One year ago, a friend sent me an e-mail with a few PDFs attached and the following note:

From a faithful reader: please please please can you post the dog chart with intercalations of CS rates by state? I would LOVE to see Florida or New Jersey stacked up against golden retrievers and Pekingese.

Naturally, I began immediately making charts for her. After all, she might truly be the smartest person I have ever met and has as many board certifications as a dog has legs (except for Little Tripod here). However, my “research” on the “internet” led me to uncover the troubling “truth” about dogs and cesareans and I recoiled in righteousness and horror, vowing to return to composing this piece when the time was right.

Of Bitches and C-sections: A Powerful Exposé of a Movement

An article in the October 2011 issue of the Green Journal titled Vaginal Birth: A Relic of the Past in Bulldogs and Women? made the point that better pelvic floor research is needed before pushing prophylactic cesarean on human patients. More importantly, the article highlighted a real problem in our culture: dog cesareans.

Outraged, I read a completely unrelated article from the UK on dog cesarean rates by breed and I knew I had to do something right then and there. I needed to be a voice for those bitches. If I didn’t speak up for them, who would?

I began writing and found that not only were many people surprised to learn of the over-medicalization of the whelping process, but there is also a small percentage of people who feel that all-natural is always the way to go, no matter what. In fact, they already had a framework established for explaining it and receiving dogs who had a bad veterinary experience and it goes like this—dogs are being duped right and left by conniving veterinarians because vets secretly hate bitches. Did you know this?! I didn’t! Wow!

Newly enlightened, I read everything I could about whelping. I turned to the internet and found the following evidence:

Fact: Naturally-whelped puppies sparkle much more than cesarean puppies. 

It’s the natural oxytocin that makes them superior, obviously.

Fact: Bitches are at their most powerful when they are whelping.

Afraid of her power to rip your arm off? You really ought to see her in a whelping box.

I familiarized myself with natural whelping literature.

Owner-Coached Childbirth Classes available through The Learning Annex

At first, I just called it like I saw it.

Then there was some of this because it is clearly relevant.

Kanye didn’t let Lassie finish and Timmy never made it out of that well.

There were wolves. Three of them.

My blogging on the topic got some attention from advocacy groups and other bloggers.

NAPB (National Advocates for Pregnant Bitches) issued a statement about the dangers of the puppyhood movement and how the rights of the bitch should never be sublimated by the perceived rights of the litter, as the state cannot legally intervene as parens patriae to the unwhelped.

ICCAN (International Canine Cesarean Awareness Network) put out a press release on the importance of bitches educating other bitches on the dangers of veterinary care.

The Skeptical Vet left the following comments on 10 sites:

Alt+C, Alt+P

I was asked to help plan and was interviewed for a documentary about the dog cesarean problem.

I made some really important charts and graphs.

Chihuahua mad. Chihuahua calls bullshit on suspected macrosomia claims.

(J Small Anim Pract. 2010 Feb;51(2):113-8.)

That was all effective to some extent, but it was time to hit the streets and really let everyone know about dog cesarean rates.

I personally took to the dog parks for some hardcore Distractivism™ to let dogs know their breed’s cesarean rate.

Everyone knows this one exists solely because I have waited four years to blog a picture of poo.

August 2012 marks four years of blogging and I have thought for a while that a lot of bitches are barking up the wrong tree. Is it helping anyone to cling to ideals of a time past and leaders who are pretty out of touch with the modern whelping female? If someone’s goal is to reach so-called “mainstream” dogs, then they’re not listening or paying attention. They’re proselytizing and trying to spread what they think is a universal truth. That’s all well and fine but how much should a philosophy that is shared only by a very small percentage of pregnant and laboring females be used to influence health policy that will affect everyone?

Thank you for trusting me to keep a space open for respectful dialogue and for sharing your struggles and triumphs with me, both on the blog and personally. My ears, mind and heart have been open even if I appeared to be just goofing around sometimes. If any sociologists want to research the concept of the modern social activist, you should get in touch with me, as I have been observing all of this as if from the outside for at least the last two years.

I’ll be around on the Facebook pages (The Unnecesarean and VBAC) because those have grown into thriving, respectful communities and I think they are well worth any time invested in them (and are a fine vehicle for some of the goofy PhotoShop stuff). I think that CesareanRates.com is a valuable resource and I hope that one day the site is completely obsolete because the government provides accessible, current hospital data to the public. For now, you’re just stuck with me compiling stuff at my kitchen table.

