BirthCut

A few weeks ago, I was interviewed by a journalism student for an article she was writing on cesarean sections. While it does contain a few typos and some inconsistencies with my actual story, overall it is a good article and thought I would share it here.

Michele Demont opened her eyes and had no idea where she was. Looking around the poorly lit room, she saw all sorts of medical equipment blinking and beeping at her. The smell of disinfectant filled the air. As she tried to sit up to orient herself, a blinding pain cut through her torso, forcing her back onto her bed. Lifting the stiff hospital sheets, Michele looked down to see cold metal staples holding her stomach closed in a raw red line across her midriff. She heard a noise to her right and looked to see a nurse moving towards her, holding a wriggling, faceless newborn out to Michele. As she opened her mouth to scream…she woke up, in her own bed.

Michele had been having nightmares like this since she had her first child a couple months ago. During the day, too, her mind kept drifting back to the hospital. Less than ten weeks ago, she was racing to the southeastern Connecticut hospital and everything seemed to be moving too fast until she was admitted. And then it turned into a waiting game. “I was a month overdue,” remembered Michele, “but I was induced before I was ready, and my son was facing the wrong way, and I wasn’t given time.” So Michele, who was anxious and exhausted, consented to having a cesarean section.

During the procedure, Michele had little idea what was going on, and felt at a loss when it was over. “I didn’t see my son’s face until three hours after the birth. They put his face next to mine and three seconds later they yanked him away,” said Michele. “When they brought him back to me in my hospital room hours later, I hadn’t seen him for more than thirty seconds.”

Months after, this feeling of disconnect to her baby, Mason, and restlessness still plagued Michele daily. “It didn’t really hit until I got home from the hospital, when things got back to normal again,” she said. “There was a feeling something was wrong and I couldn’t pin point it at first. I felt something was missing.”

Michele isn’t the only woman feeling this way. Across the country in town halls and on the internet, women are voicing their “cesarean rage.” As c-section rates continue to rise, women are beginning to demand why. Many of them feel these c-sections are pushed upon them and that there is a lack of communication and agency in hospital settings. However, doctors argue that these surgeries are safer for delivering the baby and often prevent malpractice suits. If these women push to change legislation and make cesarean sections less common, will hospitals and doctors suffer?

Over the past two decades, cesarean section rates have continually risen. According to the American College of Obstetrics and Gynecologists, the rate of cesarean sections has risen to 31.8%, over 300,000 more c-sections than seven years ago. Doctors, like Dr. William Schweizer of New York University’s Langone Medical Center, argue that the c-section rates continue to rise, because of malpractice suits over the infant’s health. “The cesarean section rate has a lot to do with malpractice,” he said. “The fetal and maternal complications that can arise from a delivery with forceps are often greater than those associated with cesarean sections in a world of bloodbanking and sterile operating techniques.”

Cesarean sections have an added layer of complication to them. Until recently, vaginal births after cesarean sections, or VBACs, were rarely performed. Doctors believed that the complications that led to the initial c-section and the scars resulting from that surgery would make a successful vaginal birth impossible. “When VBACs were first thought about,” said Dr. Schweizer, “there was a saying, ‘Once a cesarean, always cesarean.” However, in 2004, the American College of Obstetricians and Gynecologists (ACOG) changed this position. With the advances in technology and cesarean procedures, VBACs could be performed as long as the obstetrician and an anesthesiologist were present for the delivery.

This is where much of the controversy is stemming from. Women are arguing that doctors are not giving them the birthing choices now available to them. “It’s the woman’s body and she should have a choice,” argued Michele. “She shouldn’t have to have unnecessary surgeries. Overtime the path may change and people will see it as a woman’s right to choose.” Despite the sanctioning of VBACs, c-section rates are continuing to rise. And while some may see it as a lack of choice in hospitals, there are other contributing factors and changing trends in the birthing world that make more VBACs impossible and more c-sections necessary. According to the Center for Disease Control, the percentage of births delivered by cesarean section was 60% in 2000 and increased to almost 80% by 2006, more than twice as high for single births. Also, the older a woman is and the more cesarean sections she’s already had increase the necessity for another cesarean section. According to Dr. Schwiezer, “The whole idea is you need to weigh what are the risks and the benefits for the patient and for society.”

However, Michele was not too old nor had had previous c-sections or problems giving birth previously nor was having twins. “My doctor told me my pelvis was too small,” said Michele, “and my son was too big for me.” Three years after having Mason, who weighed 8 pounds 7 ounces and was 20 ½ inches long at birth, Michele had her second child, Hannah, who was 7 ounces heavier and a little taller than her older brother. And Michele had her naturally.

When Michele found out she was pregnant, she was determined to be better prepared than she was for her first delivery. While her first choice was to give birth at a birth center, when Michele found out they would not support her VBAC, she turned to a midwife. “She came to my house for all of the appointments and would stay and talk for as long as two hours and we built a friendship,” said Michele. “I’m glad I went with the home birth, because I had supportive people around me and I felt in control.”

This sense of control and agency is what many women find lacking in hospitals. Michele soon found this out through her website, BirthCut.com. She created it while recovering from her c-section. “It’s a place where not only women but men also where they can share their stories,” said Michele, “and help in the healing process and have their stories be heard.”

Sites like Michele’s have begun popping up in huge numbers. CesareanArt.org and BirthTruth.com are two of the most visited, while the International Cesarean Awareness Network (ICAN) holds both online forums and real-world support groups. “I posted my birth story on a blog and people started commenting on it,” said Michele, “and I realized this is normal and I can actually talk to these people and not feel weird.” It was here that she found the real problem: the lack of agency or power for the patients. Thinking back on how little information she received before and during her cesarean section, Michele said, “Of course theres a time and a place for interventions, but a lot of the time it’s overkill. If you’re a hammer, everything you see’s a nail. Doctors try to fix something and if it’s not broken the intervention causes more problems than it solves.”

Women like Michele and the members of ICAN hope to change not only the way patients are viewed in hospital settings, but also legislation that will not make it so easy for doctors to choose cesarean sections over vaginal births. “I know a lot of other birth advocates that are head of organizations,” said Michele, “and I’m actually partnering up with iCare Connecticut to try and lower the c-section rates and change the way of birth in the stat. Little by little I’m getting myself out there and I hope it continues.”

And little by little, things are changing. At Langone Medical Center, for instance, Dr. Schweizer is practicing what Michele preaches. “I really cannot stress the fact enough that the doctor-patient relationship is important,” said Dr. Schweizer. “As for being too medicalized, there are real risks that can happen with birth and we can’t forget that maternal morbidity rates are high in other parts of the world. In the United States, no maternal death is acceptable.”

As for what the consequences of Michele’s actions may be, one can only wait and see. Hopefully, more doctors will take a similar stance to Dr. Schweizer’s and give more agency and power to the patients. And, hopefully, Michele’s and other’s plan will not backfire, situating doctors between the law restricting c-sections and between lawsuits demanding them. This overwhelming sadness I felt lasted awhile. I would go over in my head what I could have done differently. I felt like anxious and I had a hard time falling asleep even though I was exhausted. I was thinking about it every day at least and then after that I found other women like me who turned more into anger. I turned negative feelings into positive things, like meeting other women like me and birth advocacy. And I’m 100% positive I wouldn’t have had my home birth if it hadn’t been for my c-section.”