On February 2, 2010 California Watch, published a story about California’s maternal mortality rate.  It reported the maternal mortality rate in California had increased from 4.3 deaths per 100,000 births in 1996 to 16.9 deaths per 100,000 births in 2006 (the last year statistics are available).

The article cites some factors that are thought to be contributing to this upward trend, and it was not a surprise to me to read that C-sections, and repeat C-sections are one of the main factors officials are finally now considering for the increase in deaths.   The article points out that C-sections are now the number one surgical procedure performed in the United States.

How can California, have such a high maternity mortality rate?  One would think, after the way modern medicine is used in birth today, that the opposite would be true.  This trend is actually not just being seen in California- the entire US maternity mortality rate has also been increasing to the point that it is worse than in some developing countries.  As of 2007, the United States ranked 41st in maternity mortality out of 171 countries.

Officials are now conceding that the increasing C-section rate, might have something to do with the maternal mortality death rate.  As the California Watch article points out, “doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.”

Along these lines, while researching this blog post, I came across an interesting report from The Joint Commission dated January 10, 2010 on preventing maternal death.  It cited a study by the CDC which listed the six leading causes of maternal deaths between 1991 and 1997. The second leading cause was was hemorrhaging, causing 17% of the deaths. The fourth cause was infection at 13%.   The report goes on to identify and cites two out of the four common preventable errors that lead to death were: failure to pay attention to vital signs following a C- section, and hemorrhaging following a C-section.

It is interesting that a leading cause of maternal death is hemorrhaging, and one of the most common errors that leads to death is hemorrhaging after a C-section. The CDC reported on these findings thirteen years ago, and officials are just now seriously considering there could be a link between C-sections and a significant rise in the maternal death rate?   It doesn’t seem like this has been a hidden fact, or that the research wasn’t being done.  This seems more like a case where statistics and research has been emerging for years, but has been largely ignored or brushed off by medical officials.  Until now.  When California’s maternal death rate is worse than some countries like Bosnia or South Korea.

I have my own theory that the higher a state’s C-section rate is, the higher the maternal death rate will be.  While the CDC reports on the C-section rate for every state, not every state publishes their maternal death rates.  I could only come up with an handful of state statistics for 2006 on maternal death rates.  It’s not enough to draw a definite conclusion.  But consider that  Pennsylvania had 19 maternal deaths and their C-section rate was 29.7 percent.  Washington had 20 maternal deaths and their C-section rate was 28.4 percent.  Compare that to California who had 95 maternal deaths and a 31.3 percent C-section rate, and Texas, who had 90 maternal deaths with a 33.2 percent C-section rate.

It’s no secret that other countries who have lower C-section rates also have lower maternal death rates.  In Ireland for instance, the C-section rate averages around 21 percent.  A joint UN/WHO report in 2007 found that Ireland also had the lowest maternal death rate in the world for women dying during or after pregnancy.  Only one out of 47,600 women died, compared with one in 4,800 in the United States.  The C-section rate in the United States in 2006 was 31.1 percent.  It has been projected (but not confirmed yet) that the C-section rate in the US for 2007 will be 31.8 percent.

The California Watch article tells of a medical director in California, Dr. David Lagrew, who in 2002, banned elective inductions at his facility before 41 weeks  or pregnancy, except in rare incidents.  Inductions more than double the chances of C-sections.  The article says,  “as a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.” (bold print mine)

This should have been great news, but as expected, the hospital lost money.   On average a C-section costs twice as much as a vaginal birth.  Yet, we are constantly told that revenue has nothing to do with the increasing C-section rates.  It is because the C-section is “medically necessary.”

If Dr. Lagrew was able to decrease “medically necessary” C-sections in California, right when the maternal death rate was increasing, it ought to be done elsewhere. If Ireland can have the lowest maternal death rate in the world, despite not having all the technological advances that the United States has, and has a considerably lower C-section rate than the United States, that should tell all the officials out there who are trying to figure out why the maternal death rates are increasing, that C-sections are a significant factor in maternal death rates.

