An official statement was made today that says Baby Blue is taking over a whole floor, but is in an executive suite, with their own security detail and that she was not born via c-section, scheduled or otherwise.

As you’ve probably heard by now, Beyonce Knowles and her husband, Jay-Z, welcomed their daughter, Blue Ivy, this past weekend. You might expect this post to be about the reports that Beyonce chose a scheduled c-section, but honestly no, I have a different bone to pick with the whole situation.

The NY Post is talking to a dad who was prevented from visiting his premature twins because of security for Beyonce and her entourage.  Apparently there have been several such shut downs at the hospital during her stay, which reportedly encompasses a whole floor, minus the NICU, and costs an estimated $1.3 million for her stay.  This is also sad, that families in their times of need can’t get to babies.  What about moms who needed to nurse babies?  What about families who may have only had a few hours left with a baby who was very ill?  This is ridiculous.

The public health person is me started churning this over in my mind last night as I tried to sleep.  My first thoughts were to the waste of money.  Shouldn’t all patients have privacy?  Be it Beyonce and Jay-Z or me or you or anyone?  Okay, so that’s annoying, they get to pay extra and have windows darkened and people restricted from being in the halls.  The average person can’t afford it and probably doesn’t want it or care.  But then I started wondering – what about all the women in labor who were registered to have babies at Lenox Hill around now.  Do they get shunted to other hospitals?  In labor?  At what cost and to whom?  Maybe they just get shuffled to another area of the hospital, one less convenient for them and the medical staff, an area that maybe isn’t set up to specifically care for obstetrical patients.  What about the fancy modular birthing beds and birth balls that Lenox Hill brags about on their online tour? Did those move too?

To open a hospital, you need to get a certificate of need (CON).  That says there is a need for these services in this community.  Who is meeting the needs of this community while the whole floor is taken up for one family? While I used to think that Brad Pitt and Angelina Jolie were crazy to have their first baby, Shiloh, in Namibia with their LA physician by their side for her scheduled c-section, at least I know that once they were out of the OR, there wasn’t all this craziness in the clinic where she gave birth.  Even Michael Jackson, known for his extremes, simply took the baby and immediately left the hospital, paying for care in his own home.

_{Photo © Dreamstime}

1. Education: Continue to talk about what your local cesarean section rates are, particularly compared to the national data. Talk about what a healthy cesarean rate might look like and why a cesarean rate that is too high can hurt mothers and babies. Remember, we’re not against all cesarean births, they can and do save lives. We’re against the overuse of this surgery because of it’s harm to babies, mothers, the health care systems and ultimately society.
2.  Support Moms: Moms get caught up in the middle of all this data slinging. They only want to do what’s best for their babies and many times they are really confused about what that is right here, right now. Support them in finding out accurate information, support them in their decisions, support them no matter what, be that physical support in labor, emotional support before and after, be that informational support.
3. Teach the Art of the Second Opinion: When a mom is trying to make a decision about having surgery, talk to her about the benefits of a second opinion. (Let me say it’s also a great relationship to cultivate with some practitioners in your area.) She either gets information that confirms what her practitioner says and she goes back and has a cesarean that she feels really positively about or she learns that she may have more options and choices. A well done second opinion is rarely a bad thing.
4.  Listen: What’s going on in your area? What are people saying about the data? Do you see hospitals talking about their rates in a more positive way? Perhaps they are feeling really great about their efforts and want to redouble them, but perhaps they aren’t reacting at all. Ask them about it. What about the practitioners in your area? How are they responding? Is this an opening for you to go in and talk to them some more about lowering the cesarean rates? (This includes raising the VBAC rates.)
5.  Act: This is not the time to get complacent. This is the time to keep on keepin’ on. Teach childbirth classes, take on doula clients, talk to everyone you can about this data and other data. Talk about the primary cesarean rate, talk about the VBAC rates, talk about what the impact is on breastfeeding… Find your area of expertise and talk about how this effects that topic. Teach. Write letters. Blog. Twitter. Whatever it is you do, do it.

While a single data point doesn’t tell us much, while you may be tempted to be disappointed that there was basically no change, remember this: The cesarean rates have been hurtling upwards for over a decade, a year where there is numerically speaking very little movement in the number is effectively a huge change. We can’t tell by looking at this number why the cesarean rates didn’t continue to rise. We have plenty of guesses, including the extraordinary efforts on the part of mothers and birth activists, but I’m going to say that we will likely find that we have allies.

How will you keep on keepin’ on in the mean time? Share your ideas and stories in the comments.

_{Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National vital statistics reports web release; vol 60 no 2. Hyattsville, MD: National Center for Health Statistics. 2011.}

As the preliminary birth data is released, the cesarean rate is up yet again to 32.9% of all births.  This is another record high for the United States.  The VBAC rates are not released with this preliminary 2009 data.  It is also too early to begin seeing the effects of the new ACOG guidelines for encouraging vaginal birth after cesarean (VBAC).  What’s your take on the cesarean rate – will we start seeing it go down next year?

