labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Monday, January 14, 2008

Media Hype

I found this article interesting on the rising rates of cesarean sections in the US. Our Bodies, Our Blog initially drew my attention to it. I think it presents some interesting questions about how to proceed with research and clinical trials on c-section and vaginal birth. But the one thing that I want to talk about is maternal requested c-section.

Inevitably, maternal requested c-section gets cited as the reason for increasing the rates of surgical birth. And it's usually an obstetrician stating this. But, in fact, maternal requested c-section is quite rare. Yes, really. The media may lead us to believe differently, but it's generated by celebrity births (most recent celeb c-section was Christina Aguilera) that get big press. Oh, and if you want to guess who has had vaginal births, most likely it's the press reports that lack the mention of "c-section". Because, you know, they would never want to say that a celebrity gave birth vaginally.... that would be so un-cool to know that a celebrity in this day and age may have actually damaged her goods. Only heathens and us little people do that. But I digress....

Back to this maternal requested crap. For example, the Listening to Mothers II study reports that most women would not choose a c-section for no medical reason even if it were offered. I had also done a literature review for a previous course in school, and could not find evidence to support maternal requested c-section as reason for the increasing rate of surgical birth. (I'd post my actual paper, but don't know how to do this.... not to mention I am sure none of you want to read my 12 page article. Plus there is always the threat of plagiarism, because the paper is that good).

There are actual websites out there by obstetricians using the "it's your body, it's your choice" advertisement for their support and practice of c-sections by maternal request without medical cause. One such site has a picture of Britney Spears as the example of those ever-wise celebrities who always do the latest and greatest of everything. If you google "maternal requested c-section" you are bound to find them. I think there is also an organization of physicians that have joined forces and organized a coalition to "save" c-sections by choice. You have to register to get to any of their supporting data, and they also use the lure of celebrities. Because, you know, Britney makes a really good role model.


Anonymous said...

i was surprised to learn that Nicole Richie was fearful of birth, so she went to a hypnotist to help her over come her anxiety about the birth. AND had her baby girl vaginally.

i'm not a big fan of her, but it's awesome that she tried other things first to overcome her fear instead of opting for major surgery.

Anonymous said...

I have a new post at OBOS from yesterday that is also related to issues of research in birth. The question of randomization is a really interesting one to me, but your point about accurate categorization and identification is important as well.

I am a Monkey's Momma said...

And while these OB's are "fighting" to preserve maternal request cesareans, where are the OB's standing up to preserve maternal request VBAC's (or even vaginal birth in general)??

It kills me that the when "choice" is discussed among the obstetrical community, the only choice they are referring to is whether women should be able to elect unnecessary surgery or not. What about the flip side?

Labor Nurse said...

monkey momma- I totally agree. If these MDs are truly supporters of "choice", then why are they not allowing the FULL choice of options?

Anonymous said...

And, actually, I'd love to read your paper. :)

Cyndi Gross said...

There is so much fear that is attached to birth. Most of the stories that are told (friends, Family, TV, Movies, Media) are based on pain, torture and usually some major life-threatening complication. We have become such a “surgery society” that having a C-Section is now the "in" thing to do.

Women need to be educated on the realities of birth. I think if they heard (and saw) stories on what natural birth looks like, they might be less fearful. Maybe even empowered!

As far as the OB’s advertising C-Sections, they are only giving women what they are asking for. Let’s face it, C-Sections are much easier for the OB’s and more cost effective for the hospitals.

Unfortunately, it is not easier for the mom and the costs for her… have nothing to do with money.

CrazyRN said...

I've had 1 patient who requested a C/S in the 20 months I've been an OB nurse, but in her case, it was for a legit reason.

I think I'm very fortunate to work with a team of doctor's who try everything they can to have a woman birth vaginally, even after a previous C/S.

It seems as every time I watch a birth show on TV the majority of them are born via sections.

Labor Nurse said...

Cyndi, I have to disagree that c/s are cost effective. They are not; they cost almost twice that of a vaginal delivery. But I do agree that planned c/s are more convenient for MDs. They'll never schedule one in the middle of the night or a weekend!

Cyndi Gross said...

Labor Nurse,

Sorry, I meant more cost effective for the hospital and docs, not the patients.

There's more money to be made on C-Sections and extra days for recovery.

Jaime said...

I never understood someone who would want to have a c-section versus vaginal delivery.

I was told I would probably have a c-section with my last child due to the gestational diabetes and her size. I refused (and I got alot of pressure to change my mind, especially with being told the baby could be so large she could be harmed or killed if something went wrong).

In the end, she was smaller than two of my other children at birth that I had without gestational diabetes and she was born with ease.

Cyndi Gross said...

Labor Nurse,

Sorry, I meant that C-sections are more cost effective for doctors and hospitals. Not for the moms.

The cost for them (moms) has nothing to do with money.

AtYourCervix said...

I looked back at our surgical book for November, and found that we had 2 "officially recognized" elective primary c/sections listed. I was very curious to know who initiated them though - MD or patient. Not working on either case, I have no idea. I'm guessing it was the MD, because interestingly enough, it was the same MD who did both primary elective c/sections.

I have also heard about a patient recently who was to have a primary elective c/section for a history of uterine fibroids. She was in active labor, and as she screamed her baby out in the OR (vaginally), she yelled "who is responsible for me if my uterus ruptures????" No, it didn't rupture, but it was so ingrained in her by the MD that it "could" rupture, that she was so fearful of it happening.

AmyinMotown said...

Hi. I am a writer for Strollerderby and this blog I fascinating to me. I am due in a few weeks with my second baby, and I still remember how much the friendliness and professionalism of the labor nurses at the hospital where I had my daughter just meant the world to me. Hearing what it's like on the other side of the bed is fascinating!

Incidentally, I'm opting for a repeat C-section this time (the first time it was an emergency) and my doctor really refused to push me one way or another. I appreciated it, although I had SUCH a hard time making the decision I kind of wished he would have!! He reassured me about my chances to have a successful VBAC and when I opted to do a repeat c, reassured me about that as well. So some don't sleaze it up :-).

I'm going to link your blog for my Friday playdate. ( think, Babble will get you there anyway).

Labor Nurse said...

Cyndi, oh! In that case, yes it is more cost effective for doc's to do c-sections. They can be in and out, go to the office after and see more patients, and still go home at the end of the day. They'd make less having to sit around and wait for a baby to be born vaginally.

AmyinMotown, I've also seen doc's like yours. Unfortunately, I work with only one right now, and chose her as my gyn. I like the fair and balanced approach and appreciate when it's presented to me as such.

Unfortunately, I think what Jaime experienced isn't unusual. Some doc's don't realize that they may be inserting their bias (I've seen this in many nurses as well) when presenting "options" to their patients. But is it really a fair option when you tell the person that with option A risk is virtually eliminated whereas option B is so risky that if you chose it your baby will likely be maimed or killed. Now what mother in her right mind would chose option B if this were the only info she was getting?