When It Comes To Refusing C-Sections, We Need To Give Women A Little More Credit

shutterstock_124023148Last week, a doctor threatened to call the police on a woman who was refusing a c-section. Now, a woman in Ireland – who is two weeks overdue according to hospital records – has consented to an emergency c-section after being taken to High Court by the hospital. When are people going to realize that the spiking trend in c-section births is making women believe that hospitals don’t actually have their best interests in mind?

The woman disputed her due date – which she claims is actually March 18th, not February 24th as the hospital claimed. The hospital was concerned about the scar on her uterus from a previous c-section – claiming that if she delivered naturally it could rupture, putting herself and her baby in grave danger. The baby was delivered via emergency c-section – weighing in at a little less than seven pounds. The weight of the baby itself makes me question whether the woman was in fact right about her due date.

The previous post I referenced was a very different situation than this one. Apparently, that doctor was supportive of the woman’s desire for VBAC until “complications” arose. In this case, however, it was the woman’s due date that had everyone up in arms – a due date that she disputed.

People get annoyed when women take their health into their own hands. With mixed messages from the medical community and those trying to get the facts about VBAC out there – I’m not surprised. VBAC has become something that is almost impossible to achieve in some states. The Florida hospital where I hope to have a successful VBAC in a few months has a 43% c-section rate. That terrifies me. That along with the fact that in the state of Florida a doctor and an anesthesiologist have to be present for the entire birth – makes my VBAC seem almost impossible to achieve.

The risk of uterine rupture associated with VBAC is actually really, really low. With no prior vaginal births it is 0.87%. With every successful VBAC you have it gets even lower: 0.45% with one successful VBAC, 0.38% with two. And these statistics include all ruptures – not just catastrophic ones. The risk of catastrophic rupture that effects the health or life of the mother and baby is even lower. From VBAC.com:

For women whose labors begin spontaneously, uterine rupture is reported to be less than 1% and the risks similar to those for women having a first birth.

Medical experts state that the risk of a uterine rupture with one prior low-horizontal incision is not higher than any other unforeseen complication that can occur in labor such as fetal distress, maternal hemorrhage from a premature separation of the placenta or a prolapsed umbilical cord.

I think it’s important to remember these statistics when we hear stories of women refusing medically recommended c-sections. It seems as if even those of us that are the staunchest supporters of a woman’s right to choose what happens to and with her body are quick to judge women who take their deliveries into their own hands. From a comment on the story of the woman who was almost arrested for her refusal of a c-section: “I think it’s completely arrogant for a woman to thumb her nose at her highly experienced and highly educated doctor, especially at the expense of her child’s safety.”

In 2010 the National Institutes of Health (NIH) sponsored a Consensus Development Conference to review safety of and access to VBAC. The panel’s ultimate conclusion was this:

“The data reviewed in this report show that both trial of labor and elective repeat cesarean delivery for a pregnant woman with one prior transverse uterine incision have important risks and benefits and that these risks and benefits differ for the woman and her fetus. This poses a profound ethical dilemma for the woman as well as her caregivers, because benefit for the woman may come at the price of increased risk for the fetus and vice versa… When trial of labor and elective repeat cesarean delivery are medically equivalent options, a shared decision-making process should be adopted and, whenever possible, the woman’s preference should be honored.”

(photo: Naypong/ Shutterstock.com)

Be Sociable, Share!
You can reach this post's author, Maria Guido, on twitter.
Be Sociable, Share!
  • Kathryn Eaton

    Thanks for the quote, but I feel like you’ve taken my comment completely out of context. The comment I made was based on the information that was provided in the article, which stated that the woman’s doctor (a doc known for being supportive of VBAC) was recommending a c-section because the baby was showing signs of distress. My comment had nothing to do with her wanting a VBAC, it had to do with her ignoring the doctor when he said her baby was in trouble. From the information provided in the article, it seemed like at that point the mother was putting her own desire for a VBAC above the health and safety of her baby.

    I think my attitude also stems from my observations of someone I know personally, who I believe put her own “birth plan” desires above her child’s health. She was two weeks overdue when she finally went into labor, and she labored for three days without intervention, against medical advice. What happened was that her baby ended up inhaling meconium in the womb, the woman ended up with an emergency c-section, and by then her baby was in so much trouble that he had to spend two weeks in the NICU. Is it fair that this child had to suffer because she wanted her unmedicated natural home birth badge of courage?

