– January 15, 2010
Of the five friends I have who delivered their babies at Royal Columbian Hospital, four of us had 30+ hour labours ending in emergency Cesarean sections. I have wondered how it could be that four out of five young, healthy women could all have so much trouble delivering our babies naturally that we would need our babies cut out of our bodies.
In the time following my own C-section I assumed it must be simply selection bias – we five weren’t necessarily representative of the general birthing population at Royal Columbian. Yet when I came across the Fraser Institute’s hospital report card, it resurrected the concern that too many births are ending with C-sections at RCH. According to previously private data the Fraser Institute unearthed through a Freedom of Information request, more than a third of mothers birthing at Royal Columbian delivered by Cesarean in 2007 and more than 80% of women who have had C-sections repeated the surgery to have their next babies. You can see that between 2001 and 2007 the rate of Cesareans at Royal Columbian has gone up to 32% from a low of 28%, and the VBAC rate (vaginal birth after Cesarean) has gone down from a high of 23% to only 18% .
This isn’t a problem only at RCH. About 30% of all births in B.C. were by C-section in 2007, and the VBAC rate was just 16.4%.
The World Health Organization says the C-section rate for any country need not be higher than 15%. Given that we have a publicly funded (and struggling) health system, the fact that we are seeing more than twice the recommended Cesarean rate is cause for economic as well as health concern. Among the long list of reasons to be concerned about the increase in C-sections on childbirth.org is this little factoid: “A cesarean costs nearly twice as much as a vaginal birth ($7,186 average vs. $4,334 average in 1989 in the US). It has been estimated that in Quebec, Canada, if the current rate of cesareans (18.8%) were reduced to that of Finland (11.9%), costs incurred by the provincial health care system could be reduced approximately $19 million per year.” Yowza.
In my first interview with the OB/GYN while I was pregnant, I asked all the questions recommended by my library of books: what is the C-section rate, what were their opinions on a variety of interventions, and other questions designed to get a sense of their level of support for a ‘natural’ birth. I had signed on with a team of six doctors, at my family doc’s behest, and each time I met a new one, I asked the same questions. Everyone responded that they would only use interventions and offer pain relief if ‘necessary.’ As I later discovered, ‘necessary’ is a matter of opinion.
Like many young women, I had assumed with my first pregnancy that I was at low risk for major complications. I had an easy pregnancy. I was only 25 and generally healthy. I had endured jokes about having “childbearing hips” more times than I could count. So I skipped the chapter on Cesareans in What to Expect When You’re Expecting. I spent the part of my birth preparation class that covered C-sections fantasizing about the relatively effortless and even pleasurable home births I had read about on the Internet. Labour was hard and long, but I had read almost every book for new mothers in the New Westminster Public Library (and a few more I ordered from Amazon), so I was expecting that. As my labour lengthened, I heard the empty ward begin to fill with other mothers’ cries followed by their babies’. My doctor kept going home. I laboured with little guidance from the nurses, grateful for my husband’s stalwart support.
My son was born after about 30 hours of labour followed by what I have learned is a textbook cascade of intervention: gas for the pain, doctor breaking the water to try to hurry the birth, followed by an epidural, hours of fruitless pushing and then an emergency C-section when we discovered the baby was poorly positioned. It’s possible that the outcome could have been the same had I been encouraged to labour in my own time with more support from my care provider. The experience of the birth of my daughter makes me wonder, however.
Those who follow me on Facebook or Twitter know that my second baby’s birth was ‘a triumphant VBAC’ (as my midwife Tracy Simpson described it on the Mama Love Midwifery Facebook page). It was a very short labour, also at Royal Columbian, and ended in the natural, medication-free birth I had so wanted with my first.
The midwife made all the difference. At least twice in my four hours labouring at the hospital, the OB on staff said he wanted to prep the OR for a repeat Caesarean. At one point the baby actually went back up the birth canal before the water broke, causing an increased risk of the umbilical cord wrapping around her neck. The OB wanted to send me for the C-section then, but the midwife recommended a controlled breaking of the waters, in which the OB carefully punctures the water sac and guides the baby down to ensure the cord doesn’t wrap around her neck. Then, towards the end, my baby’s heart rate dropped and although the OB would have recommended emergency surgery, my midwife wanted to give me the chance to push her out. With her support, I did, and my baby was born healthy and beautiful. I felt great. Tracey gave instructions at the hospital that I could leave after the required six hours of monitoring, as soon as I felt ready to go. Will and I brought baby Nora home in time for lunch!
In the end, neither birth was intervention-free. The difference was in how ‘necessary’ was defined, and how each care provider judged what level of intervention was required. With my first birth, I felt like everyone was just waiting to see how long it would take for me to give in. That’s probably not what they intended, but it is how I felt. The second time around I got scared, and my resolve began to waver. Instead of asking if I wanted drugs or taking my fear as a sign that I couldn’t do it, my midwife urged me to be strong and fight for the birth I wanted.
So, having now experienced both a Cesarean and a vaginal birth, an OB and a midwife, I have a few pieces of advice for expecting moms in New West:
- Seek out a midwife for the best chance at a low-intervention birth. Most doctors pop in and out for periodic checks until you’re ready to push or something goes wrong. Midwives will stay with you throughout your labour, lending support as necessary. Start looking as soon as you know you’re pregnant. Midwives are in such demand now that it can be difficult to find one who is accepting patients.
- If you’ve had a previous C-section, try a VBAC. The success rate is about 75%, so there are good odds that you will succeed. While the C-section itself is less painful than pushing out a baby, when the anesthetic wears off, the recovery is weeks-long instead of days. The postpartum experience is so different … I felt battered the first time, but euphoric after the VBAC. Also, with every repeat C-section, your risk of major complications with future pregnancies increases (important if you think you may want more kids).
- Throw out the birth plan. A piece of paper won’t matter during labour. You’ll have more success by putting your effort into choosing a care provider and support people who you can be sure will lend you the strength to have the best birth possible.
- Question your doctor. Don’t just ask if something is really necessary. Ask what will happen if it doesn’t get done, if you can try something less invasive or if you can delay just a little longer. Sometimes babies just need a little more time and we all should be a little more patient.
- If you do have a C-section, you are not alone. Once you start talking about it, you’ll probably discover a shocking number of others who have too. It’s also very common for women who have C-sections to feel sad or angry about the birth experience. It’s totally normal.
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