I couldn’t think of a better way to sign off than by mocking myself and the evolution of my activism in a blog post. Later, bitches.

(To comment in the Facebook module, you must be on this page: http://www.theunnecesarean.com/blog/2012/8/8/the-final-post.html. Why? I have no idea. Just click on it and comment, dog.) 

I’m pleased to announce the birth of my son on July 5th at 4:05am. He was 6lbs 10oz 19in long at 37 weeks and perfectly healthy. I thought I would get to make this announcement on my favorite mommy/birth pages including that it was a VBAC after my Unnecesarean 3 years ago. Instead I get to announce that I had a medically necessary C-section in which my VBAC friendly OB came to the hospital at 3am, when he was NOT on call, to explain the pre-eclampsia blood work to me. He discussed the process of induction and my specific situation, condition, and risk factors. He told me the truth that No it was not an emergency yet and did not push as my husband and I made an informed choice. He performed the C-section and as he was sewing up my uterus in two separate layers he told me that just 5 days ago he attended another VBA2C. I’m grateful for the information and support I have gained from my mommy/birth pages that helped me to have an informed and empowered birth. I hope I get to announce the birth of number 3 as a VBA2C. Thank you all.

So you like having cesarean rates all complied on one site, I’ve noticed…

Me, too.

My friends Glen and Tara Elrod were in town and we wasted no time diving in and talking about all things maternity care. Glen, an OB in Wasilla, Alaska, asked what might be the most important question when it comes to cesarean rate reporting… why is it such a big deal for these to be formally reported? He’s exactly right. All of this should come from a reporting agency, not from Jill sitting at her kitchen table.

We talked about how there is absolutely no reason to stall on publicizing hospital cesarean rates and the government could easily use the administrative data that they already have for 44 states. Sure, risk-adjusted would be so much better, but why not just start by making total cesarean rates (total CS divided by total deliveries) public? Everything is de-identified and if there were less than a certain number performed, you simply don’t report on those hospitals to protect patient privacy, particularly in rural areas.

It really shouldn’t be a big deal. I know what the hold-up is after talking to 4,352,132 people and reading extensively on the topic. I’d like to charge forward and see what can we can collectively do about it.

But I’ve hit a brick wall. This is an all-volunteer project and the volunteer is me.

I’m going to need to go back in for another round of pulling numbers one by one from hospital association web sites or departments of health pages, because the entire point of the first phase of the site is to show the most current cesarean rates available to the public. If those lapse, which some have, then there’s really no point to keeping the site online.

I am ready to go on spreadsheet binges during which I live off the same block of cheese for a week and drink coffee and just put social skills and hygiene on hold for a while. Regular readers of this blog know that I am just a bit sarcastic, so many of them think I’m kidding. I’m not. I’m ready for those voice mails from friends telling me to “leave the house” and “put on pants” and “interact” with another “human being.” We all have our process. But it’s all gone so far past being able to justify the time I put into it. I was getting worked up about what I couldn’t do for my kids this summer and all of the things that it seems like people do and my mom, that scrappy little Buddha, paused and said dryly something to the effect of, “You know what your kids like, Jill? They like to be fed. So why don’t you focus on feeding your kids and not worry about whether they do x, y or z.”

She’s right. They also like health insurance and I like having it, too.

I really have sat here for long enough wondering how in the world I am going to make this project sustainable. There has been plenty of action (proposals submitted and such), so it’s not like I have just been staring out the window wondering about it all, trying to figure out how to fund at some of my time and cover big girl business expenses (Did you know that CPAs won’t work for in exchange for smiles and high-fives? That was news to me.). Lawyers won’t either! Side note: There is a now what I think qualifies as a running joke in the anything that deals with the out-of-hospital midwifery community about the expectation of working for no pay. It’s a vicious cycle of griping, then turning to someone from whom they want something and going apeshit with some guilt-bombs or aggressive posturing about how if you commoditize something, it’s not done with love, man. Bullshit. You just want something for free. Nice try, my womynsongmoonsister.

