"Just don't think about it, Honey, and you'll be okay!"

I recently attended one of my doula client's prenatal visits with her obstetrician.

She had been telling me about her obstetrician for several months. "I like her," she would say. "She seems open-minded and willing to work with me and respect my wishes... but I'm just not sure if she's just stringing me along or not...."

Over all, most of the reports about her doctor sounded pretty good. She did say a couple things about her that concerned me. For one, the doctor couldn't really remember exactly what her c-section rate was, but she assured the patient that it was "pretty low" and definitely not higher than the other obstetricians in the practice because she only does them "when necessary."

I agreed to come along to a routine prenatal visit and meet her doctor. My client wanted me to tell her what my impression of her doc was afterwards.

I was liking her doctor a lot.
She was saying lots of good things, answering questions openly and took plenty of time to discuss anything my client brought up.

And then my client again brought up c-sections. "You know, Dr. Smith," she said earnestly. "I just don't want a c-section with this baby. I'm counting on you to do everything you can to make sure that doesn't happen to me. Surgery just freaks me out and I don't want end up there... I'm trying to get myself educated so that I know about the risks and benefits of various things and can know what is most likely to make a c-section happen. Is there anything I can do to help prevent myself from becoming a c-section statistic?"

Dr. Smith smiled. "Oh, honey! Don't worry yourself about having a c-section! There's only one good way to deal with that fear of becoming a c-section statistic -- Just don't think about it!
You probably won't have one, and if you end up with a c-section, you can just know that it was necessary and you can be happy that you and your baby are healthy!"

Dr. Smith turned back to charting, but my mind was spinning.

Her best advice on avoiding a cesarean section? Just don't think about it!

I wonder how many other docs give this advice to nervous couples expecting their first baby?

Frank Conversations on Cesareans

Most of the “risk” that we hear discussed for Cesarean section includes the possibility of

~post-operative infection,

~blood clots,

~anesthesia complications,

~damage to the bladder and bowels,

~potential problems with future pregnancies like infertility, miscarriage, placenta accreta

and placenta praevia

~and in some rare cases, even death.

Yet, few obstetricians really cover these potential complications in a way that will give a birthing mother a realistic view of what all her C-section could entail – a whole lot more than her idea of “I’ll be kind of sore for a few days or weeks.”

A friend of mine who recently had an elective cesarean developed blood clots afterwards and was shocked to hear that they could have been a result of how she chose to have her baby. Of course, she could have read up on the potential complications and figured that out herself ahead of time, but really, physicians should either thoroughly inform their patients themselves or see to it that they are reading books and doing research and getting informed during their pregnancies. And more than just reading, “What To Expect When You’re Expecting” or watching birth stories on TV.

Sure, of course, the anesthesiologist comes in and rattles off the usual, “you could die, be permanently paralyzed, etc.” stuff as the laboring mother is doing her best to hold herself together and prepare for the long ride down the hall to the OR, wondering if her baby will be okay. Of course, she nods and says she understands and scribbles her name on the paper in between contractions. But does she really understand what she’s signing up for?

That’s what I wonder. What kind of conversations do doctors have with their pregnant patients about the possibilities of a cesarean? …Not only that it could happen to them for various reasons (some good and some not so good), but that by simply having a cesarean, they are increasing their risk for many more complications.

Do they have frank conversations with their patients about weighing risks and benefits of a cesarean for a non-life threatening issue that comes up in labor (i.e. labor isn’t happening as fast as usual) if they are planning to have more children in the future? Or do they just imply that, “If you end up with a cesarean, trust me, it will be for a good reason to make sure you have a live, healthy baby. Vaginal births are great, but don’t get your hopes too high. You don’t want to be disappointed if it doesn’t work, because, really, your goal is a healthy baby, not how you have your baby.”

What Are the Risks of Cesarean Section?

What are the risks of having a Cesarean section? …The risk of having two, even three C-sections? …For the mother, for the baby?

What are the risks of vaginal birth? …For the mother, for the baby?

If you are the typical American woman wondering about these questions, you’ll probably ask your doctor, perhaps check out a few resources online and see what the most popular pregnancy guide book, What to Expect When You’re Expecting has to say. You might even ask your childbirth educator about c-sections, and she would probably help you feel more prepared for it, by explaining when it is likely to happen and how you may feel about it if/when it happens to you.

Hearing women talk about cesareans has often made me wonder exactly what the average pregnant woman does and doesn’t know about having a c-section when she walks into the hospital to give birth. I’m on a mission to find out…

Is she adequately informed of the risks? Does she have a clear idea of the risks and benefits? Does she know as much about this procedure on her and her baby’s body as she does about purchasing her new car and comparing models?

I checked out What to Expect When You’re Expecting, and no where in its 437 pages could I find even one paragraph informing mothers of the potential risks for themselves when undergoing Cesarean delivery. The most I found for mothers was information on what a C-section would be like and how to be calm as you were wheeled back to the operating room for an emergency c-section, and then what recovery would entail – pain around the incision, possibly nausea and vomiting, possibly referred shoulder pain for a few hours and possible constipation, then it should be 4-6 weeks before you feel completely back to normal.

And this quote to put everyone’s fears to rest –

Question: “My doctor told me I will have to have a cesarean. But I’m afraid the surgery will be dangerous.”

Answer: “Today…cesareans are nearly as safe as vaginal deliveries for the mother, and in difficult deliveries or when there’s fetal distress, they are often the safest mode of delivery for the baby. Even though its technically called major surgery, a cesarean carries relatively minor risks – much closer to those of a tonsillectomy than of a gall bladder operation, for instance.”

Hmmmm…I’ve heard a few other things about cesareans recently. I’ll post them here as I get a chance…

Physician Liability

I heard Dr. Marsden Wagner, a perinatologist and former director of Women's and Childrens' Health for the World Health Organization (WHO) talk about liability risks for obstetricians who are finding themselves getting sued every time someone doesn't end up with a perfect baby.

Dr. Wagner made a statement that I will never forget. He said,

"If you're going to play God in the delivery room, you're going to get blamed for natural disasters."

Herein I believe, lies the biggest solution to our liability crisis. Doctors have led people to believe that they are "God" and if their patients will only come to the hospital where things are "safe" and where the "best medicine in the world" can take care of them, they can sit back and relax and wait for the doctor to produce a pink, squalling baby.

People are no longer being good healthcare consumers. It is implied at their very first visit that the doctor is in completely in control of everything that could happen and has a drug for every problem at his/her disposal and the eventual outcome will be secured if the doctor is allowed to "work their magic."

"So, honey, hop right up here on the exam table and put this paper gown on... We'll take a peek and tell you exactly what is happening inside you..."

Of course, people are angry and disillusioned when they obeyed all the rules, and did things the "safe" way - only to end up with this - a damaged or dead baby.

What is the solution?

The solution is better informed consumers. It's partly the health care system's fault and it's partly our own fault as consumers if we don't "read the labels" on what we're ordering.