Thursday, June 26, 2008

Scapegoating fat women once again

Here we go again. A country's cesarean rate rises, and who do they blame? The fat women. Cause you know, anything that goes wrong has to be blamed on teh obeeeesity, right?

Or perhaps it's because if you do blame obesity, no one will question anything you say, because obesity is such an easy villain for every problem these days. Blame it on the fat chicks and everyone will cluck and shake their heads but not ask anything more. Blaming it on obesity is the slam-dunk of avoiding responsibility and further investigation.

Here's the background on the story. Canada's cesarean rate has risen to an all-time high of 26%, as written about here. That means that 1 in every 4 babies born in Canada are born surgically, which means higher healthcare costs and higher risks to cesarean moms in subsequent pregnancies.

To their credit, the Canadians are sounding the alarm about the steep rise in cesaran rates, and are pointing out the many dangers of cesareans done unnecessarily. This is in contrast to the United States, where the cesarean rate is even higher (31% at last count) and yet hardly a voice in the mainstream medical community is raised against it.

So the Canadians are getting some of this right, and bravo to them for raising a ruckus about it. So they should, and maybe they will lead the way for the United States to start re-examining its own skyrocketing cesarean rate, eh?

But while I applaud the Canadians for trying to curb the rise in cesareans, I decry their scapegoating methods. To wit, primarily blaming women for the rising cesarean rate, instead of the way that doctors manage birth these days.

If you believe the press release, it's as if the doctors are being held hostage, tied to the operating room table against their will, tragically forced into cutting by factors beyond their control. Puleeeeze!! Far from it.

It's so much easier if you can blame WOMEN for the high rate of cesareans (they're too fat, they're too old, they want elective cesareans, they'll sue us if we don't do a cesarean, blah blah blah) and thereby avoid all question of having to look at your own misguided management policies. Note how neatly the doctors shunt aside the blame in their press release, avoiding any suggestion that they might play a role in the rising cesarean rate. Conveniently, it's all due to factors outside of their control.

Doctors said several factors are driving the push for surgical births, from fear of pain during childbirth and the convenience factor to the growing proportion of expectant mothers who are obese.

Twenty-three per cent of women of childbearing age in Canada are obese, and the obesity rate has doubled among 25- to 34-year-old women - the group that gives birth to more than 60 per cent of babies born in Canada ever year - in the past 25 years....

Obese women tend to have bigger and chunkier babies, as well as longer labours, which increases the risk of a C-section.

The fact is that obese women are twice as likely to have their labors induced, and induction strongly increases the risk for cesarean. One study found a 19% cesarean rate in obese women in spontaneous labor, versus a 41% cesarean rate in obese women whose labors were induced. The typical management of obese women strongly increases the chances of cesarean.

Yes, as a group, bigger moms tend to have bigger babies. It's called GENETICS. But it's the high induction rates and the FEAR of big babies that is largely driving the high cesarean rate in obese women, not medical necessity. Most big babies can be born safely, and studies show that interventions done when a big baby is suspected often actually cause more harm than benefit. But unfortunately, that has not changed the way doctors manage women who they suspect might have a big baby, especially fat women.

It's the high rate of induction in obstetrics today that has the MOST to do with the rising rate of cesarean in ALL groups, not just the obese women. But by blaming it on the fat women, the older women, the women having multiples......and by pretending there is a huge influx of women demanding an elective cesarean.......they are able to deflect any questions about their own management practices and how THEY are a big part of the high cesarean rate.

Doctors are not innocent bystanders in the rising cesarean rate, forced into higher rates simply by changing demographics and riskier mother profiles. Older women and fat women have been having babies vaginally for years. It is only recently that the cesarean rates in these groups have become so high. It's how they manage these women that has changed, not their inherent ability to give birth normally.

Although most doctors mean well, they are simply not acknolwedging to the public....or to much of the rising cesarean rate is due to their OWN PRACTICES and their own fears and their own convenience factors.

Shame on them for blaming women instead of having the courage to critically examine their own practices. As I said in an interview about an article I wrote for Our Bodies, Ourselves:

It's time to stop scapegoating women for the high cesarean rate. Changing demographics may play a role, but providers need to acknowledge that the way they manage births has been a very significant factor in the tremendous rise in the cesarean rate. They need to take responsibility for their own contributions to the cesarean rate.


Anonymous said...

The midwives who talked us through the pre- and post- natal process in England, where I delivered my son, attributed the rise in cesareans to convenience for the doctor and hospital.

With cesareans, the doctors can get the baby out, know the baby will not go into distress, and move on - instead of waiting around for the natural process to take place (along with its attendant possibility for risk, which would then have to be dealt with as-and-when it arose and not on a doctor's schedule).

We were also cautioned that forceps and other interventions are often discussed earlier than strictly necessary, for similar reasons.

I have no idea if there are statistic correlations between heavier body weight and potential for fetal distress - that would account for a few things, here...

Anyhow I have to wonder if this issue crops up as a side-effect of socialized medicine, which (in Britain at least) is struggling for funds, and therefore struggling for doctors, and therefore less inclined to take the 'let's wait and see, we can handle whatever comes up' approach.

Whatever the reason, using the incidence of caesareans as another stick to beat overweight women with is a masterful move, since it reinforces the 'you've done this to yourself, fatty' / 'don't let yourself get fat, skinny' message.

What a shame.

Anonymous said...
Check out this one... grumble.

Jenn/hippygoth said...

Hi! I found your blog link-hopping, and I will be bookmarking this. I have had so many bad experiences with doctors and lab techs when I was pregnant that had nothing to do with my health and everything to do with my weight. Thank goodness my OB and the nurses were awesome. And my daughter is healthy and fabulous.

If you want a really rage-inducing look at what people think (as if you didn't know) about fat people having babies, you can always look here. It's been a real roller coaster for me this week, reading that post on Monday and this one today.

Thanks again for making me feel human again.

Anonymous said...

Thank you so much for addressing this panic and the woman-blaming that goes along with it. I am not up on the science the way you are, but the idea, as you say, that doctors are just being FORCED to perform cesareans with no other option seems ludicrous to me. It seems more like we in North America are starting to develop a weird fear of natural birth, and any point at which a pregnancy doesn't follow "the script" exactly is enough to trigger induction or cesarean. Don't get me wrong... I realize that there are many instances where these and other interventions are medically necessary and a blessing compared to the days when women commonly died in childbirth. But like you, I am deeply skeptical of the concept that women can be "blamed" as a group for the increase in C-sections. These are decisions that medical practitioners are making and women often have too little say in the matter.