It is the white elephant the medical community, and hospitals in general won’t admit, despite research pointing them in this direction for years-decades in some instances.  And yet, the C-section rate continues to climb, and more women are dying during pregnancy and childbirth.

I looked up the modern version of the Hippocartic Oath that doctors take upon graduation.  After reading these, it is hard to be convinced that most doctors have these oaths in mind in regards to C-sections and births in the United States:

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,…”

and the last one:

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

Maybe it is as simple as that.  Maybe if more doctors and hospitals realized a woman’s body is capable in most cases of giving birth without surgery, and let their bodies do what they are capable of doing-just like Dr. Lagrew did, maternal mortality rates would drop in our country. Maybe when ”Big Business” gets out of the birthing process, C-section rates will decline, improving maternal health.

The answers to solving the increasing maternal death rate are out there, and have been for years. The question that demands an answer is, when will the majority of the medical community stop ignoring the answers?

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It has been a while since I have written on the topic of C-sections.  However, a post I wrote almost two years ago, The Reality of C-Sections, remains the most popular post on A Mama’s Blog.  It has received over 11,000 page views to date.  I decided to share my C-section experience and what I learned so others could be informed, and make decisions about C-sections based on knowledge.  I would have never been able to go out and tell 11,000 plus people my experience, so I am pleased the post has been successful. 

Of course not everyone agrees with me, and I get passionate comments from women on both sides of the issue.  Some women have chosen to share their own C-sections stories with me privately, and in the comments.  Some are horrifying.  Some are heartbreaking.  I have cried at many of the stories, because so many of the causes given for the C-sections seemed so unnecessary to begin with, and the toll the surgery has taken in these experiences, is extensive.

I have received many comments from women who say their C-sections were great experiences and they have no regrets.  I have received accusations from other readers who think I am trying to scare women.  I have been called every obscene name at least twice.  

I don’t mind a difference of opinion that is conducted in a respectful manner, but after my health issues last year, I have less of a tolerance for rude comments and readers taking personal shots at me.  Lately, whenever I see a comment has come in on the C-section post, I get butterflies in my stomach, and hope it isn’t a nasty comment.  I have defended my position so many times in the comments there really isn’t anything new that I can offer, that I haven’t already stated.  If it is a comment attacking me personally, I delete the comment.  It serves no purpose to anyone to state an argument in that manner.

I have been thinking about closing comments on that post.  At what point does a discussion run its course?   But then I will receive a comment from someone who has thanked me for writing the post.  Or a woman shares her C-section experience.  So many women have said they have cried while typing out their stories, and I believe just by being able to type out the words, it helps heal.  I know, because writing helped me start to heal from the unresolved issues I had from my C-section.

On Sunday a very touching story from Sarah was posted on her C-section experience. (It is the fifth to the last comment currently in that post’s comments).  Her experience brought tears to my eyes, and as soon as I read this sentence that she wrote, “i am not sure that i will ever get over the emotional trauma i experienced when my daughter was born,” I realized closing the comments would be a mistake.  Reading this from Sarah made me realize how deeply the emotional trauma can run from a C-section.  While it lessens, it never fully goes away.  Just like the positive aspects of birth never go away, the negative emotional tolls don’t either. 

Six years has passed since my own less than ideal and emotionally traumatic C-section.  It is disheartening on some level to read that some C-sections are even worse than mine was six years ago, and that they are still being performed at an alarming rate- almost one in three births in the United States is a C-section.  (This figure is from 2007, and is probably higher for 2008 and 2009 but the rates have not been released).  It seems at times for those of us who believe C-sections should be reserved for true medical emergencies, it is an uphill battle.  What difference really can we have?

