Wednesday, October 31, 2012

Cesarean by Choice Awareness Network - now on Facebook

A group has been established on Facebook for cesarean by choice moms, those who support cesarean by choice, those planning on becoming cesarean by choice and care providers who facilitate cesarean by choice. It is called "Cesarean by Choice Awareness Network", and can be found here. It's a closed group, meaning that only members can see what is posted in the group.

I'm hoping it'll be a place where moms and care providers can connect, share information, and work to improve awareness and respect for cesarean by choice.

Friday, October 26, 2012

A Shameful Culture

Shortly before the delivery of my son, my mother was recounting to me a conversation she had with a co-worker (while they were having a smoke break no-less) about the impending arrival of my son - the impending planned cesarean. My mother's coworker asked why a cesarean was planned, and when my mother told her co-worker that it was because it was what I wanted, her co-worker proceeded on a tirade of derogatory commentary about my birth choice. That I was a burden on the health system (that's rich coming from a woman who is on a smoke break). That women had been giving birth the way nature intended for thousands of years. That it was a real shame that I did not have confidence in my body and its ability to birth a baby. That vaginal birth was best for both mother and child and cesareans should be reserved only for those who "need" them. My mother found herself defending me, defending my choice - but more than that, defending my right to make such a choice in the first place, my right to determine what was done with my body.

I love my mom for standing up for me - as her co-worker is not some rarity. I have become far too familiar and tired with such sentiments. I spent my first pregnancy defending my choice only to have my right to choose violated, and my second pregnancy in dread that my right to choose would be violated again.

There is something that is deeply wrong about the culture surrounding birth in Canada today. It is a culture that says that it is okay to criticize the legitimate choices of others. It is a culture of fear. It is a culture of competition. It is a culture that shames women for choosing cesarean. It is a culture that shames women for choosing pain relief. It is a culture that preaches empowerment from a bodily function. It is a culture that legitimizes the denial of choice and access to modern medical technology and the most qualified care providers.

It is a culture that tells women to be proud of vaginally delivering their children and to be proud of rejecting pain relief in the process of doing doing so - it is also a culture that tells women who deliver by cesarean or with the use of epidurals that they are somehow failures or lesser women.

It is perverse and filled with misplaced pride.

I have no shame about the cesarean birth of my son. It was an informed choice. It was a safe choice. It was the choice that best met my needs and those of my baby. I am no less a woman for having had a cesarean. I am proud that I was enabled to make an informed choice about the healthcare I received - one which enabled the healthy and safe arrival of my son. I am proud of my health care providers for giving me excellent care, and for respecting, supporting and enabling my choice with regards to the delivery of my son.

Women who choose cesarean have nothing to be ashamed about, and its time we quit thinking that they do.

Saturday, October 20, 2012

Avoiding Birth Trauma: A Laudable Goal

Those that regularly read this blog, know that I do not think much about using rates of cesarean as a measure of quality for maternity care. Yet many health administrators and policy analysts seem to think that lowering the rate of cesareans is a laudable goal. In the more than two years since my daughter was born, I have come to know just how misguided this goal really is - and believe that it is time that quality in maternity care was measured differently.

Birth trauma is a negative outcome of the birth process - one that could and should be avoided in many cases.

Having read the accounts of women who have been traumatized by birth, in addition to my own experience, it is clear that birth trauma is not caused by the mode of delivery. There are women who have vaginal deliveries and are traumatized. There are women who have cesareans and are traumatized. There are women who have vaginal deliveries and are not traumatized. There are women who have cesareans and are not traumatized.

Birth trauma is also not caused by the location of delivery. There are women who are traumatized by home birth. There are women who are traumatized by hospital birth. There are women who are not traumatized by home birth. There are women who are not traumatized by hospital birth.

Further, birth trauma is not caused by the choice of care provider. There are women who have midwives and experience birth trauma. There are women who have doctors or obstetricians and experience birth trauma. Further there are women who have midwives or doctors or obstetricians who do not experience birth trauma.

