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Sitting in a waiting room last week, I picked up a magazine and stumbled upon a picture of a pregnant belly- hurrah! My favorite kind of belly! Unfortunately, what ensued was, I think, a nefarious article promoting elective cesarean sections. I was so distressed that I ripped the article out of the magazine, to protect less-critical readers from being misinformed, and brought it home. I haven't been able to throw it away, though, because I think I want to rip it apart publicly first. So here you go:

Brought to you, ironically, by the Life section of Time magazine, page 65:

HEALTH: Womb Service. Why more women are making caesareans their delivery of choice
By Alice Park

Long before she even met her husband, and well before she decided to become pregnant, Euna Chung made a firm decision about how she would deliver her children [Hope she doesn't want more than four, because if she gets C-sections, she is likely outta luck.]. "I knew for years that I waned a caesarean section," the 31-year-old Los Angeles-based child psychiatrist says. [Nice touch, listing Chung's credentials. I bet lots of people will take her for an expert even though she most likely has no experience with normal birth, sadly, like most women.].

She isn't diabetic, doesn't have hypertension or, for that matter, any of the other risk factors that might [MIGHT! MIGHT! MIGHT!] indicate the need for a C-section. But a combination of having watched traumatic vaginal deliveries in medical school [Yes, medical school is where they train folks to deal with traumatic vaginal deliveries, which occur very rarely, especially among women in comfortable surroundings who have lots of personal attention and assistance. Perhaps if Chung had done some research or had some experience with the innumerable non-traumatic midwife assisted (or obstetrician-assisted, though to be assisted by an OB in a hospital, in my findings, is less common) births, she might have had more confidence] and hearing about her mother's difficult emergency caesarean experience after trying to deliver vaginally [I can't help but wonder if her mother would have been able to deliver vaginally in a more supportive environment; I will never know.] helped make up her mind. " I had a fear of going through labor and ending up with an emergency C-section anyway [I'm sorry nobody told her that her and her baby's prognoses were far more favorable had they had the beneficial experience of labor before finally proceeding with the C-section; allowing the body to go into labor spontaneously is always the best-case scenario, even in the case of eventual C-section.]. I didn't want to deal with it."

So six weeks ago, when she was ready to deliver her first child [Who was ready, her uterus or her schedule?], Chung checked herself into the hospital on a day she had already scheduled [I don't like this attempt to make this type of experience seem empowering, when it pales in comparison with the sense of empowerment achieved through a normal birth experience.], underwent local anesthesia [The woman is not getting a filling! Calling an epidural block "local anesthesia" is deceptive and euphemistic, in my opinion.], and several hours later had her baby by caesarean, without any complications [I guess some people don't consider an incision that hemisects the abdomen a complication.]. Pretty tidy way to conduct the often messy business of childbirth [Ok, wait a second. Hold the phone. On average, a cesarean section results in the mother's loss of ten cups of blood. Let me say that again, in case anyone missed it. Ten cups of blood. Tidy? I have witnessed over fifty, probably closer to seventy five, vaginal deliveries. Ten cups of blood? I haven't seen it. If the mess we are referring to is a minimal amount of feces, quickly and respectfully cleaned away by a care provider, some amniotic fluid and a placenta, I think we need to reconsider our definition. I have observed cesareans. To call them tidy is a blatant lie. Necessary, sometimes, of course. But tidy, they are not.]. Yet Chung sometimes feels defensive about her decision [Too bad Park doesn't elaborate on the possible legitimate reasons a mother might feel defensive of such a decision, but I guess that isn't the point of the article.]. "There is an admiration of women who are able to do a vaginal birth without pain medications, then breast-feed, and do everything else perfectly [Not perfectly. Just normally. Vaginal birth and breastfeeding are nothing more and nothing less than normal.]," she says. "So I didn't go around advertising that I had chosen to have a C-section." [If she had, perhaps someone might have been able to be loving and understanding of her reasons, and willing to have a real conversation with her about the seemingly insurmountable challenges that pregnant women face in our culture.].

Chung has unwittingly stumbled upon the latest battleground in maternity care [I think it is disturbing to think of maternity care as a venue for a series of battlegrounds.]. Just as moms and even doctors once clashed about the importance of breastfeeding, they now debate the benefits and risks of vaginal births and cesarean sections [Talking about the risks of normal vaginal birth is like talking about the risks of having a bowel movement. While some may be more difficult than others, and things can go wrong, they are normal physiologic processes. To compare vaginal birth with cesarean surgery is apples-and-oranges.]. Rates of C-sections have been climbing each year in the past decade in the U.S., reaching a record high of 31% [!] of all live births in 2006. That's a 50% increase since 1996 [!!]. Around the world, the procedure is becoming even more common: in certain hospitals in Brazil, fully 80% of babies are delivered by caesarean [!!!]. How did a procedure originally intended as an emergency measure become so popular? [Mad props! Great question!]. And is the trend a bad thing? [Props revoked.].