I found out how much of a difference one person’s experience can have this past weekend.  I was getting my haircut, and only have it cut every few months now.  My stylist, “Emily,” told me she was seven months pregnant, and of course I congratulated her.  Emily is young- at least young from my perspective- she probably is not older than 25.  She knows I have two boys, and she asked me what hospital my kids were born at.  I told her, and told her I had a C-section with my first son and a VBAC (vaginal birth after cesarean) with my second son.  Emily asked me which was better- the C-section or the vaginal birth.

I told her the VBAC by far.  I told Emily I was holding my baby seconds after he was born, versus not being able to hold my baby for an hour after birth with a C-section.  I told her I was able to eat 30 minutes after the VBAC, versus three days after with a C-section.  I told her I bonded instantly with Cole after he was born, versus five days with Ryan, after the C-section.  I told her I was nursing Cole within minutes after the VBAC, versus an hour with the C-section.  I told her I felt better three days after the VBAC birth versus twelve weeks, with the C-section.

Emily was quiet for a minute, and I was wondering what her reaction was going to be.  She put down her scissors and told me, “Thank you.”  I was a little surprised, because I was expecting her to tell me she had heard C-sections weren’t that bad.  Emily told me that she wanted a natural birth, and so many people have tried to talk her out of a natural birth.  She also said so many have told her that she’ll end up with a C-section anyway.   Emily said she was starting to doubt if she could really give birth naturally, but hearing my comparisons, it firmed her resolve.  Emily said unless she had a medical emergency, she was going to give birth naturally, and not let anyone talk her into a C-section!  It was so encouraging to hear a younger mother with that attitude.  I told her of a few resources that could help her even more, and she thanked me again for being honest about my birth experiences. 

I have thought about this exchange for a few days now, and after reading Sarah’s sentence, the realization became very clear.  Emotional trauma from a C-section does not ever completely vanish. It will always be- to some extent or another- with us.   It doesn’t matter if it was a week ago, twenty years ago, or if it was a medically necessary C-section or not.  We can never go back and undo what was done.   But our honest experiences with C-sections can be more powerful to someone who is seeking information than any books, or medical professional.

When women are told they need to “get over” their traumatic C-section births, by ignoring the parts of their birth experience which were negative, or traumatic, it doesn’t ”magically” make everything better.  It harms the women again, because now it isn’t acceptable to share or to talk about anything that isn’t a positive birth experience. 

There are still women, like Emily, who believe their bodies are capable of giving birth the way they were intended to do so.  There are women who don’t believe insurance companies, hospitals, drugs and surgeries are the answer to birth.  These women want to know the truth, and are seeking answers.  On the opposite side, there are so many women who had no one who shared their C-section experiences with them, when they had to make their decisions.  There are women who have lost so much, and and have been hurt from C-sections.  How do these two sides come together?

By telling our stories.  It doesn’t matter that some won’t agree with you.  It doesn’t matter that some will tell you to get over it.  It doesn’t matter that some will tell you, you should be grateful your baby is healthy.  It doesn’t matter that some will accuse you of trying to be overly dramatic.   It doesn’t matter that not all C-sections are traumatic for everyone.  What does matter is ours was.  What does matter that someone else’s will be too.  What does matter is we talk about it.  It matters that we share our stories, and honor our birth experiences- all of them. 

For the women who refuse to accept a C-section is the normal way to give birth, by sharing our experiences, we confirm their instincts, and they confirm ours- a surgical birth is not usually the best way to give birth.  Most importantly, by talking about it your spirit starts to heal.  A little at time.  Never completely, but enough. Our experiences become patched together like a quilt.  This is enough to make a difference, one birth at a time.

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Before I had my kids, I used to workout.  In a real gym.  With actual exercise equipment like treadmills and weights.  Not that carrying around a baby who was 15 pounds eight weeks after he was born (Cole) or a toddler who was 25 pounds (Ryan) at the same time wasn’t a good workout, but it wasn’t exactly the same.