    I lump women who make decisions like these in with those who refuse to vaccinate. They think their “Ph.D. in Googlology” (as another commenter so amusingly put it) qualifies them to ignore hundreds of years of medical advancements. So yes, I think that their attitude, in general, is arrogant, though I’m not saying that in some cases there aren’t extenuating circumstances.

    Finally, in response to this: “It seems as if even those of us that are the staunchest supporters of a woman’s right to choose what happens to and with her body are quick to judge women who take their deliveries into their own hands.” I fully support a woman’s right to choose what happens to her own body, up to a point. Without opening the whole “personhood” can of worms, I would posit that by 40 weeks gestation, a baby has rights, too, and their health and safety should garner equal consideration as that of the mother.

    • http://www.facebook.com/katyeshom Katy Khan

      I agree with everything you said! And as far as my delivery went…I made it very clear that I wanted a vaginal delivery unless my dr. felt it was medically necessary for a c-section …if she thought i or my baby had needed it, I would have absolutely done it. I can’t imagine going against medical advise, it just baffles me. Vaccines, c-sections and all that.

    • meteor_echo

      And yet you’re so smug when a woman wants a c-section as her birth plan. Choice goes BOTH ways.

    • Once upon a time

      I think all of our comments have been taken out of context. The problem isn’t a woman wanting a vaginal birth over a caesar, the problem is women putting their babies health at risk because they’re so rigidly fixated on their birth going exactly as they planned – not to mention this dangerous trend of people mistrusting their doctors in favour of Dr Google.

      Quote all the stats you want. They don’t apply in the cases you’ve provided.

    • Cathie2027

      docs don’t know everything either..they’re fed what is “the best medicine” info at that time. Maybe if they weren’t given kick backs for prescribing meds, I’d have more faith in them, until them they’re licensed pill prescribing crooks.

    • Cathie2027

      just for the record docs don’t know everything. Watch the documentary “The bUsiness of Being Born” and you’ll see what I mean. They give you pitossin to speed up the labor so they can go home, that causes distress on the baby and poof- there’s you “Necessary” c-section. YOu know just a few years ago- smoking while pregnant was OK, thalidomide was an FDA approved drug and we all kow what problems that caused. And yes I am one one those moms who refuses to administer vaccines-after all if they were soooo safe they wouldn’t make you sign a waiver.

    • Kate

      Sigh. I have seen the Business of Being Born, and like most sensationalist documentaries, I took the info with a grain of salt. I support women advocating for themselves, but to operate on the assumption that all doctors are out to get you is kind of silly. It’s not like we would read an online tutorial about how to fly an airplane and then assume that we know better than a trained pilot. Yet people do that all the time with doctors. Seeing one documentary does not make me an expert in obstetrics.

  • Just a thought

    Women seem to have forgotten that pregnancy is a natural thing, not a health condition. Also, it seems to be a trend lately for doctors to push women to have c-sections. I personally think that the fact doctors get paid twice as much to perform a cesarean as apposed to vaginal delivery has a lot to do with this. I’m not saying that women who want to have c-sections is wrong, because everyone should do what it takes to get their baby here safely. However, I do believe it becomes an issue when women are scared into having a c-section.

    • Blueathena623

      Well, how do you define “scare”? In this case (see my comment) and the other case, trained medical professionals found actual evidence (a scan found something in this case, and fetal distress in the other) that meant that they, as trained medical professionals, thought a vbac would not be safe. If a doctor tells me that my appendix is severely inflamed and might rupture so I need an appendectomy, is that using a scare tactic, or presenting me with the medical facts?

    • Kathryn Eaton

      Nice appendix analogy. I totally agree with you!

    • chickadee

      Check with Dr. Google first before you have your appendectomy. You might find that the internet disagrees.

    • Kathryn Eaton

      Ha ha this is hilarious. I had an emergency appendectomy a few years ago and I can just imagine this. ER doc comes in and says, “We need to get you into surgery immediately or you’ll die.” “No, no, Doc, hold your horses. Let me just Google that….” SMH.

    • Tinyfaeri

      That isn’t what smart phones are for?

    • Just a thought

      Wow way to take my comment out of context guys. Of course women should listen to their doctors, especially in an emergency situation. However, I do think women should do research on finding a doctor in their area who best suits their birth plan. It isn’t a secret that some doctors will do things for money and their own convenience as opposed to what’s best for their patients. If this woman had really trusted her doctor she may have opted for the safer procedure.

