Unecessary Cesareans

So, not the most pleasant way to start out our new year, but our national Cesarean Section rate is somewhere around 29%, possibly even higher now, given that this data was from 2004, and we’re still awaiting the final tallies from 2005 at this point. To quote Marion Toepke McLean from her article Cesarean on Maternal Request in this month’s issue of Midwifery Today: “For the woman with complete placenta previa, or the woman who, for whatever reason, needs to give birth abdominally as the lifesaving or safer course, I can recommend cesarean. But 29% of birthing women do not fall into this category”. (emphasis mine…and speaking of doctors opinions and policies…or lack thereof…on cesareans on maternal request, check out Womens Health News.)

Obviously, other people feel similarly, and in a landmark case decided in Massachusetts, a court ruled in favor of the plaintiff, Mary Meador, a woman who gave birth via cesarean section and claimed that the risks of VBAC were misrepresented to her and that she was coerced and misled into having a cesarean—so, basically suing for receiving an unecessary cesarean section. (Editor’s note 1/6/07: It has come to my attention that this case is from 1993, so not really landmark these days, although it’s nice to know a precedent like this exists. I wish it had made more of an impact.)

One has only to look at womens’ responses to cesareans that they know are unecessary to see how destructive and devastating this practice can be. How can anyone think that coercion qualifies as informed consent? What amount of pain and anguish can lead to art like this?

In my practice as a nurse, I cannot tell you how many times I’ve seen a cesarean performed for no good reason at all: for provider preference, because he or she wanted to go to sleep, or get to their office hours on time, or because of provider ignorance. Just last night at work, I was with a woman who was moderately preeclamptic with increasing amounts of protein in her urine (an ominous sign). I agreed with the obstetrician’s decision to deliver this baby immediately, but because her baby was breech, she was told that cesarean was her only option, end of story, sign on the dotted line, please. No informed consent, no weighing of the benefits and risks of induction and breech delivery versus cesarean. Forget the fact that this was her fourth baby, and that her first three babies were all uncomplicated vaginal deliveries. Forget the fact that she had a “tested” pelvis that was more than adequate to accomodate her baby (a tiny little peanut that ended up weighing 6 lbs. 8 oz.). Because of lack of provider skill, because of lack of provider education, because breech deliveries are so rarely performed any more, by any one, this woman had a primary cesarean.

Cesarean is increasingly becoming the correct response to any birth that deviates even slightly from “normal”. Cesarean is nine times out of ten (the Meador v. Stahler and Gheridian case aside) the trump card that will stand up to court scrutiny. Doctors are so concerned about not doing a cesaeran that it’s very easy to forget the other angle to it: cesareans are major abdominal surgery, with more risks associated with it than vaginal birth. Imagine what our world would be like if doctors felt more strongly about the possibility of being sued not for failing to do a cesarean, but for performing a cesarean that was unecessary? Imagine how much longer trials of labor would last, how much higher our VBAC rate would be, how much more time women who are being induced would be given to allow their bodies to go into labor. Imagine the increased time and attention that would be spent with true informed consent, and the weighing of options? Imagine how much lower our cesarean section rate would be.

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