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Monday
Apr122010

(Introducing) CesareanScar.com

(Same url, but the site was changed to a bloggier format; much nicer and easier to maneuver.) 

 A few days ago, the cesarean rates for California came out. As I read through each hospitals' percentages, the blood drained from my body; I felt weaker and weaker with each statistic read. From 70% at Corona Regional Medical Center to 13.3% at Providence Saint Joseph Medical Center, the average in the state 32.7%; more than twice what the World Health Organization recommends. I sat alone, letting the tears fall down my cheeks.

I started shaking, feeling sick to my stomach. How? How? How could this be happening? The sickening feeling grew as I remembered the stats were from 2008; they were most certainly going to be higher for 2009 (and here we are in 2010).

What could I do? What more could I do? I started brainstorming with myself. I scanned the Vaginal Birth After Cesarean (VBAC) sites, looking for strategies for changing The System. The word "education" came up over and over again. But, how? How do we educate more women earlier, before they have that first cesarean? Those of us in the natural birth world have struggled with this question for over 40 years. We've tried everything from conferences to articles to speaking on national television. But, nothing seems to help.

Expressing my despair on Facebook that night I read the statistics, several of us threw out ideas, considerations of what we might do differently. Some were extreme (a la PETA), like throwing red dye on obstetricians as they walked in the hospital -and others were still noisy- picketing outside the offensive hospitals. After that, we were at a loss. The possibility of being on Oprah is miniscule (she doesn't talk about childbirth on her show), so barring that, how can we get the word out that thousands of women are being unnecessarily cut every single day. Women who become at greater risk for a multitude of complications that can include death and a lifetime of disability.

My body felt possessed.

When I process, think or develop an idea, I do something else, allowing the ideas to run as a constant hum underneath my conscious thought. On the television that night was Stripped: Greg Friedler's Naked Las Vegas, a show about the making of the book Naked Las Vegas. Fiedler photographed people clothed and then naked. Nothing erotic about it at all. Simply a demonstration of what people look like in and out of their clothes.

Watching, I was reminded of Shape of a Mother, a beautiful site where women send in pictures of their bodies, real, stretch-marked, floppy, saggy and not air-brushed. Sarah and I both sent our photos in and are on there somewhere.

The underlying hum started getting louder. I began searching sites for photos of cesarean scars. I found several, but they were more clinical than emotional. As a midwife, I've listened as women talked about their scars, held new mothers as they cried about their surgeries, nodded as they exposed their deepest sadness about their cesareans.

What would the scar say if it could speak?

CesareanScar.com was born.

The site will evolve; I know that already. But, I wanted to start... did not want to wait. I began asking women to send me three things.

1. a photo of their scar

2. what the scar says to them when they look at it

3. what the scar says when they touch it

Within a few minutes of creating the site (before it went live yesterday), I knew I wanted to have a section for photos and stories about the immediate post-surgery days, while still in the hospital. I knew the next section would be photos and stories about the transition to being at home, how having a scar affected those first six weeks postpartum. I also see a section, a resigned and endless place for the long-term stories; how the scar affects a woman years later.

I don't believe all scars speak of sadness. I know some scars are joyous triumphs of a saved life, a rescue for mothers and babies and even silent sentries protecting what lies beneath. I want all stories. I want to hear what women's scars have to say because I am sure they have a lot to tell us.

Beyond what I want to hear, I have illusions of grandeur that women will find the site, prayerfully, before they have their first babies. When women Google "cesarean scar" they will happen upon this site and read -and read and read. If women have already had one cesarean, perhaps hearing there are alternatives to a repeat cesarean will put a bug in their ear about VBAC.

I'm humbled by the two stories already there. For those that join me in this venture, we get to watch the project grow from its infancy. I'm very excited and feel like I am doing something beyond being a midwife for women wanting a VBAC (which, I know, is a great thing all in itself). I just can't sit by watching women be cut over and over again.

Here in San Diego, the hospital doing the most births is Sharp Mary Birch; their cesarean rate is 41.6%. Beyond disgusted, it was long overdue I did something more.

Reader Comments (18)

What is going on in Corona???

I've always wondered what could be done to educate women about birth before they are pregnant, before they are thinking in terms of their own immediate births. What teaching opportunities might help shape our ideas, long before we put ourselves on the path of following and trusting cultural norms that may not be in our own best interest? Sharing experiences sounds like a good place to start.

April 12, 2010 | Unregistered Commentermelissa

Even as I'm disgusted by the c-section rates (and ours in Florida, especially SOUTH Florida, are heinous!) I kinda cringe at the suggestion that by merely "educating" women we can reduce the c-section rates. I think we need to educate physicians! Or maybe penalize them for having c-section rates over 20%. Or something.

