The system is broken if it doesn’t leave people whole – Part 2

Previously: Part 1: I maunder on about my experiences as a doula

I’m making this all sound a little grim, that’s because it is a grim business and the statistics bear that out. In British Columbia, where I live, the current c-section rate is over 30%. It’s not a stretch to suggest that for every three women who give birth in this province, one will end up with major abdominal surgery. This is not a supportable rate. The World Health Organization recommends that a reasonable c-section rate should be no more than 5-10%, and this rate has been shown repeatedly to produce the best outcomes for mothers and babies.

Now if a reasonable rate with the best outcomes is 5-10% and our current rate is over 30% then 20-25% of birthing women are having unnecessary surgery.

Let me repeat that.

The medical model of birth as practiced in British Columbia (and the rest of Canada and much of the United States) results in 20-25% of all birthing women, perhaps as many as 1 in 4, having unnecessary surgery. 2/3rds or more of the c-sections performed do not improve outcomes for mothers and babies.

And of course, it’s not as though the women who are giving birth vaginally are getting off scott free in this system. They’re birthing under the ever present threat of major abdominal surgery, for one thing. Forceps and Vacuum extractor are used 3.4% and 6.3% of the time, so that means another 10% of women at the very least are having episiotomies and having their babies pulled out with varying degrees of skill. 45% of women have epidural anesthesia, which is certainly successful, most of the time, at blocking sensation, but also makes far more likely the perceived need for “augmentation” of labour, including artificial rupture of membranes and pitocin augmentation – I couldn’t find a rate for pitocin usage, but it tends to be fairly high, often as much as twice as high as the c-section rate. 21% of women in BC also have their labour artificially “induced”.

Women are having pretty awful birth experiences. Not universally, of course. But a lot of them.

I used to explain to people how the cascade of interventions worked, how one intervention would lead to another and then another, and how one simple bad decision on the decision tree could lead to a seemingly necessary (but really unnecessary) c-section. And in my explanation, I’d pile them on a little. My hypothetical birthing women experienced as much intervention as I could believably throw at them in order to demonstrate the point.

And people were a little disbelieving. Who could blame them? It does seem a little outrageous that doctors, who are in the main probably well-meaning people, could end up performing unnecessary major abdominal surgery on one fifth to a quarter of their healthy birthing patients.

But the problem with my hypothetical is I saw it played out or heard about it played out in almost exactly the ways I’d described far too many times. It wasn’t just an illustrative fiction, it was a common reality.

Next: Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change
Part 5: The system is broken. What next?

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