I keep sane by laughing about it all with a friend (Me: “Hey, the underside of my dog’s tongue looks like a piece of ahi sashimi.” Her: “Lucky. I can’t afford sashimi.”) who is also a single mother barely getting by but WHAT THE HELL SHE IS A DOCTOR NOW AND WORKS NIGHTS AT THE HOSPITAL AS AN INTERN AND HOW IS THAT EVEN POSSIBLE? Oddly, she says that she takes comfort in having a predictable life plan and doesn’t understand how I can just create stuff on the fly, which sort of blows my mind. I think she is just being nice.

I bounced some ideas off another friend, who finally asked me something like this (paraphrased):

Look, dumbass, have you ever considered that it looks professional enough to where people just assume it’s already funded?

Truthfully, I hadn’t really thought of it that way but it makes sense. I did this as research in conjunction with a presentation at the APHA Annual Meeting last October. I had some long-term goals and ideas for it, but the main thing was just completing the research, showing exactly what is available to the public and measuring if people were interested in seeing it. My favorite is that people think, as I used to, that Google ads pay big bucks. LOLZ. Big LOLZ to that. It’s about 100 bucks a month for both sites. I have been blessed beyond belief to get to work with Jim and Camilla, authors of The Pregnancy Power Workbook, this summer, by the way.

My lady consiglieri (and God bless their tolerance of my e-mails) suggested crowdfunding. Their feedback went something like this: If it’s a community that wanted and requested the information and work, you might as well ask them to help you keep it going as long as you can. Let the public decide how long CesareanRates.com can run. They decide and you just walk away and go work somewhere else if there is no interest. Work is work.

Yup.

We worked on creating a fundraising campaign to get the absolute bare minimum of what it would take to justify this work through the end of the year. Partial funding is fine. If half of the amount comes in, I will be happy to keep things hopping until around the end of September or whatever the halfway mark is.

As I am prone to overexplaining, I thought I would publish this post about the campaign to explain it to my regular readers and fans and stalkers and critics or whatever you are. I am in a really good place of feeling satisfied with what has been accomplished here. I did the research. I presented it as a freaking layperson at the American Public Health Association Annual Meeting. I somehow managed to become the person with 97% of the information on cesarean rate reporting in the U.S. when the experts whom I consult never seem to have more than 85% of the overview of all of the datasets available and what the deal is with them. I could walk away with a smile and be proud of everything I have put into it.

So it’s on you all now. I’m available to do the research, the outreach, the communication with the public, the advocacy and the spreadsheet/graph binges. I’m even free to blow off steam by posting corny crap and vagina jokes on The Unnecesarean. Lucky, lucky you on that last one. Head on over. Check it out. I’m about to find out what I am doing for the next few months of my life and possibly through the end of the year. Like my dear friend, the single-mom doing her internship, it will be nice to have something of a plan and an idea of how far this will go. Thank you. Oh, and if you ever want to hear more about cesarean rate reporting, you should call me if you have an hour or two free because I think this is The Most Exciting Topic in the World and I think I may have pushed the limits of friends in my life who want to hear me get all amped up and chatty about it. I see signs that they are bored, but those signs don’t mean stop talking—they obviously mean I just am not being animated and loud enough! MOAR CESAREAN RATES AND HEALTHY POLICY FOR YOU RIGHT NOW!


Jill

This search arrived on the blog:

“hospital doesn’t allow vbac, so should I stay home to labor until its too late?”

I would like your thoughts on this. If you have experience with this from either the patient or provider side, please share. Comments left here or on one of the Facebook pages will be de-identified and compiled for a future post.

You are both working in busy practices. What made you decide to dedicate your (lack of) extra time to write this workbook?

Camilla: The busy practice setting inspired the question, “Do you think our patients know what questions to ask”. When in the exam room I usually ask, “Do you have any questions? The answer is usually “no”. I truly believe the answer is probably “yes”, but the woman doesn’t know what she needs to know or what questions to ask. She may think, “if it’s really important, my provider will tell me what I need to know”. Or even, “they seem so busy, I’d hate to bother them with such a basic question.” With these concerns, Jim and I decided we would write a workbook full of basic pregnancy questions. Questions that would allow women the opportunity to learn at their own pace.

Jim: For me it was the true sadness the came about when patients would come in with a bad outcome with something that could have been prevented with a little knowledge… [click over to read more]

Share  

This is based on a conversation after a recent conference, but I’m not saying which one.