I think that c-sections are great, if the mother and baby really need it, but these days it seems like it is the new “fad” to get a c-section.  People are now scheduling their births into their lives because everyone is so busy these days.  I think that scheduling c-sections or scheduling to induce labor is a scary thing.  Due dates are not accurate, and if the due date is off you might be taking that baby out of the mother way too soon.  Our class helped out at an event called “Oh Baby!” and one of the ladies told us a story about someone who had a scheduled c-section, but their due date was off and the mother was only 32 weeks, and they baby had to stay in the hospital.  I think that due dates are a scary thing, because you do not know your due date for sure, and a lot of people get anxious if they are past their due dates. 

Through this semester I kept on thinking how grateful that I was taking this class.  I think that birth is not talked enough in our country.  I think that if more women were informed about birth in our society than our system would be different.  I feel lucky that I know this information so that as I get older and get ready to have children of my own, I will be well educated on the birthing process and I can be in control and give birth the way that I want to do it.

The biopsych of birth class comes to an end; Dr. Uzelac was telling us that talking about birth in the “real world” is different than how we discuss it in our class.  After taking this class for a whole semester I have come to really be passionate about the way that birth in our country is portrayed.  When I come across different pregnant women, I am going to have to try my hardest to project my opinion in a very careful way, especially being a 19 year old college student who has never giving birth before, why would pregnant women ever take advice from me?  I look forward to coming in contact with these challenges.

                My sister-in-law ended up having a cesarean, due to high blood pressure towards the end of her pregnancy. My nephew’s birth weight was 9lbs 6 oz. After the delivery when her OB came to see her the next day she said to my sister-in-law “There is no way you would have been able to push that baby out.” This is just so irritating to me. Doctors have no confidence in women and their bodies, and if they make statements like the one said to my sister-in-law, they are making women feel like they are not capable. They are taking away their confidence of themselves and their bodies. And for the most part the woman will believe their doctor, because they’re the doctor, not you.

                As a nursing student, I have seen two c-sections. The first one I saw, I had to walk out before the baby was “born” because I the smell of the skin being cauterized made me feel so sick to my stomach and like I was going to pass out.  The second one I saw I was able to stay in the OR the whole time. I could not believe how barbaric the procedure was. Cutting, cauterizing, pulling, shoving, it was really hard to watch. As the doctor prepares to reach in and grab the baby, he has the nurse or assistant use what looks like a big shoe horn to hold/pull back on the incision to make as much room as possible for the doctor to get inside and remove the baby.  No wonder the woman is in so much pain afterwards, they push and pull and shove her insides around and deliver a baby that apparently was in distress (which is, most of the time, actually healthy at birth). If doctors weren’t so busy looking at the printouts of the electronic fetal monitor there would not be so many c-sections. They see a few decelerations and get all panicky, well what do you think that baby has been doing in there for 40 weeks? It probably has decelerations every day of gestation, only now that it is visible on monitor the doctors can use it to back up their advice that the woman should have a cesarean.

                With my own experiences and in reading both Cassidy’s Birth and Goers A Thinking Woman’s Guide to a Better Birth, I don’t know how a woman could want or be okay with having an (unnessary) cesarean.

The cesarean section is a form of major surgery and like any other, it (usually) includes anesthesia and a warning of any associated risks (any potential complications during or after). While the medical community may provide people with information about the procedure and inform a woman about her options, a lot in the decision making will be affected by what an attendant thinks is necessary to keep a baby safe. These decisions are made based on factors like breach births or fetal distress, which may be, but are not always be an indication of alarm or an end-all for a vaginal delivery. I am not saying that high risk patients or emergency cesarean sections are unnecessary, but that the criteria for deciding on having a section are broadening and causing an increase in cesarean rates that should be cause for concern.

  I believe that this increase is due in part to the belief that cesarean sections are a quicker and safer alternative than natural birth. What I believe to be underemphasized by the medical community when educating patients, is the impact a C-section can have on the birth experience and the toll it may take on a woman and her family during recovery. Typically, a woman who undergoes the procedure of a cesarean section have their arms strapped down as a safety precaution, their face shielded from the sight of the surgery, and are medicated to block the pain of the incisions, extraction and stitching. After a baby is taken out of their uterus, it may be hours before the mother gets to hold or feed her baby for the first time. Even after leaving the hospital a mother will feel discomfort, she is not permitted to move around very much, and is given a weight limit for things she can pick up or carry. And lastly, despite the recent innovation of the “bikini-cut,” physical and/or emotional scars are something that may stay with them forever.

Lesser reasons for this increase in frequency of cesareans may be the result of fear of pain and trauma with a vaginal delivery or the notion that vaginal delivery is antiquated.  Although doctors do not always readily accept requests for cesareans from healthy pregnant women, it does still happen. I believe the most important take-away message from all of this is that vaginal delivery is a safe and natural experience for women who are not truly high-risk. Cesarean sections play an important role in helping those who are high-risk, but a completely unnecessary and potentially dangerous role for those who aren’t.

