Wednesday, May 23, 2012

A 50-75% Chance of "Needing" a Cesarean?

Another gem from My OB Said What?!?
“You Have A 50-75% Chance Of Needing A Cesarean Section Next Time…” 
“You have a 50-75% chance of needing a cesarean section next time, because you are short and overweight.” 
– Perinatologist to mother during preconception meeting...after the mother had already had a successful vaginal birth
This is how many doctors perceive us because of our size (both height and weight).  They simply conclude that there is virtually no way for us to birth a baby vaginally, never considering that their own biases around size and their common interventions with short/fat women (inducing early, having a low threshold for surgery) influences these outcomes.

The kicker here is that this woman has already had a vaginal birth, and despite difficult conditions too.  Once you've had a vaginal birth, your chances of having another is greatly increased....yet in his eyes, this doesn't really count at all if you are fat and short.

Older women get the same kind of grief.  And so do VBAC moms.  And it's all nonsense, frankly.

Yes, there is some research showing higher c-section rates in fat women, older women, short women, blah blah blah.  But RARELY do they consider whether it's really that "risk factor" or instead the way they manage the labors of these women and the fear they have around these risk factors that increases the cesarean rate more than the risk factor itself.

In obstetric research,the problem is always assumed to be with the woman.  Not the care provider's management or perceptions of risk, but somehow the fault of the woman herself (or her obesity, or her age, or her shortness, yadda yadda). I almost never see studies raise the question of provider perception or management at all.

It's time for care providers to recognize that their management of women is an integral part of high c-section rates in certain groups...not the only factor, but a much stronger factor than is generally acknowledged.

I have a dear online friend who is currently having a difficult time finding a provider who will support her for a VBAC.  This despite the fact that she has already had TWO VBACs.  It doesn't matter; they just see that she's fat and had a prior cesarean.

This is really pissing me off. Especially since I'm all of the above.  I'm short, "morbidly obese", old, and a VBAC mom.  Most doctors would look at me and tell me I had NO chance of having a vaginal birth because of these four risk factors....and yet I did.  Twice.

Risk factors are not absolute sentences. MOST women, even with risk factors, can birth just fine, if they can just get care providers to "let" them have an adequate chance at it.

It's long past time for care providers (and researchers) to recognize that the way providers manage and perceive women with risk factors has a lot to do with the outcomes associated with them.


Janie said...

you have a greater than 75% of not being my doctor from this point on.

Anonymous said...

Same Janie: run Forest run as fast as you can!

Heather R said...

I was just informed that I have an 88% chance (seriously where do they get these numbers??? It's not like he whipped out a calculator in front of me to calculate my risk!) of having a c-section with this pregnancy because of my weight.