We were talking about how long birth plans all look the same after awhile and contain some requests to not perform procedures that haven’t been routine for a long, long time. 

The consensus was that someone with a good sense of humor could crack their doctor up if they slipped this into their chart when she or he wasn’t looking:









]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16762884.xmlBirth in the Mediakourtney kardashian epiduralkourtney kardashian give birthkourtney kardashian water birthwater birthJillFri, 15 Jun 2012 21:08:44 +0000http://www.theunnecesarean.com/blog/2012/6/15/in-kase-you-actually-kare.html250314:2598633:16737452 ]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16737452.xmlVBACVBACVBAC riskelective repeat cesarean rickercsvbac after 2 c-sectionJillThu, 14 Jun 2012 17:29:20 +0000http://www.theunnecesarean.com/blog/2012/6/14/where-are-women-sent-online-for-information-on-vbac-after-tw.html250314:2598633:16716035I received a request for info on the risks of VBAC after 2 or more cesareans versus planned repeat cesarean with 2 or more cesareans and thought it might be interesting to crowdsource it and see how the 16,000 Facebook fans would respond.

Here were the links provided. What do you think of this snapshot of resource sharing in terms of information shared, sources and the community itself, if anything?

]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16716035.xmlCamilla Bicknell NPChildbirth EducationJames Betoni DOpregnancy workbookthe pregnancy power workbookJillWed, 13 Jun 2012 16:26:17 +0000http://www.theunnecesarean.com/blog/2012/6/13/what-is-the-pregnancy-power-workbook-all-about.html250314:2598633:16689619

 

 

I told Jim and Camilla that I would introduce them personally to my readers. I bet they never anticipated such a slick production with flawless editing and a web cam that only eats a few bites of sound here and there. You’re welcome, Jim and Camilla.

Also going to just point out that that’s my chair creaking in the background so don’t jump to conclusions.

Jim Betoni is an OB-GYN of two decades who just recently went into Maternal Fetal Medicine. His desire to work with women with high risk pregnancies…

]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16689619.xmlHuman Rights in Childbirth Conferencechildbirth conference hague amsterdamJillSat, 02 Jun 2012 12:47:14 +0000http://www.theunnecesarean.com/blog/2012/6/2/human-rights-in-childbirth-conference.html250314:2598633:16537012Go sign up to watch the webinar so you can witness this piece of history. The array of people that came together from all over the world—not just those who took the stage but the audience members as well—was impressive to say the least. I had no phone service and no internet connection for a few days, so I haven’t been able to post updates on anything. ]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16537012.xmlJillWed, 23 May 2012 14:10:52 +0000http://www.theunnecesarean.com/blog/2012/5/23/find-a-doctor-that-will-support-you.html250314:2598633:16410392http://www.theunnecesarean.com/blog/rss-comments-entry-16410392.xmlACOGACOG ACMBirth TechnologyLaerdalannual clinical meetingchildbirth simulatorsJillMon, 21 May 2012 12:38:54 +0000http://www.theunnecesarean.com/blog/2012/5/21/childbirth-simulators-mobilize.html250314:2598633:16367424Pharma Vagina to teach every med student that birth must occur in the lithotomy position. I’m not going to pretend that seeing all of the birth simulators displayed on their backs in the exhibit hall… ]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16367424.xmlCesareanChoice in BirthMidwivesmidwifeobJillFri, 18 May 2012 13:22:31 +0000http://www.theunnecesarean.com/blog/2012/5/18/obs-midwives-lies-and-i-have-no-idea-how-to-title-this-post.html250314:2598633:16328118
Here are a few things I have learned, and I have learned them in a pretty unique manner, mostly in the last year or two. ]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16328118.xmlJillThu, 10 May 2012 16:25:26 +0000http://www.theunnecesarean.com/blog/2012/5/10/video-caesarean-section-at-full-term-for-contracted-pelvis-1.html250314:2598633:16208768Share 

My friend Grace hit the motherlode of videos for medical history junkies on the Wellcome Film YouTube channel.

This series of three silent British films from 1930 shows and describes (with language that reads like a standardization checklist) in detail the cesarean section.

Part 1:

Part 2:

Part 3:

]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16208768.xmlChoice in BirthJillThu, 10 May 2012 16:01:17 +0000http://www.theunnecesarean.com/blog/2012/5/10/quick-hit-what-to-reject-when-youre-expecting.html250314:2598633:16208489Share 

Consumer Reports published an updated guide to overused procedures in maternity care, aptly and cleverly titled, “What to reject when you’re expecting.”



