Monday, June 2, 2008

Cesarean Rates in Women of Size

One subtle form of discrimination against fat women in pregnancy is the high cesarean rate.

When a c-section is needed and life-saving, it's a very wonderful option to have......and no woman who gives birth via cesarean should be made to feel "bad" or "guilty" or "less of a mother about it......but when cesareans are done routinely or unnecessarily, it adds a lot of risks to both mother and baby.

Nationwide, our cesarean rate in the U. S. has risen from about 5% in the early 1970s to about 30% in 2007. And that's for women of all sizes.

Some recent studies have found that the c-section rate in "morbidly obese" first-time moms is nearly 50%. That's about 1 of every 2 big moms, undergoing major surgery with all its attendant risks.....and that's just in the first-time moms.

The repeat cesarean rate is even higher in this group. Although studies vary on exact numbers, some studies show that between half and three-fourths of "morbidly obese" women have their babies today by cesarean. This is totally unconscionable!

The stories I hear suggest that many doctors consider being fat incompatible with vaginal birth, despite the fact that in the past, most fat women had their babies vaginally. More and more, doctors are just scheduling non-labor cesareans for women of size.....even though cesareans are more risky in women of size.

Or they induce labor early "to get a smaller baby".....which actually strongly increases the risk for cesarean, while also making a harder, more painful labor for the mom. Unfortunately, few women of size know to question these decisions.

I recently published a major article about the cesarean rate in women of size on the Our Bodies Ourselves website, discussing ways to lower this rate. It's a very evidence-based article and was reviewed by a number of doctors and midwives, but it is written in language understandable by the average reader.

I also gave an interview about why I wrote the article to the Our Bodies Ourselves blog. Appropriately, they titled it, "Fat Women Can Give Birth Vaginally." It gives further perspective on the issue and why more dialogue is needed on the topic.

I hope readers will check out the articles, blog about them, and put a link to them on your blogs. This would really be helpful in raising the profile of the article so we can get this information out there to women who need it.

This is such an important topic, and one that is so ignored on both activism the birth field, fat women are blamed for their high cesarean rates and told to lose weight (by weight-loss surgery before pregnancy if necessary!).....and in the fat-acceptance field, there is little awareness of birth-related issues for women of size and therefore few fat pregnant women think to question their inductions and cesareans.

The issue of unnecessary cesareans is not just a one-time issue. Their health implications may go well beyond a woman's first c-section pregnancy. Research shows that each successive cesarean puts the woman and any future babies at risk for more complications, sometimes life-threatening ones (Silver, Obstetrics and Gynecology, 2006). The placenta in subsequent pregnancies can implant dangerously low, risking severe bleeding and death, or it can even grow into or through the uterus itself, putting the woman at risk for hysterectomy and even death. Some studies report a higher rate of stillbirth in pregnancies after a cesarean. Furthermore, internal scar tissue from the surgeries may cause long-term pain and bowel problems later in life.

And recently, health insurance companies have even begun to deny coverage to women who have had cesareans! If 1 in 3 childbearing-aged women have had cesareans in the country, that's a lot of women potentially being impacted. For fat women, the impact would be even more disproportionate, giving insurance companies yet another reason to deny healthcare coverage to women of size.

In a society that increasingly sees cesareans as "minor" and "just another way to have a baby," it's important to realize that a high rate of cesareans has potentially major implications, sometimes in ways that it is difficult to foresee. We cannot be complacent about it, not in women of average size, and especially not in fat women, who, with such a high cesarean rate, are being placed at disproportionate risk for problems.