I think it’s exciting to be living during a time of such change; not only when it comes to birthing techniques, but everything else that’s going on in the US.  It’s times like these where the industry is facing such opposition that real change will take place. It may take several years, but I do see radical changes in our future.

Reference
Goer, H. 1999The Thinking Woman’s Guide to a Better Birth. Canada: The Penguin Group Inc.

I suppose every woman has a few affirmations that speak to her more than the others.  For me, the crux of the collection was this:

I am prepared to calmly meet whatever turn my birthing may take.

I didn’t have a lot of expectations for my birth.  I wasn’t expecting it to be short or easy.  I kept an open mind about Mongan’s claim about birth not needing to be painful, and knew that I would deal with the birth beautifully whether it was painful or not.  But I really, really, really wanted my homebirth.  I was terrified of needing a hospital transfer.  I was terrified of needing a C-section.  I was terrified of letting go of my dream.

I am prepared to calmly meet whatever turn my birthing may take.

I just  couldn’t hear it enough.

But a few weeks before my birth, I came across a very unusual birth story.  It goes as follows.

Sivan was pregnant with her fourth child and preparing for a homebirth.  She was diagnosed with gestational diabetes in the middle of her pregnancy, but she did not let that worry her.  Her 39-week ultrasound estimated the baby’s size at an impressive 4.4 kg (9.7 lbs).  This did not bother her either; she knew how notorious ultrasounds are for being inaccurate.

But her midwife was concerned.  She took a good look at all the factors involved, and told her that with all the data she had, she did not feel safe accepting this birth at home, and with great sympathy told her that in her professional opinion, a C-section would be the safest course for this particular baby.

Sivan was shocked.  She trusted her midwife and knew that she would never recommend a planned C-section without a really good reason, but she couldn’t grasp the idea that her midwife would tell her such a thing.  What about the inaccuracy of ultrasounds?  What about the inaccuracy of the glucose tolerance test?  What about the idea that women’s bodies have been doing this for millenia and know how to birth big babies too?

Eventually she began to accept that her midwife was not just being over-cautious.  In the case of gestational diabetes, it is the shoulders of the baby that put on a lot of weight, and the risk of true shoulder dystocia in this case was too high to ignore.  She did not want to put her baby at risk.

But a C-section?  After all her hopes for a perfect homebirth?

Sivan described going to the beach and watching the waves and wanting to just give birth there, alone, trusting her body to do what it knew how to do, proving to everyone how wrong they were.  She cried for the loss of her dream birth, feeling helpless, hopeless and disempowered.

As she sat there, she got a call from her midwife.  “Just wanted to check in on you.  I know you will be okay.  You’re not the type of person who gets stuck in the past, I got that feeling from you long ago.  Just remember one thing: at the surgery, despite all the disappointment, you are still going to meet your baby.  Remember?  It’s a celebration!  Go in celebration!”

From that moment, something changed.

Sivan went home and informed the hospital that she would not be coming that day, but on Sunday.  And that her surgery would not be on Sunday, but on Tuesday.  Why?  Because that’s what she wanted.  She was taking this birth into her hands.  Who said a C-section couldn’t be an active birth?!

She and her husband arrived at the hospital like a pair of celebrities arriving for their premiere, all dressed up and full of joy.  They asked every staff member for his or her name and chatted with them.  Sivan insisted on sitting, not lying down, on the bed as she was wheeled into the OR.  As the surgeon prepared for the incision, she asked him to tell her exactly what he was doing.  She described the moments of joy as her son was born, and when he was brought to her from across the curtain and put next to her cheek; how she wriggled her arm out of the restraint and stroked him.  Her husband waited with the baby carrier, took the baby and never left his side as the operation was completed.  Sivan insisted on giving the surgeon a hug before she was wheeled to recovery.  Determined to recover and see her baby, as soon as she felt some sensation in her legs she tried to move them, and she expressed some colostrum to prepare her breasts for nursing.  She refused morphium for the pain and had them give her Ibuprofin instead.  The staff was in shock at her quick recovery and determination to function.  When her beautiful, 9.8-pound boy was finally brought to her, she didn’t wait even one minute before attaching him to her breast.  “Don’t you want to wait until we reach the ward?”  The orderly asked in amazement.  No.  Not a chance.

She turned one of the worst nightmares of any homebirther into a positive, happy experience.  A celebration.  After all, a birth is a birth.

I am prepared to calmly meet whatever turn my birthing may take.

After I read that story, something changed in me as well.  I realized that the lack of control I had over my birth did not mean I was helpless.  There is always a choice, and the choice is in your response to the situation you are in.  You can choose to see a C-section as a failure, a nightmare.  Or you can choose to see it as a birth; not what you wanted, not ideal, but a birth nonetheless.

Suddenly, I was able to let go.

And my birth was amazing.