In My Mother's House

Saturday, March 13, 2010

The Miami Herald

www.miamiherald.com/2010/03/13/1527325/how-to-avoid-a-c-section-in-south.html

BY CASEY WOODS cwoods@miamiherald.com

Learning that I was pregnant was joyful. Facing the prospect of giving birth in metropolitan Miami was not.

Here, where the Caesarean section rate is 51 percent, a mother has to be very aggressive -- or very lucky -- to give birth the old-fashioned way. I read books, took classes, switched doctors and queried state agencies in a quest for the serene, natural birth I'd always wanted.

It often felt like I was going to war with the entire medical establishment.

There is no question C-sections save lives. They are an important part of modern obstetrics. Yet the way they are casually meted out in Miami-Dade County is profoundly irresponsible. People talk about C-sections as if they are interchangeable with a natural birth. They aren't.

Mothers with C-sections face higher rates of future infertility and chronic pain. C-section babies have more difficulty breast-feeding and are more likely to have asthma and other respiratory problems. The National Institutes of Health cited some of these risks at a conference this week on the rising rate of repeat C-sections.

Beyond the health ramifications, this overused procedure comes at a steep price. C-sections cost nearly twice as much as a normal birth. Maternity and newborn care rank at the top in costs for private and government insurers -- 29 percent of Medicaid hospital costs.

Gratuitous C-sections also exact a sacrifice that is much more difficult to measure: they deprive women of the experience of giving birth naturally. Of course, for mothers who had a C-section, their baby's health was more important than the birth method. Yet many wish their experience had unfolded differently -- not least because recovery time from a natural birth is much faster than a C-section.

At 37 percent, Florida has the second-highest C-section rate in the country, and Miami-Dade leads in that dubious distinction. Of the 10 Florida hospitals with the highest Caesarean rates, six are in Miami-Dade.

Doctors cite a complex blend of factors driving up the rate. More mothers are older, more are overweight and more are undergoing infertility treatments. Parents are easily spooked by what were once considered manageable complications and opt for C-sections. Medical recommendations have changed, and certain women -- such as those with breech babies or who had a previous Caesarean -- are told they shouldn't chance a normal birth.

There is also no monetary reward for a doctor who patiently waits out a long labor when insurers often pay more for a 45-minute C-section. And if something goes awry and a lawsuit is filed, a doctor who has performed a C-section can say he took every possible action to prevent harm -- a powerful motivator in this litigious environment.

``I've never heard of a doctor getting sued because he did perform a C-section,'' said Dr. Salih Yasin, vice-chairman of the obstetrics department at the University of Miami's Miller School of Medicine. ``It's usually because he didn't.''

Doctors say they perform C-sections ``only when it's medically necessary.'' I discovered during my pregnancy that's a subjective designation. For some doctors, C-sections are ``medically necessary'' 20 percent of the time. For others, it is 70 percent.

What's ``medically necessary'' increasingly overlaps with what is convenient.

I started my pregnancy under the care of a three-doctor obstetric practice that came highly recommended. It quickly became clear, though, that our philosophies differed. They were dismissive of my desire for a natural, drug-free childbirth and occasionally sarcastic about my queries. Many of the pregnancy books suggest writing up a ``birth plan'' to let doctors know your expectations, but they weren't interested.

Finally, one of them told me, ``Look, we don't do birth plans. We are your birth plan. If you're not comfortable with that, you'd probably be better off with another doctor.''

I picked up my medical records on my way out.

In my search for new doctors I was dismayed at how little information is available. Neither state medical agencies nor the hospitals give out statistics on specific doctors' rates of C-sections. Expectant mothers are dependent on word-of-mouth.

Through a friend, I found wonderful doctors committed to natural childbirth. The catch: Their practice is so popular that I often sat three hours in the waiting room for monthly checkups.

My quest for a natural childbirth didn't stop with my doctors. I exercised to build up stamina and hired a doula, a female ``labor-coach'' -- factors that studies show lead to lower C-section rates.

I was fortunate that no complications arose that would have made a C-section unavoidable. Though my 17-hour labor was arduous, in the end my son was born without drugs or scalpels.

I just wish I hadn't had to fight so hard, but that's what happens when you live in a place where natural childbirth is seen as an aberration instead of what it is: The best medical outcome for women and their babies.