What woman, laying in a hospital bed for hours in excruciating pain, is going to rely on her previous education when her doctor stands over her and solemnly "informs" her that her baby is too large or in distress, or that she COULD continue to TRY to birth naturally, but it will probably be many more hours and end up in a c-section ANYWAY. Women are placed in a very precarious position of ( in the eyes of the hospital team) choosing to be selfish and continuing labour, or choosing to save her baby's life. And even if the baby wasn't as large as promised (threatened?) or the pitocin COULD have been turned down or off, there's always the handy-dandy cord around the neck to justify the surgery.
And what woman wants to face the possibility or LIKELYHOOD (at least right away?) that she was coerced, lied to, ripped off, or that she "failed" in her resolve to birth naturally?

And finally, how do we KNOW for sure, without being there, her c-section was un-necesary? We can be PRETTY confindent with the horrific surgical birth rates, that it WAS most likely not necessary, but about 10% ARE, and she may have been one of them.

I guess what I'm saying is, it's almost impossible, no matter how much education we provide women or how much they personally have acquired, for women themselves to lower their own c-section rates when told, in labor, that their baby may die if they continue. I think most would err on the side of caution when faced with even the remotest possiblity that their choices may cause the death or permanent damage of their babies. And that is what OB's are counting on, that most women WILL choose to have a live, undamaged baby when faced with the "choice".

Unless more women stay out of the hospital, or physicians, hospitals and insurance companies get their acts together, I really don't see a dramatic reduction of cesarean births in our near future.

April 12, 2010 | Unregistered CommenterColleen, LM

this looks like a great project.

As a young,childless woman, it continually astounds me how little many of my peers are aware of the basics of pregnancy and childbirth, and all the issues surrounding it.

April 12, 2010 | Unregistered CommenterQoB

Narrative Therapy at it's best. Allow the stories (or scars) and the women to speak their truth. Fan-freakin'-tastic idea.

April 12, 2010 | Unregistered CommenterLouisa Wales, LM, CPM

@Colleen: I do understand about "educating" women and expecting they will make different choices. We teach in so many different ways, this was a new way for me to get the information out about the repurcussions, short and long-term, of having/choosing a cesarean.

You are absolutely right. A woman, even if she's absorbed the words of the wise women on CesareanScar.com, being told she has to have a cesarean to save her child, isn't going to spend half a second second-guessing what she needs to do. And, you are also correct that many/most women don't consider that their cesareans might not have been necessary until some/a lot of time has passed.

So, why do the site at all?

- To give a voice to the women who might not have been able to find it yet. (I received a letter from another midwife today that said she had a friend who'd had a cesarean, saw the site and knew she needed to write, letting her scar speak. She said that up until that point, she never even considered the scar... she was pregnant, in labor and then a mom - no transition. She ended it with, "I wonder what my scar has to say?" There are many reasons I started the site, but that one is the biggest.
- To acknowledge there are many "scars" from a cesarean, not just the physical one. One that Sarah likes to bring up is the financial scar, how insurance has grabbed a great deal of their money, how many families are financially devastated after the surgery.
- To pull women together, giving them voices with which to harmonize. Women can feel so alone; we don't have to process/grieve/celebrate alone.

@Louisa: Thanks!! Thanks so much.

April 12, 2010 | Registered CommenterNavelgazing Midwife

Thank you for this. My scar has a story to tell, and I will work on putting it in writing. Maybe not right away, though, because I am currently focusing on looking forward - towards my vbac this summer - and have already dealt with the emotional scars to the point where I am in a positive place for the time being. I will come back to contribute, though. And thanks again for this. I so appreciate your blog and all of the wonderful information and insights you share.

April 12, 2010 | Unregistered CommenterNicole

70%!

I don't get the "educating women" bit. Nobody I know who had a c-section had planned on it (the first time). Every single person wanted a vaginal birth with maybe "just" an epidural.

Including me--I had my c-section for breech presentation. I tried all kinds of things to get her to turn. I was plenty educated on the topic; I had just already chosen a provider that automatically did c-sections for breech presentation. Of course it wasn't really a choice--I went to them because they were close and they were on my insurance. And they were busy and kind and seemed good.

I guess you mean "educating women" not to use OBs? Which is fine for some, but not for all. For example, I'm way too high-risk for a midwife. And I'm not comfortable with a home birth. And there's no birthing center near me.

I think the issue more is the OBs! They're the ones who are deciding on c-sections for a while host of very sensible reasons (e.g. litigation).

