Wednesday, August 5, 2009

Random Ranting Post

When I was pregnant, I was always on Baby Center and the like reading up about what size fruit that may baby was, what was going on this week in the womb, etc. Well, I still get updates through some message boards from those days. I came across and interesting article while I was randomly looking at some of the messages for old times sake...see it below.

I suppose it just really hit home with me. Some of you know that I really did not like my bit. Mainly because they completely knocked me out and I was completely out of it for hours afterward, instead of enjoying first moments with my new little baby. After reading up on some things months after, I came to the conclusion that my cesarean was completely avoidable and unnecessary. In my eyes, many c-sections are unnecessary. I came to realize that you really have to advocate on your own behalf - doctors are motivated to perform c-sections for two main reasons in my mind...convenience and money. They can schedule you and 'take the baby' when it fits into their perfect little schedule - they don't have to miss their appointments at their office and they can be home by dinner. Also, they charge about three times as much for you to have a c-section and it takes a lot less time to perform the surgery. For me, the doctor was at my bedside in the labor delivery room at 4:14 and Tyler was born at literally took them 10 minutes to whisk me away from my room, get me in the OR, knock me out, and cut my baby out of me. Pretty amazing how quick it can happen...especially when you think about how long some other surgeries can take. It was a true emergency c-section when 4:14am on 2-29-08 rolled around...but the cascade of interventions began at my ob's office at 5:00pm the prior night. If I could go back in time and know then what I know now...things would have turned out differently. It's too bad that I spent my time reading up on how Tyler was the size of a grape an apple or a grapefruit rather than reading other more worthwhile material. But you just don't know at that point - you know? You are in pregnancy la-la land and your doctor is always going to do what is best for you right? You'd have no reason to assume otherwise. And in their minds they are.

And the sad thing is that there is an attitude out there of 'once a c-section, always a c-section.' If you don't want one the second time around, you might have a hard time finding someone to help you in that regard. I've read what the stats are on uterine rupture that people are always concerned about after a section...and I've heard of so many doctors that inflate the stats when they tell their patients. And I think that the excuses that Dr.'s use to coerce people into repeat sections are many times bunk as well...failure to progress, the 'big baby' card, or the 'you're too small to get the baby out' card. Many of these things can be overcome in fairly simple ways...but it might require a little patience and effort on the part of the doctor.

I could so relate to the part in the below article where the woman named Kayla was talking about her experience with Pitocin...that was SO what it was like with me. I was having horrible contractions every minute...I think at about 5cm. After discussing it with my new doctor, she said that I was probably having the contractions that you'd normally have at 10cm when I was only at 5cm. It made it pretty impossible to hold of on the epi at that point - which I wanted to as long as possible!

Anyways, this has turned into a horrible rant. Apologies! It's just a hot button with me, and I could probably seriously rant on like this for quite a while!

Here's the link to the article, and I copied and pasted it below, too.

Dr. Jan Christilaw was in the operating room the day a routine incision was made into a young mother's abdomen to deliver her baby.

What happened next, Christilaw says, "is something we never want to see."

Normally, the placenta separates from the wall of the uterus after birth. It's lacy almost, and not like solid tissue. "You can take your hands and sort of scoop it up, it's like breaking cobwebs as you go," says Christilaw, an obstetrician and president of B.C. Women's Hospital and Health Centre in Vancouver.

But the placenta had eroded through the wall of the uterus, a condition known as placenta accreta. As soon as they stretched the opening of the uterus to deliver the baby, "the placenta started bleeding everywhere," Christilaw says.

They couldn't get the bleeding to stop. The woman was losing two cups of blood every 30 seconds.

The only way to stop the bleeding was an emergency hysterectomy. The woman was in the operating room for eight hours and lost 15 litres of blood.

It used to be that obstetricians might only ever see one or two cases of placenta accreta in their lifetime. Although still rare, obstetricians across Canada say one of the most feared complications of pregnancy is increasing as a direct consequence of the nation's rising cesarean section rate.
Virtually all placenta accretas occur in women who have had a previous C-section, and the risk increases with each additional surgical delivery. The placenta attaches to the old C-section scar. Scars don't have a proper blood supply to feed a placenta, so it keeps burrowing into the uterus until it finds one, sometimes pushing through the uterus completely and into the bladder or other organs.

The condition can be detected by ultrasound, but not always. "You almost never see it in a woman who has not had a C-section," Christilaw says.

Today, about 28 per cent of babies born in Canada are delivered by caesarean. In 1969, Canada's rate was five per cent.

More than 78,000 caesarean sections were performed in Canada last year, making it the single most frequently performed surgery on Canadian women.

"We don't know what the ideal rate is," says Dr. Mark Walker, a high-risk obstetrician at the Ottawa Hospital and senior scientist with the Ottawa Hospital Research Institute. "I think it's fair to assume it's lower than where we are now."

Walker says changing demographics -- older first-time mothers, more multiple births from fertility treatments, more mothers with hypertension, diabetes, obesity and other health problems -- are not enough to explain an almost doubling in the C-section rate since the early 1990s.

Neither is there evidence to support the idea that women are seeking C-sections on demand. Studies from Ontario suggest less than one per cent of caesareans are for "maternal request."
The Society of Obstetricians and Gynaecologists of Canada says the vast majority of caesareans are done for medically valid reasons. But there are concerns that too many are being ordered because labour isn't progressing quickly enough, and that thousands of "routine" interventions are now being done that increase the odds of a woman needing a surgical birth.

What's more, the number of women who give birth vaginally after a previous C-section is dropping dramatically, meaning more and more women are having repeat C-sections.

