Sunday, September 21, 2008

Examining our rising C-section rates

Today marks the launch of a 3-part story I wrote for the Ledger-Enquirer about the rising Caesarean rates in Columbus – and across the nation. Two of the three stories are in today’s paper. The first story is an overarching look at the many factors that have driven C-section rates way up over the past decade (nationally the Caesarean rate has climbed 50 percent over the past ten years). The second story is a look at what expectant mothers can do to decrease their odds of having a C-section. Local experts agree that women do have power to reduce their chances of needing a C-section, partly by being informed and prepared to meet the various challenges and complications of childbirth.

Several of the experts cited in the article offered their suggestions for mothers-to-be regarding good pregnancy and childbirth books and videos. Their suggestions follow. In addition, Columbus mother Katy McRae, who is expecting her second child any day now, shares her story of how she was pushed toward a Caesarean she now believes was probably unnecessary. This is an online feature only, so be sure to take a look. And then, if you have the time or inspiration, consider sharing your own birth story on the mom2mom forum. To launch the discussion, Elaine Mills, chapter leader for the International Cesarean Awareness Network of Atlanta, shares her story of the “cascading interventions” that led to a Caesarean in her first pregnancy, along with the story of her most recent VBAC (or vaginal birth after Caesarean) with her third child after two prior Caesareans. Go to the Ledger's mom2mom site, click on forums and scroll WAY down to "Labor and Delivery: birth stories" to read Elaine's story.

Then coming tomorrow, we’ll have a final story that looks specifically at the reasons VBAC is becoming a rare option in Columbus.

But first, four sets of reading suggestions (preceded by the person recommending them). Feel free to comment on these suggestions or offer some of your own.:

Melissa Terry Flynn, a certified nurse-midwife with Obstetric and Gynecologic Associates of Columbus:

“My favorite books are ‘Gentle Birth Choices’ by Barbara Harper and ‘Ina May’s Guide to Childbirth’ by Ina May Gaskin.
‘Gentle Birth’ has a DVD of the same name, and ‘The Business of Being Born’ ” is great.

Val Staples:
“I usually recommend ‘The Thinking Woman’s Guide to a Better Birth’ by Henci Goer and ‘Active Birth: The New Approach to Giving Birth Naturally’ by Janet Balaskas. I’m currently reading ‘Pushed: The Painful Truth About Childbirth and Modern Maternity Care’ by Jennifer Block and ‘Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First’ by Marsden Wagner. As far as movies, I love ‘Gentle Birth Choices’ by Barbara Harper and the new Ricki Lake movie (The Business of Being Born) is really good too. Paulina Perez’s ‘Special Women’ is good for someone interested in doulas.”
Dr. Joseph Eikelberry, vice chief of staff at The Medical Center and an obstetrician and gynecologist with Obstetric and Gynecologic Associates of Columbus:
“The classic textbook for pregnant women is ‘What to Expect When You’re Expecting’ but I really like ‘The Girlfriends’ Guide to Pregnancy.’ It has much of the same information as the more formal ‘What to Expect…’ but it presents the information in a more humorous way, from the perspective of someone who has gone through pregnancy rather than presenting information in a more factual and medical manner.”

Dr. Joseph Tate, a clinical assistant professor of gynecology and obstetrics at Emory University School of Medicine and an obstetrician and gynecologist in private practice in Norcross, Ga.:
“In general, ‘What to Expect When You’re Expecting’ seems to be the standard.”

And here is the story of one Columbus woman’s regret over a Caesarean that might have been avoided:

Columbus mother Katy McRae says she learned the hard way that it’s important to investigate a provider’s track record when it comes to performing Caesareans vs. vaginal births.
Before the birth of their now 2-and-a-half-year-old son, Peyton, McRae and her husband, Michael, had taken The Bradley Method childbirth classes, had written a birth plan and were hoping for a natural birth. But at 36 weeks McRae’s doctor told her that her baby was too large –and that a Caesarean was the safest option.
When McRae initially resisted, her doctor asked her to have her husband come into the office. There, McRae said, the doctor delivered a verdict that scared them into compliance: “I cannot guarantee the lives of your wife and your unborn child without a C-section.”
So at 38 weeks, McRae went to the hospital for a scheduled Caesarean and delivered a healthy baby, Peyton, who weighed in at 8 pounds, 2 ounces.
“My son was a normal healthy weight and size,” McRae said. “In fact, family members and friends who work in the medical field were kind of like, ‘That's it? That's the ‘big baby?’ "
McRae believes now she may have been pushed toward Caesarean by a doctor who was either afraid of a lawsuit (since large babies can pose risks to a laboring mother) or perhaps drawn to the efficiency and convenience of a scheduled Caesarean – as opposed to a long-drawn out and unpredictable natural labor and birth.
For McRae the experience of Caesarean felt grueling and dehumanizing. She said her doctor never talked to her during the procedure. And Peyton was rushed off to an incubator after they had difficulty getting his temperature, so McRae didn’t get to see her newborn son for an hour and a half after his birth.
It would later take Peyton 8 weeks to learn to latch on while breastfeeding, and McRae wonders if the Caesarean birth, the epidural she was given before it, or the lack of instant bonding between her and Peyton had a role to play in his difficulties.
As the epidural wore off, and McRae– her skin itching all over and her body shaking and cold – began the long process of recovering from the surgery, she told her husband she never wanted to go through a Caesarean again. She said they contemplated having just one child.
When McRae did get pregnant for the second time she knew she wanted to attempt a VBAC. She went through the phone book for three days calling doctors in town to see if they would offer her a trial of labor.
She said, beyond her personal emotional and physical aversion to Caesarean, the reading she did convinced her that she faced more risks of a complication with a repeat Caesarean than with a VBAC attempt.
In the end she found only one practice in Columbus that would allow her to attempt VBAC – Thomas Nathan Malone and his son Thomas Michael Malone, in practice together -- said they would offer McRae a trial of labor provided her medical history suggested she would be a good VBAC candidate and provided she went into labor naturally.
Now she is set to deliver a daughter with them – via VBAC if all goes as planned – in late September. Her due date is Sept. 28.
McRae said the experience of working with doctors who “are on the same page” as her has been renewing. Now she says, even if she needs a Caesarean, she will feel confident it’s the right decision.
And she encourages other women to shop around for a doctor that truly fits their vision for birth. She thinks if she had asked more questions of other women in the community, she would have realized she was working with a doctor who was quick to opt for Caesarean.
“I wish I had asked more questions – not necessarily from doctors,” she said. “I wish I had taken the time to have gotten other women’s experiences with different doctors.”

*** One last note: The e-mail address listed by my byline in today's paper is no longer accurate. If you would like to e-mail me directly, please contact me at Of course you can also leave comments here for others to read as well.


Tina said...

What to expect when you are expecting should be flushed down the drain. Never read it!!!!
It is the wors book ever. I read it in the beginning of my first pregnancy and the joy oof being pregnant was taken away from me. It made me feel so sick and worry. The way it is written is so negativ.
Val Staples book list rocks!!!

I am a Monkey's Mama said...

Of COURSE the OB recommends WTEWYE--it's the worst case scenario survival guide to pregnancy!

Any woman who looks at all of the books mentioned by all of the so called experts can easily see the difference in quality information that is offered.

WTEWYE is like taking a hospital birthing class. It is guide for how to have a hospital birth the way "they" do it.