As for my scar, that's a different issue. When I think of it it's mostly because of its continued weird numbness. I like the idea of the site! I just don't see how it will keep people from c-sections, unless more women than I can imagine are really choosing c-sections.

April 13, 2010 | Unregistered CommenterAntropologa

What a great idea for a site. How powerful it will be.

I will add a link to your site from mine. :)

April 13, 2010 | Unregistered Commentermichele

Barb,
Don't let it become another toothless site.
Require women to name the doctor and city they got their cesarean. That will get attention.

In NYC and other teaching hospitals the numbers also reflect that we now have legions of residents that never ever get to see an unmedicated natural birth during their residency. And it's not important enough to their programs to be made a requirement.

April 15, 2010 | Unregistered Commenterdewi

Barb, Sadly, Sharp Mary Birch's c-section rate is even higher than that reported. I'm not sure if the given numbers are due to underreporting, or because it only goes to 2008. I worked L&D there until 1 year ago and we had monthly stats posted. Last spring, c/s rates were consistently between 45-50%, my friends/coworkers tell met that it has increased to around 50% over the past year since I left. Gross! And they still wonder why I opted for a home-birth.... :)

April 15, 2010 | Unregistered CommenterAllison

I work postpartum at a midsized community hospital. One night about a month ago 70% of our PP patients were c-sections. It is crazy. My question is when are we going to see maternal morbidity and mortality statistics start to tank because of the increased c-sec rate? Then the next big question will anyone care? We actually lost a mom recently, an otherwise healthy 30 year old mother of three who had c-sec. No one is quite sure what happened yet. MAybe HELPP, maybe fluid overload, but whatever it was I fear it will become more common not less.

April 18, 2010 | Unregistered Commenterbaby-mama runner

wow. So powerful. I am adding a link right now. I think this is needed and healing and educational. Thank you.

April 22, 2010 | Unregistered CommenterAnisa

The UN rates means nothing. It was thought up by a few guys in a room more than 30 years ago. Research shows that if more sections were done, less babies would die and be injured. Of course, midwives consider a c-section to be a worse birth than a dead child. This is why so few women want you.

What arrogance trying to educate the rest of women. No one wants to "educate" you because it is like teaching a pig to sing. It doesn't work and it just annoys the pig.

April 28, 2010 | Unregistered Commenteranon

You are absolutely incorrect that midwives feel a cesarean is worse than a dead baby. That you even think that demonstrates your ignorance of a midwife and her education and compassion.

April 28, 2010 | Registered CommenterNavelgazing Midwife

@anon - if you have/had/know a midwife who thinks that a c-section is worse than a dead baby, then you know the wrong person.

midwives and doulas are there to be the advocate of a woman and her body.

often that means she will help reduce the risk of c-section or other medical interventions that are often not needed.

ALWAYS it means that her goal is to have a healthy mom and a healthy baby.

April 29, 2010 | Unregistered Commentertara

I am curious as to how many times "just" an epidural eventually becomes an epidural with pitocin augmentation, or furthermore, an epidural followed by cesarean. I have witnessed many, many births, primarily in Germany, but in the past five years solely in the United States. During my five years supporting births in America, it has yet to occur that a medically unnecessary epidural resulted in a vaginal birth.

Perhaps "education" should rather be "regulation" of the use of harmful drugs on a mother and child during labor. It seems unthinkable that anyone would ever be allowed to willingly drug a newborn baby cradled in her mother's arms unless this newborn were to have a medicinal need that chemical drugs would be considered life-saving. So why is it considered acceptable practice while the child is still in the womb to use drugs as a means of comfort? Could this not potentially be considered recreational drug?

May 10, 2010 | Unregistered CommenterStill processing....

I am curious as to how many times "just" an epidural eventually becomes an epidural with pitocin augmentation, or furthermore, an epidural followed by cesarean. I have witnessed many, many births, primarily in Germany, but in the past five years solely in the United States. During my five years supporting births in America, it has yet to occur that a medically unnecessary epidural resulted in a vaginal birth.

Perhaps "education" should rather be "regulation" of the use of harmful drugs on a mother and child during labor. It seems unthinkable that anyone would ever be allowed to willingly drug a newborn baby cradled in her mother's arms unless this newborn were to have a medicinal need that chemical drugs would be considered life-saving. So why is it considered acceptable practice while the child is still in the womb to use drugs as a means of comfort? Could this not potentially be considered recreational drug use?

May 10, 2010 | Unregistered CommenterStill processing....

wonderful idea...educate! educate!!! love this.

July 13, 2010 | Unregistered CommenterStephanie Thiess

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