Dr. Michael Klein calls it the industrialization of childbirth, where, in today's risk-averse society, women in labour are being treated "as an accident waiting to happen" and where doing something is always better than doing nothing.

"Physicians and society have helped women basically believe that childbirth is no longer a natural phenomenon, but an opportunity for things to go wrong," says Klein, emeritus professor in the departments of family practice and pediatrics at the University of British Columbia.
"But the fundamental issue is, we aren't improving outcomes by doing more C-sections. For the first time in Canada, we are seeing the key indicators for mothers and babies going in the wrong direction."

Risks to babies range from accidental lacerations when the surgeon cuts into the uterus, to neonatal respiratory distress. Research suggests two times as many babies born via C-section will end up in an incubator with water on their lungs, or with serious respiratory problems compared to babies delivered vaginally, because a C-section interferes with the normal hormonal and physiological changes associated with labour that prepare a baby to take its first breath.

Risks to women include higher risks of hemorrhage requiring a hysterectomy, major infections including blood infections, wound infections and bladder infections, and blood clots in the lungs -- and every C-section increases the risk for another.

"If you have a caesarean section for the first birth, the probability of having one the second time around is huge, because of the difficulty women have in getting a doctor to look after them once they have a uterine scar," Klein says.

The worry is that the scar will pull apart during labour, causing a uterine rupture.

"If you have a catastrophic rupture, you can get into big trouble," Christilaw says. "You can have a negative outcome for mom or baby. In severe situations, the baby can die or become damaged -- but that's a very rare outcome."

Her hospital is encouraging more VBACs -- vaginal births after caesarean -- in carefully selected women. "In those women who attempt a VBAC, our success rate is well over 80 per cent."
But less than one in five women in Canada with a previous C-section delivered vaginally in 2007-08. Eighty-two per cent had a subsequent C-section.

Christilaw says the only thing preventing Canada from seeing "horrific" complication rates from C-sections is the fact women are not having as many babies as they once did.

"A C-section can be a life-saving manoeuvre for a mother or baby. Nobody is saying differently," she says. "What we're trying to say to people is, a C-section is not a benign thing. If you need one, that's different. But you should not be doing this unless you absolutely have to."

C-sections are frequently the end result of a cascade of interventions that often starts with inductions.

Tens of thousands of women in Canada have their labours artificially induced every year, often via intravenous infusion of artificial oxytocin. Oxytocin is naturally produced by the human body. It's what creates contractions in labour. Today in Canada, one in five women who gives birth in hospital is induced.

What doctors fear are stillbirths. But alarmed by the rising rates of inductions, the Society of Obstetricians and Gynecologists of Canada recently urged doctors not to consider an induction until a woman is at least one week past her due date.

Claudia Villeneuve says that women are getting induced "if they're two, three, four days overdue."

"Inductions are rampant," says Villeneuve, president of the International Cesarean Awareness Network of Canada. "You have a perfectly normal mom who comes in with a perfectly normal baby, and now you put these powerful drugs into her system to force labour to start."

The "humane" thing is to offer an epidural, she says. With an epidural, a woman can't feel pain in the lower half of her body. But epidurals slow labour, sometimes so much that labour stops. "Now you have to get this baby out," Villeneuve says. Two-thirds of first-time C-sections are done for "failure to progress."

Klein says epidurals are too often given before active labour is established.
"The majority of women today get their epidurals in the parking lot."

Kayla Soares had been in mild labour at home for 24 hours when her contractions suddenly stopped. Doctors told the Edmonton mother she would have to be induced. She was three centimetres dilated when they started the oxytocin drip.

"It was the worst pain I've ever felt in the world," she remembers. "I wasn't having contractions at all and then they put me on the oxytocin and every half-hour they would boost it up, so the contractions were coming every minute, pretty much. It was like going from nothing to being in crazy, absolute labour, and in so much pain." Eleven hours later, she was still just three centimetres dilated. "That's when they said it was enough, and they were doing a C-section.
"I didn't want to do it. I was asking, could we just have more time?"

Three weeks later, she still couldn't get out of bed without help. Her incision had become infected. "It felt like I was ripping apart every time I moved. It was a pretty brutal recovery."
Soares had her second baby in June. "I was dead set on having a VBAC," a vaginal delivery after cesarean. "It was a fight, an uphill battle the whole time with doctors." One obstetrician asked her her shoe size. "She said that because I was a size five and smaller framed that I definitely was going to have another caesarean and that a VBAC wouldn't happen. She said that because I was a 'failure to progress' the first time I'll be a 'failure to progress again.'"

Two weeks before her daughter was born, Soares started going in and out of labour. "They had me convinced it was causing stress to the baby even though the tests said everything was fine. They had me convinced it was enough, because I was overdue and they said my incision was going to rupture," she says.

"They just kind of scared me into having another C-section."


Rachel said...

I totally agree with you Kristin. I was just lucky to have found a midwife...and for your next pregnancy you might consider one. They are SO patient and completely in support of your decisions. I was able to find one here in Phoenix that is just as sweet as the one I had in New York. The best part is that they deliver in the hospital so in case there are any complications then doctors are there to help. Anyway...I hope you get your VBAC and have a great experience with your next...which I hope is soon! :) :)

Kristin said...

LOL! Thanks Rach! I think I'm taking a breather before baby #2!!!

Actually, I did switch to a midwife for my first annual check after I had Tyler. She seems WONDERFUL. Just from the couple of nice conversations I've had with her, you can tell a HUGE difference.

I can't believe how big Owen is getting! I hope I can meet him someday!