Friday, February 13, 2009

Cesarean Soapbox

I find myself taking on the mantle of cesarean awareness advocate. I didn't do this intentionally, and I must say not even willingly. But God's plans are not our own, and here I am, facing another cesarean with the realization that change must come.

I continually marvel at the incredible inroads made in natural birth. The advocacy of mother/baby health, as well as dignity, has etched permanent changes onto the face of birth. This is fabulous, and I am excited to see the options for women opening up more, and more. However, that same advocacy has not quite reached cesarean. I find this ironic since optional cesarean, and repeat cesarean is on the rise; and of course my own personal experience of five, soon to be six cesareans fuels my passion for more proactive policies based on mother/baby bonding, emotional support, and physical tenderness. Just because I walk into the hospital on the planned date, in no immediate pain, and all necessary preparations ready does not mean that my births are any less monumental. Yet, for reasons that obviously escape me, staff, doctors, and hospitals in general tend to treat cesarean births on par with hemorrhoid removal - necessary but nothing to be proud of.

I can say this with a modicum of authority, since I have delivered naturally with my first, and labored to complete with my second before beginning the cesarean journey on which I now find myself. Things like husband participation, mother/baby separation, and priority of nursing which are all seen as non-negotiables within natural delivery are a far cry from standard inclusion for cesarean. It was only my last delivery that I finally successfully argued my case for Christopher to be present during the administration of my spinal (the nearly identical procedure used for women in labor to receive an epidural). Up until that point I was walked alone into a sterilized OR room, made to face a complete stranger already garbed from head to toe in a medical gown and mask, and told to hold still while a needle roughly the size of Connecticut was inserted multiple times into the small of my back trying to find the magic spot for the anesthesia. In fact, Christopher nearly missed the birth of his first son because the nurse responsible for calling him in once the procedure was underway simply failed.

My other bone of contention is the automatic separation of mother and baby at delivery. Rather than keeping baby with Mama and Daddy during mother's repair hospitals will often whisk the newborn to the nursery, forcing Dad to make an on-the-spot decision of staying with his wife during the final stages of a rather major operation, or going with his tiny infant to participate in those first irreplaceable moments of life. No easy decision for any man! This is made all the more difficult by the realization, often coming after the decision, that once you leave the sterile OR you are not allowed to return. I have spent hours alone during the immediate post-partum rush of emotions lying on my back completely isolated from everyone. To call this depressing would be an understatement. The irritant is that it is not necessary! Hospitals do not need to remove the baby to the nursery during mother's repair. They don't do it during a natural delivery. Mother shouldn't be left alone, without husband or baby, when no medical complication requires it. The bottom line to many of these policies is staff convenience, hospital savings, and conveyor-belt like medical care. Unacceptable.

Also up for mention is the management of pain during the hours and days following the surgery. There is technology available for accurate, site based analgesics which can combine the long-lasting comfort of pain management with the freedom from systemic medications often causing drowsiness, and poor mental acuity. Of the half a dozen hospitals in the area around my home only one doctor at one hospital uses this technology. Why? Why are more hospitals not availing themselves of new advances designed to lessen patient recovery time, increase mother's comfort, and support mother/baby bonding because of the increase in alertness? Because change requires expense. It requires trial, error, and the willingness to learn something new. In other words it slows down the cash-machine of surgical birth, and places responsibility on health care professionals to do more than show up at the appointed time. I do not say this flippantly, shaking my fist to a "down with all western medicine" rally cry. I truly appreciate our country's work in the advances of medical science. I value doctors, nurses, and the many other professionals required to make even the simplest procedure possible. And I don't believe at the heart of these many people they consciously realize the ways they have divorced the humanity from the humans they care for. However, the unfortunate reality is that divorce is precisely what has happened.

So, where do we go from here? For me, I continue to work tirelessly to compassionately, but consistently explain to all parties involved what these policies mean to me, personally. Sharing the human experience opens the eyes of those worn hard by thousands of women turned faceless by sheer volume. My anesthesiologist for Josiah noted to my obstetrician that he appreciated the emotional support given to me by my husband's presence during the administration of my spinal. He pointedly observed that I seemed much more relaxed than many other mothers he worked with, and recognized that it correlated to the unique presence of Christopher. After years of professional experience it took one woman asking, "why?" to help him open his eyes to a reality not difficult to understand. It is with that encouragement that I continue to ask the same question to others.

Finally, the education and personal responsibility of other mothers, like myself, faced with cesarean delivery and unwilling to simply accept the standardized norm for the past 50 years is necessary for a real change. Health care systems can only be given half of the blame for our current climate. The truth is that if women stopped allowing others to make decisions for them, without reading, understanding, and weighing their options hospitals, doctors, nurses and staff would not be allowed to get away with the dehumanizing decisions that remove the dignity from patients in all walks of life.

But this is just my soapbox.


  1. this is why I love your blog. Something I've known so little about...yet known you felt strongly about. Here, I get to read what your heart feels and I couldn't agree more. You are a Dr. Martin Luther King of the cesarean realm. :)

  2. Thanks Kelly :) I think Dr. Martin Luther King Jr. might be taking it a bit too far; maybe just Martin Luther. HaHaHa I could nail this blog to the church's door.

  3. Dorothy P.10:10 PM

    Wow. You've enlightened me, Trisha. I had no idea what you've been through. It's as if the birthing experience is negated once you set foot in the surgical suite. The medical staff forgets that the patient is actually awake for this procedure. Sounds like you found the chink in the armor by appealing to the anesthesiologist. He is on the front lines of this battle, after all. Not that you've ever been one to be short on words, but I'm proud for your candor and willingness to put this story out there.

  4. I am so glad that I am not the only one who feels that way about c-sections. I have had 3 c-sections and have not even gotten to experience the joy of natural birth. You of all Trisha knows what happened with my first, (I don't wish it on anyone) but we never get more than we can handle. Trisha I feel your pain, good luck with this new little one.