No, Dr. Maiman this might not be a cause for celebration...

I have a problem with automatically celebrating declines in rates of caesareans without understanding why the decline happened, and whether or not there was any significant repercussion from the change. I have a problem with the assumption that vaginal birth is good, and caesarean birth is bad. I have a problem with a very superficial understanding of what is a very important health issue for both women and their children.

In short, I think the focus on caesarean rates is wholly detrimental to the health of women and their children. Which is why – I get annoyed by articles like this http://www.nlm.nih.gov/medlineplus/news/fullstory_144198.html - that trumpet the decline of first time caesareans as some kind of public health success story. It might be, but the disservice to women and their children, comes from the assumption that the road to better health and well-being goes straight through the birth canal.

The issue of birth – and the issue of planned caesarean versus planned vaginal birth, is complex, incredibly complex, and the focus on rates of caesarean over-simplifies it. The focus on the rates of caesareans, ignores many things that matter a great deal and deserve greater attention.

There are so many things that I’d like to know before considering whether or not the movement in caesarean rates is a good thing and off the top of my head here’s just a few things:

1. Was the decline in the rate of urgent/emergent caesareans or in the rate of planned caesareans?

2. Was the decline a result of a change in the demographics of women giving birth – for example were the moms younger, more likely to be a healthy weight at the start of their pregnancies, were they less likely to be gestationally diabetic, were they planning on larger families?

3. Were there more 3rd and 4th degree tears?

4. Were more moms suffering from incontinence a year after the birth?

5. Were there more low APGAR scores?

6. Were there more deaths?

7. Did more or less moms consider the births traumatic?

8. What happened to rates of post-partum depression and/or PTSD?

9. Were any moms who would choose caesarean denied access to their delivery method of choice?

It’s true that the risks of caesareans mount with the number of caesareans that are had – and for women planning large families it is important that they pursue the birth plan that gives them the best odds of success. However, I must strenuously disagree with the assertions made by Dr. Maiman in this article that “The risks to mother and baby are much higher in a caesarean birth than in a vaginal birth” and “Vaginal delivery is the preferred method for having a baby, Cesareans should only be resorted to when its absolutely necessary.”

Vaginal delivery is not the preferred method for delivering a baby for many women – particularly those who suffered adverse consequences that could have been avoided had they been delivered by caesarean. Further, it is very debateable as to whether or not the risks of caesarean are “much” higher for both mother and baby than a planned vaginal birth. There is some evidence http://www.ncbi.nlm.gov/pubmed/19941705 - that looked at 40,000 term deliveries from 1994-2002 and compared planned cesarean for breech with planned vaginal for cephalic and found the maternal morbidity (life-threatening) was similar in each group but that life-threatening neonatal morbiditiy was decreased in the pre-labour cesarean group.

However, as long as we’re focused on the headline cesarean rate, and lowering it, at what might be tremendous cost – we will never get to what really matters: the health and well-being of mothers and their babies.

Yes, cesarean mothers also give birth...

Language is powerful. The words we use can convey ideas, foster understanding and create new ideas. Words can also be used to exclude and to inflict harm on others. Words, aren’t just words – they are filled with meaning and are the primary tool that human’s use in social interactions with others.

Recently, I came across a tweet, although I’ve heard the same sentiment expressed elsewhere: “Cesarean mothers did not give birth.”

My immediate reaction is that this might be the dumbest sentiment that I have ever heard expressed, but also a kind of anger at the ideas that are implied by this sentiment. The idea that caesarean mothers are somehow lesser mothers than those who both planned, and managed to have vaginal deliveries. The idea that the only “real” birth is a vaginal birth. In this statement is a kind of backhanded insult to every woman who ultimately became a mother via caesarean – a kind of one-up-womanship that should be called out for the kind of garbage that it is.

Birth marks the end of a pregnancy – it is the process by which a woman becomes a mother, and hopefully emerges physically and psychologically healthy from with (ideally) a baby whose health has not been compromised by the process. The definition of birth bears no mention of mode of delivery because, frankly, mode of delivery is irrelevant to the definition.

A caesarean birth is not a “fake” birth, they do not issue “caesarean certificates” instead of “birth certificates”, they do not ask for “date of caesarean” instead of “date of birth”, and my kids both celebrate “birthdays” – regardless of how they were born.

Sometimes the things people say go beyond being stupid – it’s a shame though, that such silliness can hurt so many and that such silliness is often in an over-abundant supply.

While we're at it - bottle fed babies are also "fed", adoptive mothers are also "mothers" and stay-at-home moms and working moms equally love their children.

When Nurses make Medical Decisions Instead of Doctors and Patients...

I think I know what really happened in my case. It is disturbing.

The head nurse at Victoria General decided that elective cesarean for whatever reason deserved to have the lowest priority and to never actually get on the slate.

A health professional who I had never met, who I had never discussed my pregnancy with, who decided in her judgement that I was not deserving of respect for my medical wishes.

Where have I come up with this theory?

From an OBGYN nurse who frequents an online discussion forum who decided to comment on a thread I started for Cesarean by Choice Mothers. She declared that there was no way that an elective cesarean was available in Victoria and then indicated why.

According to Tikitorch at Kids in Victoria:

oh yeah who? i am an obgyn nurse and yes i have been on mat leave for the last 4 months but im sure nothing has changed... even if there was elective c sections, theres no way they would make it onto the slate that the head nurse puts in order of priority for the OR, anyone with any medical condition would be above that person.

BC medical does not pay for an elective ceseran section (*unless you had a previous c section, or a medical reason for it, for example active herpes, diabetes, macrosoma etc), so if in fact you found a doctor to do it for you, and the moon and sun aligned and you got on the OR slate, you would be financial responsible for it,.,

This should provide as a warning to mothers planning cesareans by choice at Victoria General - the head nurse will substitute her judgement for yours and your doctors.

Take Stock, Regroup, Just Keep Swimming

December was a personally rough month, as such it has been a while since I have blogged. Thankfully, there was a bit of a reprieve over the Christmas break and a few of the issues that were contributing to an overall feeling of being overwhelmed have been resolved and I have had some time to regain some perspective. Something that has been a channel for a lot of the anger I have over what happened and what I could do about it is looking untenable, and as a result I have been struggling. So I have needed to take stock, regroup, and move on.

On the stock front I have a lot to be immensely grateful for - I have a husband who I love. Between us we have four healthy children. We have stable jobs. We live in a beautiful city. I am immensely grateful that I have many good friends, and am immensely grateful to have met individuals who share a desire to change healthcare in British Columbia and Canada.

In terms of regrouping, I have made a commitment to myself to set aside an hour a day to exercise. I'm hopeful that it might be adequate to stave off some of the depression I seem to have developed. I'm hopeful it will give me time to think about how to move forward, and how to get closer to where I'd ultimately like to go. I'm hopeful that I can be a better wife and mother - and that I can find a better balance.

In terms of moving on - when one door closes, another may open. I'm hopeful I can do a decent job of identifying what those doors are and can have the courage and strength to walk through them.

All the best in 2014.