This is a re-release of an article I wrote several years ago. The majority of the information still applies to all interactive support groups on the web. When leaders from the ACOG community stand in front of a panel like the recent NIH VBAC Consensus Hearing and claim to be saving that “one baby” through repeat cesareans and setting an impossible standard that cannot be met for VBACs, this is what goes through my mind. The personal loss and horrible tragedy that touches all of those families that experienced cesareans without medical indication which caused more pain and agony than can ever be replaced or healed through unreasonable protocols and restrictions of women’s choices for healthy birth.
On the ICAN-online Yahoo Group we are often accused of ignoring the risks in order to achieve an experience. The reality is, we are all too aware of the risks we take. In our world, they have names. They are women we have lost or babies who have passed too quickly on. We mourn for our sisters and when the risks are named, we picture “uterine rupture” not as a medical condition but as the face of our losses and cold, still black and white photos of those we yearn to hold one more time.
This issue is dedicated to unnecessary cesareans and the reason for this article is to count the cost of when lightning strikes. The risks say, “.5% unless that uterine rupture happens to you, then the risk is 100%.” This sounds terrifying and so incredibly personal and we try to wipe it away with the glib idea that if we had to bet on getting run over by a bus, we would take the 99.5% every time. So the risk is placed on us and we live in fear of the risk, even as a background noise through a healthy pregnancy and delivery. We remember our sisters and fear somewhere in small recesses that it could happen to us.
And yet, lightning strikes are not without the storm. The lightning that struck Amanda and left her without her son would most likely not have happened without the failed induction that left her uterus damaged with a cesarean scar. This was not the random event one would like to think in order to have peace and it was not caused by the attempt at VBAC. The original damage was done by a cesarean she did not need. The face of medicine today reflects that we are often blaming the mother for her attempt at a ‘dangerous’ VBAC and yet we rarely see the medical providers rail at an unnecessary first cesarean that falls out of a failed induction or a big baby scare. We don’t see them out at the first sign of the storm, telling us to avoid the clouds and the severe weather. We only see them when they stand over us in the aftermath, asking us why we didn’t see the lightning coming.
Placental abruption, uterine rupture, hysterectomy. This lightning isn’t without cause. The studies show us that for every cesarean, the stillbirth rates double. We lose twice as many babies with the first cut, and four times as many with the second. What happens when we have mothers having three and four cesareans? We start taking them earlier at 39 weeks, raising their risks of early infant death in order to hopefully prevent those stillbirths. And not knowing where lightning will strike, VBAC plans and trial of labor is severely discouraged in order to protect the mother and this baby, without regard to the next. The storm continues building. Is sectioning every mother with a suspected big baby or early induction worth this? If the cesarean rate continues to grow beyond 50%, what does this say for the future safety of women or their babies? Can we then expect to return back to the days of expecting more losses than living children? Right now, we stand on the cusp. We see the maternal mortality rates rising and see ourselves losing multiple women in our communities such as New Jersey for the same medical emergencies arising from their cesareans and managed births. The doctors try to convince us that these are random strikes. That no one knows and they did the most they could do to get a healthy mother and healthy baby. One has to wonder if they are reading the same research or if they are simply trying to avoid taking responsibility for starting the cascade that continues to escalate and rob us of those things most precious to us.
This is dedicated to the ones we have lost…to Marcia and Logan, to Kimberly, to Deb and Fiona and to all the numerous others who blend into facelessness and pain simply because we fail to reduce the cesarean rate and stop the lightning from striking.
Originally printed in The Clarion, Summer 2008.