Some of the rise in C-sections can certainly be attributed to women with routine pregnancies, like Chung, who make a pragmatic decision [I'm not sure pragmatic is the most precise word that could be used here. I would go with ill-informed.] to keep their deliveries just as uneventful. [As uneventful as major abdominal surgery?]. Preliminary data suggest that such cases account for anywhere from 4% to 18% of the total number of caesareans. On the medical side, better anesthesia and antibiotics are making the procedure safer [Safer than normal vaginal birth?]. Add to that the growing number of women delaying childbirth, those having twins or triplets as a result of in vitro fertilization and America's obesity epidemic--all of which increase the risks of vaginal delivery. Doctors are also becoming better at picking up the slightest signs of distress in the baby or mother and are quicker to recommend caesareans in such cases [The doctors may be quicker to recommend a cesarean, but are they right to be so? I would have to see data to support the notion that technology designed to "pick up the slightest signs of distress" have actually enabled doctors to improve maternal and infant outcomes. To date, I have only seen data indicating the opposite.].

But taken even together, all these factors don't explain the steep rise in caesareans over such a short time. Instead, says Eugene Declercq, a professor of maternal and child health at Boston University School of Public Health, the biggest change may simply be in the way we think about labor and delivery [AMEN!]. In an increasingly technological and medicalized society, maybe even childbirth is losing some of its magic and becoming less about the miracle of life and more about simply getting the baby out safely and without incident. [This may be the reality of how the system responds to childbirth, but is this how families feel? Shouldn't it be worth pausing a moment to consider if we want to take the magic out of childbirth? Might not the magic serve a purpose?]. "We put a lot of emotional, psychological and spiritual value around birthing [Seems like a good idea to me...]," says Dr. William Callaghan, an obstetrician at the Centers for Disease Control and Prevention. "But perhaps we are coming up with different cultural norms [Indeed we are, but that doesn't mean we are moving in the right direction.].

Shaping those norms are some powerful fiscal forces as well [Finally, we are talking about the real reasons for the shifting cultural norms.], such as soaring malpractice rates for obstetricians. Since doctors are sued more frequently after vaginal births than caesareans, surgery is often the most prudent choice [The most prudent for the doctor, you mean?] when there is even the slightest indication of a difficult vaginal birth. Combine this with the increasing willingness of moms like Chung to talk more openly about their C-sections [Didn't she just say Chung wasn't advertising her decision? It didn't seem to me like she was talking openly about the situation, and probably for good reason.], and we may be headed for a time when mothers make the vaginal-or-caesarean decision the way many now make the breast-or-bottle decision [Every major organization with any interest in maternal and infant health, from the World Health Organization to the American Association of Pediatrics, makes strong statements about the inadequacy of bottle-feeding. So, I guess the conclusion is that in the future many women will be duped into having cesarean deliveries the way many are currently duped into bottle-feeding despite irrefutable disadvantages.].

That does carry perils, however [Duh.]. A panel of experts convened by the National Institute on Child Health and Development in 2006 stresses that moms-to-be need more scientific data that directly weigh the benefits and risks of both delivery methods [I disagree. It is to the detriment of mothers and babies to suggest such a comparison is reasonable in the face of so much evidence that caesarean deliveries are more dangerous in every way than vaginal deliveries.]. Vaginal delivery can, for example, lead to future incontinence and pelvic damage [My understanding is that these types of outcomes are at least somewhat preventable and remediable.], while babies born by C-section may suffer from respiratory problems because of not being exposed to certain hormones during the birthing process [Among other dangers clearly more severe than incontinence.]. It will take more studies comparing the two methods for individual women to be able to determine how likely these risks are for them.

Chung remains convinced that she made the right decision for herself and son Nathan. As our ideas about birth evolve [Evolve? They are improving?], perhaps more women will feel less defensive about making the same choice [I hope not; I hope they make another choice].

*****

So I thought the article was terrible, but, lest I mislead, let me make a couple quick statements.

I think doctors do a wonderful job, for the most part, in their skill, which is attending to physical pathology. Birth does not, for the most part, entail physical pathology. When it does, I think it is, of course, appropriate to involve a skilled doctor. Until that point, I believe that the business of normal birth should be left to those for whom it is a professional specialty: midwives.

Cesarean sections make it possible to save some babies and mothers. It is an important surgery and I am glad it is available to those who genuinely need it. What most mothers and babies need, however, is a loving, supportive, empowering birth experience. And these are difficult to come by, especially in a hospital. My qualm is not with the mother in this article. It is difficult to choose a powerful birth in our culture. She is not alone. But I hope I can be a part of the movement trying to reinstill women with the sense of power, necessary for a mother, that is in jeopardy. I was horrified by this article.

Comments especially welcome.