  • Blueathena623

    Maria, I think you’re missing a key piece of the article: “Another consultant obstetrician, who gave evidence by telephone, said the latest scan carried out this morning on the woman was not reassuring and he told the court he had advised her strongly that she needs a Caesarean now.” From this it appears that no, it’s not just the due date. Something about the scan — scan of the baby, scan of the uterus, scan of the scar tissue, made medical professionals think that a vbac might not be successful. This is not a vbac in general issue, this is a “there is evidence that a vbac might be dangerous in this specific case” issue.

    We also don’t know what either she or the hospital is using to determine due date. If she had an early sonogram at the hospital, those things are pretty accurate. My doctor and I disagreed on my due date ( I knew my cycles are longer than average, so I put my due date later) but my 8, 12, and 19 week sonograms all estimated the due date I believed was true. Also, it was her 2010 baby that weighed 7lbs, not this one (although my full term baby weighed about 6.5 lbs).

  • http://www.facebook.com/iwill.findu.90 Iwill Findu

    I’m 12 weeks pregnant with my first and that this point people are already asking me about how I plan to give birth, will I breast feed or do I intend to vaccinate my child. My answer is that I intend to do what is best for myself and the child. Meaning yes I will have a c-section if that was needed, if I have problems breast feeding I will pop a bottle in the child mouth, and why on earth would I not vaccinate my child from deadly illness, since I would like as much as possible for them to reach the age of 18. I don’t understand why some people get these ideas that one thing is so much better then the other. What would you rather have a healthy baby or your stupid VBAC, because once you’re putting your child’s health on the line it is pretty stupid, if you don’t meet the needs for a VBAC have your little pity party after you book the c-section and move on.

  • chickadee

    Like others, I respect what you are tying to say, but your examples are not helping your case. Both women were trying to act against medical advice when that advice was being given for justifiable medical cause. In neither case were the doctors merely prejudiced against VBAC.

    There certainly are doctors who will not go along with VBAC, and it might be helpful to research cases where the doctors simply find the c-section to be the more convenient route.

    • http://twitter.com/mariaguido Guerrilla Mom

      The point that I obviously didn’t make very well is that I think women come to this point where they are completely untrusting of doctors recommending c-sections because they are so widely recommended. I just simply don’t believe that 43% of the women who went into labor in the hospital where I will be delivering had medical indications for c-sections. That’s crazy. But a doctor is always going to tell you that there is a medical indication. It’s not like they’re going to say – “I can’t be on call for you anymore! Gotta slice you open!”
      Clearly, I’m human and my experience taints my opinions. But I ended up with a c-section after I was told my baby’s heart rate was plummeting. I just got all of my medical records from my first birth because I am transferring doctors, and do you know what my record said my reason for the c-section was? “Overdue.”
      These women may have really needed these c-sections. All I’m saying is, we shouldn’t be surprised that some women are reluctant to believe their doctors, when so many are crying wolf.

    • chickadee

      My point was that if you wanted to lead a discussion about the number of c-sections that are questionably medically necessary, then you don’t want to lead with stories about two that were necessary.

      I am also leery of posts that say that doctors are probably wrong and then don’t actually provide any backup for saying so apart from a personal anecdote. My sister-in-law had 3 medically necessary c-sections and my sister had one as well. By your tactics, I win because I have 4 examples.

    • Once upon a time

      Yep, everyone I know who had a c-section had it out of necessity. Therefore, all caesers are medically required.

    • Blueathena623

      I’ll chime in to be obnoxious ;)
      Breech baby here — medically necessary csection
      Sister in law — two babies over 10 lbs, SIL tiny person with narrow hips, two medically necessary csections.

    • Andrea

      Most doctors do find the c-section (and to a lesser extent, the induction) a much easier route. Their time is money and they have been led to believe that THEIR time is oh so much more important than anyone else’s.

      I was talked into an induction with my 1st child, a decision that I regretted PROFOUNDLY. It meant over 16 hrs of painful labor and I was almost talked into a c-section because I wasn’t “progressing”. The nurses had gone off to get the paperwork and everything ready for me to have a C, when for some (probably God-given) reason, I had to push that baby RIGHT NOW. My sister had to rush into the hallways to find someone because that baby was coming. So neither the induction nor the c-section were needed and only a miracle prevented the second. I should have trusted that my body was going to do what it needed to do.

