Wednesday, November 23, 2005

30? Do I hear 30, anyone?

Why stop with a Cesarean rate of 29%? Women, let's get out there and make it an even 30%! While we're at it, let's surpass Brazil's infamous rate and have MORE THAN HALF of us delivering our babies surgically.

I suspect you have already read about the CDC's 2004 birth statistics. The national Cesarean rate rose to 29.1%. On the National Center for Health Statistics' summary page, they put this number in (recent) historical perspective:

"For 2003–04 the primary cesarean rate rose 8 percent, and the rate of vaginal birth after cesarean delivery (VBAC) dropped 13 percent. The primary rate has climbed 41 percent and the VBAC rate has fallen 67 percent since 1996."
With the loss of the VBAC option, women who have 1 surgical delivery are condemned to the same route for subsequent births.

The article quotes several doctors, one of whom blames the rising Cesarean rate on older mothers' wish to preserve their pelvic floor. In Red State Moron's comments section, I shared my personal experiences with this physician. Suffice it to say, I am skeptical that older mothers hold most of the blame for the upward trend.

Another doctor quoted says fear of malpractice is a key factor. I have to agree there. And as Atul Gawande laid out nicely in the November 14 New Yorker, malpractice isn't going anywhere anytime soon.

What the article doesn't discuss, however, is the cultural trend of disempowerment that is happening to women. We are being told our bodies won't labor right and won't work right after labor. AND WE ARE BELIEVING IT. We are being told labor hurts so much we should avoid the pain at all costs. AND WE ARE BELIEVING IT.

I think one of the most important things we can do to help the future of birth in the U.S. is communicate to girls and young women that they can trust their bodies, that their bodies are strong, and that they can withstand pain.

Over the weekend I was pondering ways to convey this message. One thought I had, not surprisingly, given my own experiences, was to get all girls involved in athletics and, for lack of a better term, "body arts" (yoga, pilates, etc.). The goal is not to make them athletes, but to give them familiarity with their bodies and build a sense of trust in it. Let them push themselves and see that they not only survive it, but grow because of it.

I also think anyone who has positive birth stories, should be sure to share them, especially when women congregate around an expectant mother to tell their horror stories. At least provide a counterpoint to the well-trod narrative of popular culture.

Lastly, those of us who have the opportunity to work directy with pregnant women should make sure the women are educating themselves and asking all their questions of their health care providers.


Blogger Casey said...

I haven't really thought this through, but I'm wondering how abstinence-only sex ed effects girls' attitudes towards their reproductive health. I mean, these curricula portray pregnancy as almost a punishment for premarital sex. I'm not saying that abstinence-only sex ed is calcuably influencing the Cesarean rate, but I can't help but wonder if it contributes to the culture of fear surrounding pregnancy and reproductive health, in general.

12:57 PM  
Blogger doulicia said...

Interesting point. Depending how it's taught, abstinance can also promote a women-as-victims, or women-as-passive-participants-in- their-sexuality attitude.

1:58 PM  
Blogger Julie said...

I do try to share my "positive" birth stories whenever I can. But it can be delicate. If another woman has just told a horrific story and then I start in with my fabulous home birth, how can it not sound like a criticism of the first woman's choice? Especially when we are talking about one of the most important and meaningful events in a woman's life.

9:18 PM  
Blogger birthstudent said...

Julie said, "If another woman has just told a horrific story and then I start in with my fabulous home birth, how can it not sound like a criticism of the first woman's choice"

Very true. After my c-section, I had no interest in hearing anyone's positive birth stories. I actually resented people asking me about my own birth as I (still) think it is a private experience and none of anyone's business. Now that I have had a positive birth, I still don't ask women about their births but I do like to share my story. I'm just careful about how I word things, as I am sure you all are, too. I make sure to mention that there is nothing wrong with chosing a hospital birth, ect. It's all about choices and it seems like we have less and less choice nowadays doesn't it. :)

10:01 PM  
Blogger Julie said...

The problem is, I think there IS something wrong with choosing a hospital birth, if the "choice" is the result of the cultural trend of disempowerment doulicia described. I know there are many good reasons for choosing a hospital birth, but so many women -- including myself, with my first baby -- don't even consider it a choice.

7:41 PM  
Blogger Kristy said...

And now, I'll join in (Julie is re-skinning my blog). This issue, as you know, has a thousand nails to hit upon. When I posted the CDC stats on my blog on the day they came out, a commenter told the story of how her OB just "couldn't have" watched the birth of her own child in the mirror. YIKES.

What I struggle with is the fact that this issue is just too *personal* for anyone to talk about objectively. You bring it up, and it automatically becomes an attack on "the other person's" choices. Which, of course, it is not. Until women can step outside their own experiences, no conversation, no cultural shift will take place "en masse".

6:59 AM  
Anonymous Anonymous said...

A little history: I've delivered naturally in a hospital setting twice. But my deliveries DID result in pelvic floor disorder (uterine prolapse). My mother was the same way. However my prolapse is not painful and I can live with it currently. What I wanted to share is a thought: perhaps some prolapse could be normal, much like sagging breasts after pregnancy and breastfeeding? Perhaps it is just a part of the aging process? My mother lived with hers for 30 years (without pessary) until she finally decided on a hysterectomy last year. I'm in the middle of making the hysterectomy decision for myself and as long as my prolapse is not causing me any discomfort or functional problems, I'm content with staying just the way nature chose me to be.

4:06 PM  

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