Tuesday, December 29, 2009

There are lies, damn lies, and...

I frequently use statistics when I talk to women about their birthing options. I say things like "up to 50% of first-time moms who are induced end up with c-sections" and "when you choose VBAC your risk of uterine rupture is only 0.4%!" I bring up statistics to highlight the risks and benefits of various birth options, and because I think many many doctors do not take the time to provide truly informed consent to their patients.

Over the past few months, I have been reading quite a bit about management of "postdate" pregnancies, and whether it is best to wait for spontaneous labor or induce. The study that stuck with me showed that, counterintuitively, at 41 weeks' gestation there were fewer cesarean deliveries in the induced group. (http://www.bio-medicine.org/medicine-news-1/Induced-Labor-May-Prevent-Need-for-Cesarean-Section-54811-1/) Fewer cesareans!!!! To understand why this is so earth-shattering for me, you need to know that I was induced a day past 41 weeks with my first child. After a long and miserable labor I "failed to dilate" at 9 cm and had an unplanned cesarean delivery. I spent over a year struggling with feelings of inadequacy and failure. I failed to go into labor, failed to give birth to my child, and missed out on what I consider a major rite of passage for a woman: BIRTH! Part of processing my cesarean was considering whether I had failed, or whether I had been failed by modern obstetrics.

For years I have believed that my cesarean was "necessary" by the time it was performed, but it was almost certainly avoidable had I not been induced and subjected to what so many in the birth community call the "cascade of interventions." I have progressed from blaming myself for my cesarean to blaming my induction- and I have found no small amount of triumph in pointing out that 2 of my 3 very successful vaginal deliveries occurred spontaneously well past 41 weeks. I truly believed I had gotten past the questioning stage and had reached a point where I accepted all that led up to my first delivery. And now this study.

If it is true that induction at 41 weeks leads to fewer cesarean deliveries, then maybe my ire has been misplaced. Perhaps I did experience a "failed induction" as I've always believed- but if a spontaneous labor would have carried an even greater risk of cesarean, perhaps the induction was still the best choice. The right choice. It is hard for me to even type those words, difficult for me to consider that no matter what I might have ended up with a c-section to deliver my son. It is difficult for me to think that I wasn't able to birth him and yet I was able to birth my other 3 with no problems at all. Was it his size? Was he in a strange position? Was it the calcification on my placenta? Was it because I was unsure of my last menstrual period and I was actually much further along that we thought?

If I had not had my cesarean delivery, I doubt I would ever have found my passion for birth. In that respect I am almost happy for having had it, and I most certainly do not think I would love my son any better than I do if he'd taken a different exit from my body. But I thought I was well beyond playing "what-if" when I think of his delivery, and I am surprised at how deeply reading this study has affected me.

1 comment:

  1. Being a woman who also had an unwanted c/s and really identifying with the term "cascade of interventions," I feel that we will always have moments where we are surprised that we are again playing the "what-if" game.

    Although I feel like I've come to accept my son's birth, I also will always feel that the way it happened is one of my life's biggest regrets.