I’m outraged…

I had a nice little essay on a writing topic all ready to go, and then I read this article in the Oakland Tribune. I’ve been struggling to find words to express the depth of my outrage and sadness.

According to the California Maternal Quality Care Collaborative, there has been an alarming increase in maternal mortality–not to mention the whole spectrum of problems facing premature babies–due to “elective” pre-term C-sections.

“Some early births are scheduled for the convenience of the mother or doctor; some are judgment calls that require weighing relative risks.

California Watch reported in September that women are significantly more likely to experience C-sections at for-profit hospitals across the state. In February, California Watch reported that the number of women in the state who die each year from causes directly related to childbirth had more than doubled since 1996.

Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.”

It isn’t hard to figure out that a for-profit hospital gets paid more for a C-section than for a natural birth.

I have very strong opinions on this issue: the safest place for a fetus is in its mother’s womb and only the baby decides when it’s time to be born. Of course, there are medical issues that call for intervention and I am grateful we have the technology to save those mothers and babies. But we’re talking about interrupting healthy pregnancies progressing as they should. This is nothing short of criminal.

I went into premature labor when I was pregnant with my second child. It was at 18 weeks gestation, when there is zero fetal survival. I was fortunate to have a team of skilled obstetricians and access to medical technology that halted the labor. Every day of the 5 1/2 months I then spent at bed rest bought my baby time to develop. Each passing week was a milestone of celebration. 32…33…34…(she could survive now…)35…36…(keep going, baby! Get those lungs ready to breathe!)…37… At 37 1/2 weeks, I was allowed to get up. We all thought I’d go into labor then, but Rose had other ideas.* 38…39… Full term, 7 1/2 pounds.

We should be keeping babies and mothers safe, respecting the natural processes in a healthy pregnancy, not placing both at risk for the sake of profit and convenience. Every week, every day of extra maturation gives both the advantages we were designed for.

“We are finding out that the last weeks of pregnancy really do count,” said Leslie Kowalewski, an associate state director for the March of Dimes.

“At 35 weeks, the brain is only two-thirds of what it will weigh at 40 weeks.” Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.”

That is moving in the right direction, but doesn’t go nearly far enough.

I wonder if this is an issue upon which pro-choice and pro-life factions can find agreement.

*She still has other ideas, being now 24 years old and a pre-med psych major.

Deborah J. Ross has been writing science fiction and fantasy since 1982. Her recent publications include Hastur Lord, a Darkover novel with the late Marion Zimmer Bradley, and Jaydium, available in serialized chapters and ebook here on Book View Cafe.

Find my new and out-of-print books at Powell’s online. Read my essays on the writing life and how to survive reviews in Brewing Fine Fiction.

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I’m outraged… — 11 Comments

  1. Short comment,
    Agreed about the outrage over pre-term delivery, my first was pulled at five weeks early to save mom thanks to complications, then seven weeks in ICU care for him… Second and third both full term, healthy and sturdy…
    Umm.. can’t remember what else I was going to say, too late at night. So, G’Night.

    Dan

  2. G’Night, Dan. Medical complications that threaten either mom or kid are an excellent reason for intervention. Thank God we have the means to do it, and to keep those babies alive until their bodies can catch up. I’m so glad your story had a happy ending — and hooray for two full-term births!

  3. What makes it complicated is that some pregnancies simply don’t go to full term. Sometimes the mother and doctor miscalculate when the pregnancy started. Sometimes the baby is just ready to boogie and is not going to pay attention to picky adult issues like the calendar date. My son was more than 4 weeks early by our calculations, and he was indeed small at birth. However he was fully developed and ready to go. (And he is now nearly 22 years old and almost six feet tall, so the outcome was good.)
    It is the fetus that initiates the start of birth, and I think we should all respect that.

  4. The problem is that anything that approximates a medical complication will be grist for the legal mills if anything is wrong with the baby.

    This eruption of C-sections has not decreased incidences of cerebral palsy. Yet scads of cases have been won by women whose doctors did not perform a C-section and whose babies had cerebral palsy. Get the doctors on the defensive, and they will be more willing to intervene.

  5. There is no question that premature births create developmental and health problems that can linger. It is medically and ethically problematic to have deliveries scheduled for the doctor’s convenience. However, that is not new; it has been fairly routine down the ages.

    At the same time, we must recognize that humans are probably the only animals that have difficult births due to the size of the head as well as other potential incompatibilities (Rhesus factor, eclampsia, gestational diabetes), and women died routinely in childbirth before medical aids became available.

    Finally, I find the expression “respecting who’s in charge here” deeply troubling. It rings of religious fundamentalist “the fetus is everything, the mother is nothing” dogma. Mothers are not passive vessels for their fetuses. Their own health counts for themselves, society and their families, including the children they must be robust enough to raise well.