Hat tip to New Hampshire Patient Voices


]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16208489.xmlJillTue, 08 May 2012 19:57:39 +0000http://www.theunnecesarean.com/blog/2012/5/8/new-research-shows.html250314:2598633:16178713

Share 

Nice that there is research that shows that all of the time I have spent goofing around on the Internet has had a measurable effect and that continued photoshoppery has positive public health implications.

All I am going to say about this is that I walked past that blank bulletin board at the ACOG Annual Clinical Meeting and tried to tell myself not to do something this dorky. As usual, resistence was futile. This one is for the long-time readers.

 

 

]]>http://www.theunnecesarean.com/blog/rss-comments-entry-16178713.xmlVBACJillSat, 05 May 2012 13:37:51 +0000http://www.theunnecesarean.com/blog/2012/5/5/hopes-of-vbac-out-the-window.html250314:2598633:16136374

Share 

Readers,

I have been confirmed as a panelist at the Human Rights in Childbirth Conference on May 31 - June 1, 2012 at The Hague University of Applied Sciences in the Netherlands.

If you attend, please take a few seconds to fill out the box on the form which asks how you learned about the conference with some variation of Unnecesarean, The Unnecesarean, Jill Arnold, CesareanRates.com or anything that will let them know that I referred you. Without the benefit of institutional support and without a spare $1500 in my pocket, I asked if they would be willing to help me get there and was relieved that I could help them by filling seats.

If you are in the Netherlands, then please ga naar de conferentie en vertel hen dat ik van je verzonden.

For those of you who want to stay put and attend the conference from home, you will want to get a group together and sign up for the webinar for half-off just for saying I referred you!

Please read more and reserve your spot today. My new Dutch friends can now mock me for using Google Translate to destroy their language. Het spijt me.

Jill

Human Rights in Childbirth Conference

Healthcare in childbirth is of great importance to society. This conference takes a unique, consumer perspective. It will focus on the legal and human rights issues arising at the intersection of childbirth and healthcare. The conference is being organized and hosted by affected groups, a legal research institute, and an international law program at The Hague University. Therefore, it creates a unique opportunity for a wide spectrum of stakeholders to share perspectives on the issues relating to birthing women and their families.

Doctors, midwives, lawyers, and parents agree on the general principle of client-centered care in childbirth. The conference will be a platform to explore the practical aspects of human rights in 21st century healthcare systems, and how those systems can both maximize safety and respect the dignity of the women they support.

For more information on the conference and for an overview of our esteemed panelists, please visit our website: www.humanrightsinchildbirth.com. (Facebook | Twitter)

About the Human Rights in Childbirth Webinar

This webinar provides a unique opportunity for professionals and parents around the world to be a part of the global discussion on human rights in childbirth. The Human Rights in Childbirth Conference will be LIVE streamed by a professional team, so you can watch live and join the discussion via twitter.

If you are unable to join live, you will be able to watch the conference panels at your leisure for 30 days following the conference, join the ongoing discussion via the Facebook page, and connect with the regional and international networks of professionals capable of protecting women’s fundamental right to authority and support in childbirth.

We want the conference to be accessible for your community, and we have negotiated a special price for you to join this important event!

Regular Price: €175/2 days inclusive the pre-conference publication. [Edit 5/8/2012- One day webinar option dropped]

Special Price for The Unnecesarean: $75/2 days pre-conference publication not included.

How to get this special price:

1. Go to the Registration Form: Registration Page

2. Fill in the registration form and select the webinar (you will see the regular prices but don’t worry you will get your discount!), in the field “How did you learn about the conference? *” fill in “Unnecesarean Discount”

3. Do not pay by clicking on the PAY PAL directly (then you will pay the regular price). You will receive a confirmation email from our office with the discounted price and you can pay either via PAY PAL or via a bank transfer.  The details for this will be provided in the email confirmation (this is created by a human, it is not an automatic mail, so won’t be sent directly). 

Massachusetts cesarean rate history and VBAC bans  |  Massachusetts cesarean rates by hospital, 2009

The Atlantic’s piece, The Case for Hospital Births, seems to be sending segments of the internet into a stir.