21 July 2011

C is for CYA

As I was driving into the hospital the other day, I heard a story on Public Radio International about the sky rocketing rates of Cesarean sections in the developing world. Now on the surface this might seem like a good thing. Mightn't it be that women who would have otherwise died in childbirth and infants who might have suffered birth trauma without intervention, are instead surviving the complicated process of delivery unscathed?

Except this doesn't seem to be the case. Instead, women are choosing surgical rather than vaginal deliveries because of the convenience of being able to schedule their child's birth. This in turn means that other women, those who need emergent sections, do not always have access to the limited OR space their countries' doctors have at their disposal.

Doctors in the U.S. seem to be similarly guilty of failing to balk this trend, with rates of C-section quoted at 34% of pregnancies in 2009.

Now there is a saying amongst my OB friends that the likelihood of C-section rises proportionately to the length of the expectant mother's birth plan. The message here being that the more things you try to control, the less likely you are to be able to control anything. So I kept my own birth plan short when it came time to evict Emmaline from her warm and watery first home. I printed an article from NeuroReport that suggested that profanity increases ones ability to tolerate pain and I scribbled BIRTH PLAN across the top of the first page. I thought it might be funny, but it turns out I was too busy swearing to show it to anyone.

Ultimately, though, Emmaline's heart rate dropped to 40 and they whisked me away to the OR. She emerged, screaming and vigorous, while I was in a fuzzy haze of fentanyl.

"At least you didn't actually have to have her," was the take of the childless chain smoker in the condo next to ours, as if having your abdomen cut open and put back together again is not major surgery.

But it is. It is surgery. You wouldn't have your kidney taken out or a biopsy done of your liver if you didn't really need it, would you? So why have a C-section if you are lucky enough to be able to deliver the way Darwin intended, with lots of pushing and a few F bombs thrown in for good measure?

"Whenever you have to take her, take her," I said to my OB, granting her permission to act on the dwindling heart rate we were both following on the fetal monitor. But I know that what she heard could very well have been "get her out safely or I will sue." That's the world we live in. But maybe it shouldn't be. Maybe we should all think a little longer about going under the scalpel.

And when it comes time to give Em a brother or sister, here's hoping I manage to remember that myself.

1 comment:

  1. if you listen to the full story from PRI, it's not necessarily the women in developing countries requesting the c-sections. it's actually the doctors at these private clinics essentially pushing the women into them. but still the same outcome. but i completely agree. choosing to have surgery when it may not be necessary seems a little crazy to me.