Also having read the accounts of women traumatized by birth, in addition to my own experience - the impacts are lasting and wide ranging. There are women who would like more children, who choose to forego additional pregnancies. There are women who having had a negative experience in one pregnancy, make risky choices in subsequent pregnancies in the hopes of avoiding a repeat experience. There are women who experience excessive anxiety in their subsequent pregnancies. There are women who suffer from post-partum depression and post-natal post traumatic stress disorder - many of whom suffer in silence. Some women who experience traumatic births are left with lasting physical repercussions for either themselves or their children.

Despite the significance of traumatic birth experiences, for women, their children and their families - it largely goes unmeasured. As a result it remains poorly understood and stigmatized.

Would it not be better to measure things that actually gauge quality care than to monitor a measure because it is easy and pretending that it has anything to do with quality?

Sunday, October 14, 2012

Is the patient perspective lacking?

This morning while the boy napped and my daughter burned off some toddler energy (which if it could be harnessed would solve all of the world's energy problems) by bouncing on her Rody while watching cartoons - I read a story in the Times Colonist bemoaning the rates of mastectomy versus lumpectomy it reminded me a lot of the bemoaning that goes on with respect to cesarean sections. Many of the surgeries are labelled as 'unneccessary' - however in both the case of cesareans and mastectomies patients are making decisions prospectively and outcomes are only known retrospectively.

In both cases I wonder if a better understanding of the patient perspective is needed to better assess why a more aggressive treatment is preferred over what is considered a more conservative treatment with equal or better outcomes?

Further, if patients are freely choosing these more aggressive treatments, what are they gaining over the more conservative options? Lastly, if these surgeries are a result of patient choice, should they be bemoaned as unneccessary?

The challenge is that the information in the system is limited to what was actually done and lacks information from the patient and provider perspective on why what was done was done. This leads armchair policy analysts and some health system administrators to conclude that there is waste in the system caused by 'unneccessary procedures' (there is waste in the system, but I for one am not convinced that it is caused by people undergoing 'unneccessary' procedures).

Being a patient who would have undergone what some would consider an unneccessary cesarean for the birth of my daughter and did undergo a cesarean for the recent birth of my son, I feel very strongly that care decisions should be 'patient centered and patient driven' and not 'guideline driven'. I worry that the labeling of some procedures as 'unneccessary' without complete information - in particular without either patient or provider information on why the procedure was undertaken and their satisfaction with the outcome - may result in some patients being forced into treatments that are different from that which they would freely choose for themselves (in consultation with their care providers) - and may result in less patient satisfaction and poorer outcomes than could otherwise be achieved.

We owe it to the healthcare system and the patients it serves to refrain from jumping to the conclusion that certain procedures are unneccessary and to improve upon the information available to better understand why certain treatment decisions are made in the first place. To do otherwise is to risk creating a 'health system centered' model of care.

Sunday, October 7, 2012

Are women, babies on Vancouver Island still facing inadequate access?

I've been under a bit of a proverbial rock over the last couple of months - first preparing for the arrival of baby W and then in the sleep deprived after-glow of the first few weeks of life with a newborn.

This past week I have gotten around to reading the defenses that have been filed with regards to the litigation I have decided to pursue with respect to my daughter's 2010 birth. The health authority claims access was available but not exercised by my physicians (a deprivation of patient autonomy). My physicians claim that access to the needed resources was not available, and that use of the back-up anaesthesiologist was limited to "life and limb" emergencies (a deprivation of access to medical services). There's also a sprinkling of blame the victim and inconsistencies of facts. Next stop examinations for discovery.

I also came across this news article which indicates that reports of dedicated obstetric anaesthesiology (DOBA) may have been premature. It would appear that women giving birth at Victoria General are still facing challenges accessing the services of anesthesiologists when they need them as those resources are frequently called upon to provide care to other emergent patients.

Timely access to anesthesiologists should Be a given, and an adequately resourced system should be able to provide for the needs of pregnant women AND other patients. It is deeply concerning that it appears that the problem persists.