  6. From what Deborah reports, I can see a good argument for malpractice suits over unnecessary c-sections. That might actually rein them in. And if there is no science backing up claims that cerebral palsy might have been avoided by a c-section, those suits are not likely to be successful. The current gatekeeping rules on admissibility of expert scientific testimony keep out all kinds of speculation, including some things that are probably true but cannot be proved by current science.

    For example, there was an increase in babies born anencephalic in the Rio Grande Valley of Texas. This is a rare birth defect (and a horrible one), and the causes are unknown. Some speculated it was caused by serious air pollution problems caused by the maquiladoras just across the river in Mexico, but there is no way to prove or disprove that. I know of one suit against General Motors and other owners of the maquiladoras, and I know it was settled, but I don’t know for how much (they wouldn’t tell anyone). I suspect it was what we in the legal trade call “go away money,” though, because if it had gone to trial, I don’t think they’d have gotten a dime because they couldn’t get their evidence in.

    Obviously the ideal is a fetus carried to term — and the proper term probably varies a lot — by a healthy mother. I agree with Athena that the health of the mother is of major importance, and all decisions need to take that into consideration. The mother’s health — not to mention her life — should not be sacrificed for the fetus.

    The medical news that most outraged me lately was that the Catholic Church discontinued its relationship with a hospital in Arizona after it did a late term abortion to save the life of the mother. (I think this might the same incident in which a nun was earlier excommunicated because she approved the abortion at that hospital for that purpose.) I fail to see how a religious organization can pretend to be “pro-life” when they would allow a woman to die under those circumstances.

  7. I would like to add a general note on the much (ab)used term “natural”. Cocooned by technology at all scales, we have come full circle to forgetting that 1) natural is not necessarily optimal and 2) goalposts constantly shift as once-heretical customs become culturally embedded.

    To give a couple of examples, many middle class Westerners assume raw food is always better. Yet such food was frequently lethal before reliable preservation (Salmonella, botulinum, ergot, etc) and nutrients from cooked food are far easier for humans to absorb because we have an omnivore’s shortish gut. Childbirth labor pains were deemed natural and there was fierce opposition to using local anesthetics (It’s against God’s will!) until Queen Victoria succumbed to the temptation.

    In particular, research has shown that fully one third of all pregnancies end in very early miscarriages. Given the adversarial biology of placental mothers and their fetuses, there is usually a reason for such miscarriages (severe chromosomal or genomic abnormalities). In this connection, our ability to preserve the life of increasingly premature babies is a double-edged sword.

    Bottom line: we have evolved biologically and culturally a long distance from “natural”. The move has been accompanied by serious benefits and equally serious drawbacks. Invoking natural as the desirable default, however, is long past its expiration date as a useful argument.

  8. Thank you for the link and the post.

    I was still breastfeeding my second baby when the third saw my womb and decided to move in. I knew nothing of her until the day my waters broke. So I only know she weighed 1 kg 200 g (that’s 2.6 lbs, about the weight and size of a bread loaf) at birth — a preemie indeed.

    She’s 15 now. Her eyes are OK, her brain is OK. She remembers to carry her asthma medicines with her always, everywhere. She’s a delightful person.

    But . . . having given birth (and my body wasn’t ready, OMG it HURT!) with a special newborns’ ambulance waiting at the door, having spent a month wishing I could take her into my hands instead of admiring her tiny perfection through a glass box with lots of tubes, having wasted several endless months in various hospitals with her, I can’t imagine who in their right mind would opt for elective premature birth. ‘I’m bored of being pregnant so please cut the baby out of me’?

    We do have legal abortions (up to 12 weeks unless medical reasons intervene) and not-quite-illicit elective C-sections here in Estonia. Our health professionals are worried about elective Caesareans while our Natural Birth Association is worried about too much medicine being pushed on pregnant women. I didn’t even imagine it could get worse!

  9. My first daughter was born by C-section after she went into distress. I had no idea my doctor was a southern girl until the drawl showed up when she told me, “I’m goin’ in and get that baby now.” I had hoped for a drug-free childbirth–right up to the point where I discovered that while I do pregnancy well, I do labor really, really badly, and as one of the nurses pointed out, “there is no nobility in suffering.”

    My second daughter came of her own free will about two weeks earlier than we were expecting her. Her idea. But my room mate had scheduled her delivery as if it were a manicure (having had one, I gotta say, a C-section is major damned surgery, and not a spa treatment!). She also thought breastfeeding was “bestial”, so she and I were thoroughly not on the same plane. But the notion that a birth should be scheduled for the convenience of the doctor or the mother appalls me too. And it sets up a false expectation that the child is going to continue to be convenient, which is so very seldom true…