Monday, April 5, 2010

The Importance of April

April is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring

Dull roots with spring rain.

--T.S. Eliot, The Waste Land

In case you hadn't heard yet, April is officially Cesarean Awareness Month. Why April was chosen, I couldn't tell ya. Perhaps it has something to do with T.S. Eliot (look at the last word of the first line, after all), perhaps it's less poetic and more pragmatic than that. Regardless of reason, there's tons going on, both online and out in the matrix. I won't reinvent the wheel of links that The Feminist Breeder already put together, since she already did a bang-up job. I can tell you about one major local event, for those of you who live in or near Erie, though: our local ICAN chapter is hosting a birth film series over the next two Saturdays!

Saturday, April 10th will feature mother of all birth films, "The Business of Being Born". I cannot imagine that anyone reading this blog hasn't seen this, probably multiple times, but just in case: if you haven't, watch the linked trailer and then hie thee to Netflix or whatever DVD source you use - or come to the film fest if you're around here. Then on April 17th, the less well-known but also excellent "Born In The USA" followed by the brief but uplifting "Birth Day" - NOT to be confused with the interventionpalooza reality show on TLC, but rather a lovely short film about a midwife experiencing her own home water birth. Both events take place at Mercyhurst College's Taylor Little Theater from 1 to 4 pm and will include panel discussions following the films.

Planning the event has been awesome - it came about after the public health department released the 2008 cesarean rates for Pennsylvania, and it was revealed that both hospitals in Erie had rates of 37.6%. GAH. The January ICAN meeting simmered with ideas of how to address it. I was ready to chain myself to the gates of Hamot Hospital with a good old-fashioned picket sign, but eventually, more proactive ideas started to flow. It's shaping up to be a great time - I'm especially looking forward to the panel, which consists of local midwives, doulas, mothers, an OB, and even a high school student. I'm also looking forward to the free baked goods we're bringing to slyly win the masses over to our side.

But as exciting as all that local grassroots action is, what I really wanted to post about today was a minor anecdote from my own life that illustrates just how important something as vague as "awareness" might seem.

A few years ago, I had quite a few conversations with various family members about why I was choosing home birth. They ranged from puzzled but more or less neutral (Mom) to outraged beyond reason (my doctor Dad) to supportive but concerned (my birth mom). The latter conversation was a very good, thought-provoking one conversation. My own mother who raised me never actually gave birth, as I'm adopted, and didn't really seem to have a strong opinion one way or another. My dad, well, that's probably a post in itself, seriously (think Dr. Beetlejuice, only male, and a retired plastic surgeon who nevertheless feels at liberty to pontificate on anything medical, Maude bless him). But my birth mom, with whom I am blessed to have a special relationship, had a unique perspective.

She has given birth FIVE TIMES - mighty impressive, if you ask me. All but one went pretty smoothly (I was especially easy, though she wouldn't have thought so at the time, she says); the one baby who was having a tough time rallied at the end. She expressed a lot of the usual understandable concerns: What if something goes wrong at the last minute? What if you hemorrhage? What if the baby needs resuscitation? I responded to these the best I could, explaining just how well-equipped CPMs are. She said that she did understand that most of the time birth DOES go just fine, but it's the exceptions that you have to worry about, so why not be in the hospital just in case? If you want to give birth naturally, go ahead and do it, just do it in the hospital. Just in case. A perfectly understandable opinion. I described my concerns about being subject to unnecessary interventions in the hospital, interventions that carry risks of their own, and tried to explain the difficulties within the current hospital climate, which has undeniably changed since she last gave birth. Experienced as she is, she hasn't given birth now.

She eventually said herself, without any prompting from me, "Well, I guess there are risks either way, and it's up to you to decide which ones you're comfortable with." Perfectly put. She then said she knew I would make an informed choice that was best for myself, and having expressed her fears, she let them go and never brought them up again. Yet, I still got the sense she wasn't quite all the way there, that there was still a bit of skepticism, perhaps feeling the concern about risks in the hospital was an overreaction. But, being the wonderful, supportive person she is, she remained mum.

Then, just the other day, I was telling her about the ICAN Film Series above, all the planning we were doing, how stoked I am to be a part of it, and we got onto the subject of why we were putting it together in the first place. I told her about the Erie cesarean rates being released, and she stopped dead in her tracks. Yes, I repeated, almost 40% of women in our town apparently are unable to give birth vaginally. She then asked about the national rates, and I told her that the national average was 31.8%.

She was astonished. Somehow, in our conversation two years ago (I can hardly believe it;s been that long), I never mentioned the c-section rates, and she literally had NO IDEA how bad it has gotten over the last two decades. Not a clue. "I know they had gone up, but I had no idea just how much," she exclaimed. And I would think that many women in her generation might think similarly. When she first gave birth to me, the national average was somewhere between 5.5 and 10.4%. (Can you believe that? Wow.) Her next baby, 8 years later, it was 16.5%. A big jump, but still within the realm of reasonable, according to many experts as well as the WHO. By the time she had her last, in 1988, it was up to 24.7%, and clearly becoming a problem, but as she was winding up her childbearing and had never had any really bad experiences in the hospital, it makes sense that it wouldn't really register on her radar.

So, it all became a little clearer. Without intending to make assumptions, she was unintentionally operating on the assumption that the rates were maybe around 15-20%, perhaps a little higher, and that when cesareans happened, hey, they were probably necessary. Why was I making such a big deal?

This is why we need to make a big deal about these numbers, this is why we need to get the news out, this is what spreading Awareness means. WE, the types of people who read birth blogs and pore over the latest articles and enter the breach of comment streams after said articles - we know the statistics, at least the basic ones, and I think we sometimes get so used to ranting amongst ourselves that we forget there's a huge segment of the public that does NOT know out cesarean rate has climbed to one percentage point shy of a full third of all births - they very well may be under the impression that it's still somewhere around 15 percent and wonder why these birth-fixated women seem to be getting all bent out of shape.

There was recently a nice spate of coverage by major media outlets about the all-time highs we're experiencing now, and on the ramifications of these highs. Great, excellent, hit "like" on Facebook and then "share". But we need to keep the pressure on, and use the momentum, and be visible and audible and positive, mixing and stirring. Let's get out there and breed some lilacs.

1 comment:

  1. My Mom gave birth naturally to her first four children -- pretty much 'cause labor went so fast, that no matter how quickly she hauled butt to the hospital, she never got there before being dilated to an 8 or 9. When I talk to her about my plans for a natural hospital birth for my third (which she's totally supportive of, it'll be my first natural birth), she doesn't understand my almost siege like mentality, a feeling of "I can't have the hospital take over and take control and end up with a traumatic 'emergency' like my first baby was." In her mind, it was always just go to the hospital and have the baby however you wanted, what was the big deal? As she's recently talked to more and more people though, who end up with a cascade of interventions ending in c-sections, and women being induced at 38 weeks for no better reason than they were 'done' with pregnancy (and several of those ended up c-sections), she's finally starting to get where I'm coming from. She finally said the other day, "It's a different world then when I gave birth -- I guess I can see why more women are going to midwives or choosing to deliver at home . . ."