I posted a link on my Facebook for the radio show that mentions me yesterday and got some interesting responses. I received them by text when I was away from home, and at first they really confused me.
Girl I went to high school with commented: “Why are you against that”
Against what? I thought. The radio program was about support resources for single pregnant women. I was confused. Then I got another comment.
Girl I was in the Army with commented: “Cesarean Awareness Month? I had four cesareans, and I’m perfectly fine. So are my kids.”
Okay, I thought, that’s fine. What does that have to do with support resources for single moms?
Girl I went to high school with added another comment: “Ceaseran saves lives”
Now I was really confused. At this point, my friend Mari (who did the interview on the radio show) piped in.
Mari: “The show wasn’t anti cesarean. It ws about being single and pregnant.”
When I got home and looked at my Facebook page to get some better perspective on what this conversation meant, I realized that next to my link to the broadcast was the logo for Cesarean Awareness Month, a logo The Feminist Breeder had chosen to put up for the entire month of April, the month when Cesarean Awareness Month is observed. It had nothing to do at all with the topic of the radio show, but these women saw the logo and were offended.
Many women are very defensive about their cesareans, so much so that they assume that raising awareness about cesareans is somehow a declaration of opposition to all cesareans and a direct insult to their parenting choices. To say that Cesarean Awareness is kin to cesarean opposition would be like saying Single Parent Awareness Week is about opposing single parents. That’s not the case at all. The goal of Cesarean Awareness Month is to grow knowledge, understanding and acceptance of a procedure that more than one-third of all pregnancies end in, and the effects that this has on women and children. Cesarean section is the most commonly performed surgery in the United States. When so many women undergo this procedure, its reasonable for women to want everyone to understand it.
I thought this might be an excellent opportunity to raise awareness about one cesarean issue that concerns me, so I commented on my post
“Who said I’m against cesareans?
The show is, like Mari said, about single pregnancy.
This month happens to be Cesarean Awareness Month, which is why the Feminist Breeder has that symbol up on her site. This month is not opposed to or in favor of cesarean birth. It simply wishes to build awareness about cesareans.
I’m curious, how many of us know the optimal cesarean rates? That is, the rate at which cesareans save the most lives?”
No one has yet to answer, but here it is.
The scientific consensus, based on numerous studies and epidemiologic information, is that the optimum cesarean rate is between 10 and 15%. What this means is that in places where the cesarean rate is below 10% or above 15%, we start to see more mothers and babies dieing and being injured at or around the time of birth. The further below 10% and the further above 15% it gets, the worse the deaths and injuries become. Somewhere between 10 and 15% of pregnancies need to end in cesarean in order to save the mother’s and/or baby’s life. Anything above or below that make birth outcomes worse.
So what’s the cesarean rate in the US? Well, we have the highest rate of any industrialized country. Our cesarean rate is 33%. Thats more than double the highest end of the optimal rate. Furthermore, our rates of cesarean sections are on the rise, and are projected to continue to rise.
So what? The chances that you’ll die in childbirth are still relatively low, right? Well, they’re probably not as low as you think. Of the 33 countries in the world considered to be industrialized, the US is 32nd for maternal mortality rates. That means we have the second highest maternal mortality rates. There is only one other industrialized country where more women die in childbirth than do here (its France, if you’re interested). There are 31 countries where less women die in childbirth. (It’s interesting to note that there are some third world countries who actually have better maternal mortality rates than us as well, but they aren’t included as industrialized). Their rates aren’t just a little bit lower than ours, they’re dramatically lower than ours. France’s are just a little bit higher than ours.
What about infant mortality? Well, the US is dead last in that area. More babies die during childbirth here than in any other industrialized nation in the world.
If you are a minority or living below the poverty line, your chances of dieing or having your baby die during birth in the US are dramatically higher.