After having kids, there wasn’t time for gym workouts.  My workouts tapered off into walks with the stroller.  This was easier when there was only one baby, because a two-and-a-half year old doesn’t want to ride in the double stroller- no, they like to walk.  Very slowly.  And while that is fun, it is not a workout.  

When it came time to renew the membership, I realized I had been there maybe once during that past year to take the boys swimming in the kiddie pool.  It couldn’t be justified to pay for something that was not being used.  I cancelled the membership.  I still took the boys for walks several times a week, and would get out at times by myself for a longer walk, a short jog, or in the summer, a bike ride. 

Over the years, I have forgotten (not sure when exactly) how much I liked and benefited from strength training.  I would spend hours each week at the gym working the various muscle groups with weights.  Fast forward almost seven years later, and that has been how long since I have done any type of strength/core exercises.

When I was trying to figure out what was causing my shin splints, it made sense that my shin muscles weren’t very strong.  When I was talking to Alison about it she made the point that my other leg muscles might not be very strong either, and that could be putting more stress on my shins than necessary.  This seemed like a logical explanation, so I have decided the seven year break from strength training is over!

Alison showed me some wonderful stretches and exercises last week her personal trainer had given her, specifically for running.  These were designed to use weights, and they targeted not just the legs, but the entire body, and core strength.  I was sore from them for a few days, but it really proved the point that several of my muscles groups could stand a lot of improvement.   

I’m really excited that Alison’s trainer is going to have a running workshop soon.  I am sure I will learn a lot more from her.  In the meantime I am taking it cautiously, and working with three pound weights to get started.  At home.  Because I still don’t have enough time for an actual gym membership, but for the times I can squeeze it in, I am now thinking along the lines of the rec. center.

I really appreciate all the helpful advice and suggestions my friends share with me.  To achieve my running goals, I feel like there are all these little pieces of the puzzle that have to come together.  By adding strength training back into my routine after all these years, it feels like I found another part of the puzzle!   Slowly but surely, I am going to solve the puzzle.  One piece at a time.

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Last summer, the boys’ daycare provider closed her daycare.  Cole had been with her since he had been 18 months old.  She loved the boys, and the boys loved her.  We have always been fortunate and thankful the boys’ grandmother can watch the boys on the long days I work.  

On the shorter days, Ryan is in school now, so I had to find part-time care for Cole and back-up care.   When I found J., our previous provider, it was a little easier because I had two kids that needed care.  Finding part-time care for one child, was a challenge-most providers don’t accept part-time kids.  It took me almost two months to find an acceptable replacement.    

In late November, I found A., who was willing to take Cole on a part-time basis, and to provide back-up care when the boys’ grandmother isn’t available.  When we met A., I had both boys with me, and Cole was happy as a clam.  There was another boy who was also 3, who attended full-time, so Cole would have a friend to play with.  They played great together while we were there for our interview, and everything seemed and felt right. 

But every time it is time to go to A’s, Cole cries.  He says he doesn’t like it, and he wants me to stay home with him.  Last week he asked me why I have to go to work. I haven’t experienced “mommy guilt,” on a regular basis, but the past few months it hits me every time I take him to A.’s. Last week he cried for 20 minutes when I dropped him off.  It wasn’t just a tear- he was sobbing.  I felt like I was sending him off to war. 

Part of it is he has never done anything on his own without Ryan.  Whenever he has been away from myself or his dad, Ryan has been with him, or he was in the care of his grandparents.  Part of it is he doesn’t attend day care full time, so it makes the adjustment harder.  Part of it is he is 3.  It is a hard age for changes. 

A. has been great.  I have no qualms about the care she is giving Cole.  She has done daycare for 25 years, and is very capable and loving.  She told me last week Cole almost has fun, if he would just let himself go.  She said it is like he starts to have fun, and the “remembers” he isn’t supposed to like being there, so he gets upset.  Last week we made a few changes, and I was actually greeted with a smiling boy when I picked him up.  A. switched their art days to times when Cole would be there.  He had painted two pictures, and was so proud. We also let him decide if he wanted to take a nap, or just have quiet resting time.  The choice seemed to give Cole a little control.

