information.

The only way the caesarean rate is going to drop is if labouring moms and their birth partners advocate for themselves. Doctors, midwives and nurses aren't going to do it for them.

Kelly M---,
Victoria

What am I doing?

I wrote a letter to the editor of our local paper in response to this outrageous article which appeared on Sunday. I'll post it if it gets published.

Victoria is Canada's caesarean capital
Victoria General Hospital has the highest rate of C-sections in the country

Katherine Dedyna
Times Colonist

Sunday, July 29, 2007

Nearly four labouring women in 10 -- more than 1,000 women last year -- had either an unplanned or planned C-section at the hospital, which sees more than 2,800 births a year.

The Canadian Institute for Health Information said last week that the C-section rate across the country has been climbing steadily for more than a decade. The most recent numbers from 2005-06 indicate that 89,397 babies, or 26 per cent of babies born in hospitals, were delivered by C-section, compared to 23 per cent five years earlier and 17 per cent in 1993. The reason Victoria General Hospital has the highest C-section rate in the country at 37 per cent might be a confluence of many factors, although none is peculiar to Victoria.

Doctors cite, among other reasons, older, heavier mothers; increasing numbers of women who don't want to labour long; technology that shows potential fetal problems; mothers who have had previous C-sections returning for a second; and the presence of worried fathers in the labour room.

"We don't have any good data on how much is consumer-driven versus system-driven and so on," says Dr. Jerome Dansereau, chief of obstetrics at the Vancouver Island Health Authority. "It's really difficult to dissect those numbers."

VIHA's head of family practice obstetrics at the hospital, while saying she wants the rate lower, defends it. "I've never been involved in a case where I thought that it wasn't a necessary C-section based on the evidence we have," says Dr. Deborah Bircham.

A C-section is major surgery involving an incision made through the mother's abdominal wall to remove the baby from the uterus. In healthy mothers, this leads to three times the complication rate of vaginal births, with blood-filled swellings and infections -- some life-threatening -- being the most common at VGH.

British Columbia is the province with the highest C-section rate in the country, at 30.4 per cent. Health professionals say there are many forces pushing up the rate in B.C. and across the country, and it is possible some are more common in Victoria.

For instance: Advanced maternal age is a factor in C-sections, and women over 35 make up 24.1 per cent of mothers in Victoria compared to 21.5 per cent B.C.-wide. The other explanations include:

- Patients are not as patient as they used to be, says Dansereau.

It happens weekly if not daily, that a woman is not labouring well and does not want to carry on any longer. "There is only so much as the caregiver that you can say or do to convince her to carry on, carry on, especially if you're not convinced that it's going to make any difference at the end," he says.

Luba Lyons Richardson, vice-chairwoman of midwifery at VGH, has seen the same culture shift in her 30 years of practice. "Women themselves have less tolerance for longer labours, for a baby that's a little bit in distress."

But caregivers have empathy for women with low coping skills and previous traumatic labour who don't think they can face that again, says Richardson. She knows of women who ask for elective caesarean sections and get them, depending on extenuating circumstances.

"That's another debate that rages on. If women have choice, then shouldn't they have that choice?"

- Even the mention of a one per cent risk of a negative outcome for the baby by continued labour influences mothers in favour of C-sections, Dansereau says.

Fetal monitoring is there to record every bit of risk, and that, too, has increased the C-section rate, says Bircham.

But the equipment that shows potential problems is not accurate enough to be definitive, so doctors take the cautious route.

"If you have something non-reassuring, you are obligated to deliver the baby," Bircham says.

Sometimes after a C-section, she thinks labour could have gone on another couple of hours. "But do you want to be the one that says, 'I'm sorry, we shouldn't have waited. Your baby is now going to have brain damage.' "

- Vaginal births after a previous C-section are falling. Mothers who have had previous C-sections are given the option of a scheduled C-section for their next birth because of the risk of uterine rupture. Doctors cannot force these women to try vaginal birth, even in the absence of factors that led to the prior C-section, says Bircham.

There were 301 scheduled C-sections at VGH in 2005-06, although some of those were for other complicated deliveries.

- Surgeons in Victoria will do C-sections rather than traumatic forceps delivery. Only 10 per cent or fewer of VGH births involve instruments such as forceps, far lower than the national average of 16 per cent.

"That might be a big difference and I wouldn't disagree with that," says Bircham, adding that forceps can lead to damage to the mother's perineum and to the baby.

- Doctors are seeing heavier mothers.

"There are more and more women presenting to my office with weights over 200 pounds at the beginning of a pregnancy," says Bircham, and that leads to bigger babies and reduced space in the birth canal.

- Susan Miller, an RN and prenatal educator since 1978, says protective dads in the delivery room also affect the C-section rate. "The dad will say, 'Do something, she's in pain.' " And that often means an epidural.

The epidural freezes a woman's abdomen and increases the potential for C-section because it obliges her to stay in bed, with a continuous fetal monitor, IV and blood pressure cuff, with no opportunity to help the baby change position.

Bircham would like to see a lower rate of C-sections -- and notes that if home births were factored in, the local rate would drop to 35 per cent. But she says women in Victoria get excellent maternity care.

They do not get C-sections for their first pregnancy just because they want one, she says.

But midwife Lyons Richardson won't be surprised if eventually women walk in cold with their first pregnancy and demand a C-section for any reason they want.

"Give it 10 years and I don't think it's going to be that unusual."

Dansereau doesn't rule out the rate going to 50 per cent, given the continuing upward swing.

"There is no one who could have predicted what we see today," he says, "and there is no one who can predict when it will stop."

© Times Colonist (Victoria) 2007

Beginning

The caesarean rate in North America is just too high. Something needs to be done and I don't think we can depend on the medical establishment to do it. We need to take an active role. Every woman. Every birth.