Note: Birth injury/ infant mortality mentioned in detail…
The Well Rounded Mama wrote in her post Just Another C-Section about her friend’s patient who endured a prophylactic primary c-section at 38 weeks because she was obese. Please read the original post. The following is my reply:
‘Without complication’ for the doctor is right. He’s not sitting bedside in the NICU with the baby. I am so sorry for your friend’s patient. She WILL be able bond with her baby when she and her baby are finally together—humans are so resilient. That is a hell of a way to kick off motherhood, though. I hope she has a support system of people bringing her meals, listening to her story and helping her with breastfeeding or whatever she needs.
Shoulder dystocia is an equal opportunity birth event in first time mothers—50% of the time it occurs in NON-macrosomic babies. In this case, you either inform every pregnant woman about shoulder dystocia or you can justify a 100% c-section rate. Obesity increases chances of macrosomia, but macrosomia does not mean automatic shoulder dystocia, which does not mean automatic brachial plexus injury, which may or may not resolve itself within the baby’s first year of life. The permanent cases are what the system (and parents) ultimately seeks to prevent.
Shoulder dystocia is not synonymous with injury. Most OBs that section to prevent shoulder dystocia are wanting to avoid having to be in charge of getting that baby unstuck because:
It’s terrifying. There’s a reason that shoulder dystocia has been called the Nightmare of the Accoucheur.
They are afraid that their skills might not save the baby from injury or death.
No one wants the trauma of looking up at the parents and telling them their baby didn’t make it or has to be rushed off for specialized care immediately.
No one wants the trauma of reliving their grief over and over during legal proceedings for a malpractice case if there are PERMANENT injuries. Malpractice cases are really awful and really personal and no one should be subjected to being called an incompetent, baby-maiming boob for trying their best on the job.
So the solution?
Section. Section. Section. Section.
If you section, you’ve done something prophylactic and you can walk away. Everyone is alive. Usually.
Of course, 3700 women with suspected big babies would need to be sectioned to prevent ONE case of permanent of brachial plexus injury (BPI). In my case, I found the right information in time, talked to the right people (a home birth midwife) for a different perspective and basically said that I refused to take one for the team. Fighting for a vaginal birth in a hospital is a harrowing, exhausting and unnecessary thing to go through—another senselessly traumatic introduction to motherhood, especially when I could have had the same result (a vaginal birth to my sweet little 10 pound baby) by popping a squat in the hospital parking lot. Pouring over medical journals trying to find evidence (which I found) to combat the images of a dying baby hanging out between my legs drilled into me at 38 weeks pregnant was NOT a healthy way to spend the last week and a half of my first pregnancy. My thinking was that, rather than operate, they should focus on doing whatever medical, obstetric magic it is that they’re supposed to do IF A PROBLEM ARISES.
I didn’t learn until more than two years later that there is no magic that can’t be done by an experienced midwife. Hospitals merely give women more timely access (most of the time, but not always) to a surgeon, instrumental delivery and a NICU without the need to transfer. Prophylaxis is valued more than emergency “medicine.” The entire profession should be embarrassed of their section-happy peers. Where are the advocates WITHIN the obstetric community?
Interestingly, large case studies have shown that 3% of BPI occur in babies delivered by Cesarean. Cesareans will avoid shoulder dystocia but will not eliminate BPI.
Regarding your question of who is to blame—it’s complicated. Ultimately it was that doctor’s “fault” for performing the operation, but doctors have been acculturated to believe that what they are doing is preferable. In conjunction with that, we’re now seeing attempt after attempt to essentially backfill evidence to justify the practice of aggressively sectioning women. As is typical obstetrics historically, you just fly by the seat of your pants, then try to find the evidence afterward to support the practice. Now that we’ve gone through a few cycles of childbearing women giving birth in this c-section culture, women have bought into the myth of safety, too.
I could write about this for days. I know you think posts like you’ve been writing are all gloom and doom, but the beauty of blogging is the conversation. I’m all for continuing to discuss this issue to raise the collective consciousness in our society. Thank you, Well Rounded Mama.