When we got home, I gave Cole some tape and told him he could hang the picture anywhere he wanted.  He hung it right above my bed.  I realized that he was so proud he had something to bring home.  Ryan brings home enough papers, drawings, books, and artwork to open a gallery.   Cole never seemed to be bothered by this, but I think he liked having something he brought home.

The boys ask me what we are doing the next day at bedtime.  When I have told Cole the next day was a day at A.’s, he would cry.  Last night he didn’t cry.  This morning he wasn’t stressed and didn’t cry in the car on the way over, but he did want me to hold his hand as we walked up to her door. 

A little girl in the daycare throws her arms around Cole the minute we walk in, and usually Cole stands as stiff as a board.  Today he hugged her back.  He asked me what colors I liked, because he was going to make me another picture.  I told him, gave him a hug, and then he left me to go play with the other little boy.  When I picked him up, he was so proud to show me that he had made me two pictures.  One of them was a hot pink lizard with a red tongue.  He said he made it pink, because that is a girl color.  When we got home, he hung it up right next to his picture from last week.

It is one of the hardest things to have to leave your child, when they are crying at daycare.  It is hard when they are happy, but at least you can tell yourself they are having a good time while you are gone.  I wasn’t sure what I was going to do if things didn’t improve.  It didn’t feel right to have Cole so upset when it was time to go to A.’s, but I also don’t have a lot of options.  I’m relieved that it doesn’t appear that I will have face that issue.

Having your child make a change out of necessity, whether it is day care, or because a new sibling is born, etc. is tough.  But it also gives the child a sense of accomplishment, as they adjust.  Sometimes it takes longer than we would like, but more often than not, they get there.  As parents, we don’t always have all the answers.  At times you just have to listen to your instincts, go with what you think is best, and hope it turns out okay for everyone involved.     

As Cole handed me my painting today with a big, happy, smile on his face, I was so proud of him.  He’s adjusting to daycare as he needs to, and in his own way- today was the turning point, and a milestone for him.  He will be fine.  And I will always have one very special pink lizard painting-to remind me.   

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On Saturday I participated in the Quicker Quaker Oatmeal 5K that was part of the Oatmeal Festival in Lafayette, Colorado. 

I met up with my friend, Alison, who had decided to get back into running after a two-year break due to some injuries. I have to tell a quick story about Alison first though.  I actually only met her (so I thought) in September, but have known of her for several years.  We have friends in the same circle, but never managed to meet, or be at the same functions until last September.  But she seemed to have a lot in common with me, and when we actually met at the Mile High Mama’s social media event, we hit it off right away.  We had never ran together until Saturday.  But we ran at a very similar pace, and in fact we both finished with the exact same time.  We were talking more later on Saturday and we figured out we had actually been in the Boulder Youth Symphony together 1989!  Talk about a small world!

Back to the race- it started at 9:30, and we ate a great oatmeal breakfast with every topping imaginable with Alison’s husband and little boy.  We finished breakfast and had about 45 minutes before the race started so we got organized and started warming up.  We stopped at my car to put our free oatmeal swag from the breakfast away, and got someone to snap a picture of us:

We lined up about 10 minutes before the race started, and it was crowded!  We were in the front, and it just kept getting more and more crowded.  The temperature was probably about 30 degrees.  We heard a loud “GO!” and everyone started running, so that was the big start.

This race had some elite runners in it, so they started a few minutes before everyone else.  Because of this, the roads were sectioned off.  At some point, all the timed runners were going to have to merge into a single lane, so as not to run into the elite runners.  The race course started with a nice downhill, and I was pretty certain we would be running up that hill later! 