Now the reasons for this are complicated, and include amongst other things a high intervention rate in general (not just cesareans, but also inductions, augmentations, forceps/vacuum birth, episiotome, etc.), lack of access to health care (a problem that doesn’t exist anywhere else in the world) and a lack of education. But given our dramatically high cesarean rates and our dramatically high maternal and infant mortality rates it’s not hard to draw the conclusion that at least half, and maybe as many as two-thirds of the cesareans performed in this country are un necessary and put the lives of mothers and babies in jeopardy.
Saying this does not mean that I am opposed to cesareans. Certainly cesareans do save lives. I understand that. In 10 to 15% of pregnancies. Not 10 to 15% of women, that’s 10 to 15% of pregnancies (women might need a cesarean once, but not for every birth). Anything above that is actually going to take lives, the scientific evidence is quite clear.
I can imagine the women who wrote about cesarean’s life saving potential on my Facebook being offended at this information. Lots of women are, I understand. No one wants to think that they had an un necessary cesarean, and they especially don’t want to think they underwent that because they had a lack of information or education. But I’m not trying to pass that judgement on them, or any other individual. After all, if half the cesareans performed in this country are un necessary, that means that half of them are totally legitimate. It’s just as likely they are in the legitimate camp as the illegitimate. I don’t know their birth stories, I wasn’t there, so I can’t tell them what happened and if it could have been prevented or not. What I can say is that raising awareness about cesareans in the general public can help women who have had an un necessary cesarean or who are at risk for getting an un necessary cesarean avoid them in the future, and that is one goal of Cesarean Awareness Month. It is not to tell women they are bad mothers or that they are stupid for having undergone a cesarean. It’s not to say that all cesareans are un necessary (anyone who says that is a fool), or to try and pass judgement on who’s cesarean was actually needed and who’s wasn’t (that’s for a woman and her health care provider to determine, not anyone else). It’s just to make women aware of what a cesarean is, what its benefits and risks are, and for those who don’t need them, how to avoid them.
Many women who are defensive about their cesareans are also offended by women who have negative feelings associated with their cesareans. The fact is, surveys have shown that most women do have negative feelings associated with their cesareans (I would argue that women overly defensive of cesarean probably also have negative feelings surrounding their cesareans, which is why they feel the need to be so defensive – if they were confident their cesareans were legitimate and lifesaving, they would have nothing to be defensive about), even when the cesarean was a legitimate medical emergency. The fact is that it’s normal to have feelings of disappointment after a cesarean, usually a cesarean is not what women hope for. Furthermore, given our high un necessary cesarean rate, its normal to have feelings of violation, victimization, and of being disrespected. Telling women they are wrong for having these feelings is akin to telling a woman that she is wrong for feeling negatively about a rape. Of course, some women have positive feelings about their cesareans, and that’s okay too. It’s better than okay, actually, that is what we want. We want women to have empowering, satisfying and happy births, even when they need a cesarean. Unfortunately, many women don’t have that experience here in the US. Most women report negative feelings associated with their cesareans. We need to raise awareness about that, as well. That’s where acceptance of cesarean and it’s effect on women and children come in (although, that’s certainly not where it ends).
Cesarean Awareness Month is about raising awareness of all these issues surrounding cesarean birth and more. Its not about making blanket statements like “Cesareans save lives” or “Cesareans are dangerous”. Cesareans are complicated subject matter, if anything, the idea is to banish blanket statements. You can’t just say cesareans are good, or cesareans are bad. Cesareans that are needed are good. Cesareans that are not needed are bad. Cesareans that leave a woman feeling confident, respected and empowered are good. Cesareans that leave a woman feeling disempowered, victimized and disrespected are bad. Cesareans that leave mothers and babies healthier than they would have been without them are good. Botched cesareans that leave mothers and infants injured or dead are bad. We have both kinds of cesareans in this country, and we need to recognize that, and respect the women who have experienced each kind. We should also work to increase the number of good cesareans and decrease the number of bad cesareans. That is what Cesarean Awareness Month is all about.