      I refused to have an induction with my 2nd which was of course strongly suggested after 40 weeks. I did the “stress test” and went to the ob like every day for two weeks because the baby was overdue and they tried to convince me to be induced every day. I refused. The result? Baby came when it was ready and it was a ridiculously easy 5 hr labor that resulted in a perfectly healthy 8lb boy.

      Not that I agree with the woman in THIS CASE. It’s obvious that baby is not doing well. But sometimes you have to be your own advocate against what doctors want for their convenience.

    • chickadee

      Yeah, but I am not disagreeing with that. I pretty much just said that her examples weren’t sporting her thesis.

    • http://www.facebook.com/courtney.wooten Courtney Lynn

      I wish I had advocated more for myself in my son’s birth. The OB I was seeing that day in the group practice was one I hadn’t seen before. The one I saw the most was not worried about my swelling because my BP was fine and so was my protein. I happened to walk in at the same time that my mother called YET AGAIN that day, raising my blood pressure temporarily. I should have asked for a re-check, but I was so scared when she started talking about seizures and the like. Sure enough, once I got to the hospital, my BP was just fine and so was everything else, but they went ahead with the induction. I was a classic example of “pit to distress”. The OB on staff that night honestly thought I could deliver that evening when I went in at 330 p.m.! I labored all night, pushed for 2-3 hours only to end up with a c-section. I’m pregnant again and for me, I’m just going to do a RCS. I thought about a VBAC, but I am NOT going through all that BS drama again. Just give me my baby and leave me alone.

    • K_Dub

      Courtney, I feel you! Went through similar experience, makes one feel so vulnerable, powerless and without control. Such a trauma! I hope you have a better experience this time. Hope you dont have to go to the same hospital? Maybe you find a consultant that is supporting you better? it seems so sad if you’re kind of bullied into another cesarean, but I totally understand that you don’t want the drama and in the end still have a section again. CS is such a big operation and no one should railroad you into having one if not absolutely necessary for med reasons. I wish you all the best, you’re a very brave lady!

    • http://www.facebook.com/courtney.wooten Courtney Lynn

      Thank you! It’s nice someone understands that feeling. It took me a long time to get over it and once I was, I was pregnant again! LOL. I’m actually not pressured into the RCS at all. I was totally given the option. I just chose the RCS after MUCH deliberation because I know exactly what to expect and it takes a lot of anxiety and fear out of me, which I believe is the best for me and the baby. It wasn’t the hospital itself, just the OB and the one of the nurses, both of whom were idiots. The OB who actually performed my surgery was not the same one when I started my pit there, she actually was helpful and the postpartum nurses were amazing (with the exception of one). I will be going back to the same hospital, but will definitely speak up if I’m unhappy with any of the staff. I will change nurses if need be. This time, too, it will be my actual OB that I’m seeing now who will do my surgery. I’m in a much better situation.

  • belongtotoday

    It’s all semantics. Where does patient choice end and Doctor insistence begin? Some people desire a lot of power and freedom in making their own medical decisions and some people want almost no power at all. There’s no solid line that can really be pointed to to say “Patients should have this much power but no more!” That becomes even more blurry and controversial when it involves a third person, such as with pregnant women.

    Personally, I *do* like a lot of freedom to make my own medical decisions so I find it quite scary that a Doctor could take that away simply because we disagree on treatments. That I could lose my autonomy and even the rights to my own body and be medically mandated to undergo procedures I don’t agree with or feel I don’t need.

    • Lawcat

      I think a lot of pressure comes from threat of malpractice. For better or worse, we’re a litigious society. People should have control over their bodies and treatment, but if that goes awry, the doctor/hospital is usually the deep pockets grieving family members will go after. They want to make sure they’ve done everything they could have done to not only warn a patient of risks, but to protect themselves.

  • http://www.whatwouldshethink.com/ Rachelle

    All I can say is thank god I gave birth in Quebec, where my hospital prioritizes natural births (18% c-section rate!). After being in active labor for 3 days straight, being on pitocin, having had an epidural pulled out accidentally, it was actually my MOTHER who spoke over me asking about cutting me open to get the baby out, and the nurses saying that it needed to be considered but not necessary yet. My sister and I were born via c-section, and it was my mother who told me to stop being a heroine. My doctors and nurses informed me of the pros and cons, we all (including my husband, who was my defender while I was doing my breathing exercises during contractions) decided to install a new epidural and try again with the decision that if the baby showed signs of distress, we would go forward with the c-section.

    I gave birth vaginally 4 hours later.