The course was really crowded, right about the time Alison and I felt warmed up and ready to make our move, we had to get in the single lane.  There was no room to pass, or proceed at a faster pace.  We basically had to just keep running slower than the people in front of us.  I found this really frustrating.  I hadn’t experienced this before, so I didn’t know what to do, other than just keep going and hope there would be a chance later to pass. 

We got to the lake about the half way point, and had to run up a hill to get to the trail on the lake.  Once on the trail, it was narrow and there wasn’t any room to pass.  I was also a little more tired, because I am not used to running up hills. I made a mental note that I was going to have to start training on more hills!  Here’s a picture of Alison on the lake trail:

 photo by Steve Gandy

As we started running downhill, the course opened up a bit, and we started to pick up the pace, and break away some. By the time we were finished at the lake and back on the street, the entire street was opened (since the elite runners were finished by this time) so there was a lot more room to run and find a pacing.  But now, all the “little” downhills we had run at the beginning were coming back as uphills.  I glanced at my watch, and saw we were at 22 minutes. 

I was getting really tired!  As we ran up that first hill that was so nice at the beginning,  but was now making my thighs burn, I told Alison the hills were killing me.  She asked me if I wanted to walk for a while.  That snapped me out of it!  I wasn’t going to wimp out and walk!  I told myself I could get through the hills, and we finally reached the top.  Then we just had to keep turning down street blocks that thankfully, were flat.  My mind seemed to think every time I turned the corner, that would be the finish, but every time we turned the corner, it was another corner.   I didn’t look at my watch again, because I didn’t want to know.  It seemed like this race was taking forever! But we were passing people.  I felt like my pacing, timing, and overall presence of mind was a bit off.   

There was finally a volunteer as we turned another corner who said it was the last corner, and as we turned, I could see the finish line, probably a block away.  Here’s me heading for the finish:

 photo by Chris Gilstrap

It was very satisfying crossing that finish line!  The clocks there said 30:56, and I was really surprised.  I thought it would be more like 35 minutes at least.  I heard Alison right behind me.  We gave our timing paper to the volunteer, and it was over!  Alison’s husband and little boy were at the finish. 

Then I heard  “Hi Heather, I saw you pass me there at the end,” and it was a friend from high school.  He told me his time, and I had finished a few seconds ahead of him.  Then another friend from high school joined us a few minutes later, who had also run.  It was like a mini high school reunion, and it was fun catching up.  We talked about the course, and I was told even the Bolder Boulder doesn’t have as many hills in it as the course we had just ran.

The official results were out a few hours later, and  both Allison’s and my time was exactly 31 minutes. I ended up 18th in my age group out of 78 runners. Out of 663 women, I finished 197th, and out of 1086 total runners, I finished 444th.   I was really happy with the results.  I told my sister before the race, my goal was to finish in the 30th percentile for my age group and I finished in the 23rd.

I learned so much from this race.  First, I need to train on a little steeper terrain.  Not all the time, but enough so that a few hills don’t throw me or tire me out next time.  Second, Alison said she noticed I wasn’t breathing as effectively as I could be.  Thirdly, I need to have a mental plan on how to adjust for the race, if I can’t get my pacing down, or have room to run like I want to for the next race.

I was very happy that I had no shin pain during the race.  Afterwards, my shin bones felt slightly sore to the touch, but I had no muscle pain like I did after the last race.  

Alison and I enjoyed running together and figured we are perfect running partners, so we are going to start running together once a week.  I plan to enter at least one 5K race a month, and hopefully get faster times each race.  Alison and I are going to start training for a 7K (4.3 miles) race in March.  This is for the longer term goal of competing in a 9K (5.6 miles) race in early May.  If I can handle these distances, and my shins hold up, I am going to run in the Bolder Boulder on Memorial Day, which is a 10K (6.2 miles) race. 

One thing I can say about running is it is never boring.  There are always challenges to conquer.  I like that part.  Each race presents a new set of challenges.  By eliminating them limitations are peeled away.  What is uncovered in the process, a layer at a time is strength.

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