When April Blackburn found out she was pregnant with her first son, she planned on having a natural birth. She discussed it with her obstetrician, felt supported through the process and never considered a cesarean section.
“Sections were never discussed,” says Blackburn, 28. “It never even occurred to me to ask about a C-section or that they were even that big of a deal because they are portrayed as blasé. When you see someone on a TV show or on a movie or wherever have a section, they don’t treat it any different as a vaginal birth.”
Her doctor scheduled an induction, and later canceled it. Blackburn went into labor on her own the day after her due date. She labored for 20 hours and was fully dilated, but her baby had not descended. Her doctor said she could keep pushing or have a C-section. Nervous and exhausted, she opted for the section and delivered Ethan, a 10-pound baby boy, now 2.
“It was not a good experience,” says Blackburn. “My doc was supportive and nice, but I couldn’t stop shaking during the section. My muscles were so fatigued, and I didn’t want to hold my baby because I was so strung out on morphine. It was not the birth experience I was hoping for, and I don’t remember a lot of it.”
On November 17, 2013, she delivered a baby girl, Alaina, in a Vaginal Birth After Cesarean or VBAC, a decision she says she’s “much happier with.”
“The VBAC went great,” she says. “Very fast labor and no problems during. I did have a bad tear as I delivered which has made recovery a little more difficult. But overall, I’m doing great. Lots more energy than after my section and much more bonding time since I didn’t have all those drugs in my system.”
Louisiana ranks No. 1 in the nation with a C-section rate of 39%, according to 2010 (the most recent) data from the Centers for Disease Control and Prevention. The national average was 32.8% in 2010, a 496% increase from the national average of 5.5% in 1970.
It’s an alarming statistic, local doctors say, and some of the blame can be attributed to Louisiana’s high obesity and diabetes rates. However, they also blame elective inductions, doctors scheduling when a women will go into labor based on control and convenience for the doctors, a fear of being sued and monetary gains.
“Some of it is health, some of it is cultural, some of it is paternalistic medicine,” says Dr. Elizabeth Buchert, an OB-GYN with Associates in Women’s Health in Baton Rouge. “Some people blindly trust their doctor, and it should be that way, but it’s not always in the patient’s best interest. Medicine is a business, and you have to be really critical about who you’re choosing.”
Buchert has been vocal about protesting elective inductions, and Associates in Women’s Health in Baton Rouge announced last spring that the practice will no longer induce labor before 40 weeks.
“In this community, we do a lot of elective inductions,” says Dr. Terrie Thomas, an OB-GYN with Associates in Women’s Health. “If you look historically, in the late 1980s, the induction rate was about 90 per 1,000. In the late 1990s, it was 180 per 1,000 births. Whenever you do more inductions when the cervix isn’t ready, you tend to have more C-sections.”
During Monique Gollner’s first pregnancy, she asked her obstetrician if he would consider doing an elective C-section for her.
“I asked him, and he said, No,'” says the 32-year-old Baton Rouge mom of three girls. “I had some fears of vaginal delivery. I had heard so many stories of friends who had fourth-degree tearings, tearing through and through. Now, I know they had been induced. But I didn’t know any of that six years ago.”
Nineteen weeks into her first pregnancy, she was diagnosed with placenta previa, which means the placenta is covering the cervix, the opening to which the baby exits. Because of the location of the placenta, a C-section is required.
“I was totally okay with the C-section,” Gollner says. “I felt like there were more things I would be certain about. The planner in me enjoyed the idea of the C-section.”
She delivered her first daughter, Leila, now 5, at Woman’s Hospital via C-section. After the birth, Gollner was taken to recovery and her daughter was taken to the nursery. They weren’t reunited for a few hours. She didn’t get to nurse her daughter as soon as she would’ve liked.
“Overall I felt very comfortable with how things went with the surgery, but it took forever for the epidural to wear off. I didn’t get a chance to nurse her right away, and it was really important to me that she learned to latch,” says Gollner. “That was disappointing to me.”
When she got pregnant with her second daughter, Eloise, now 2, Gollner explored the option of VBAC. But after being diagnosed with gestational diabetes and having lingering fears of tearing, she decided to have a repeat C-section.
“I chickened out,” she says.
However, Gollner says she found the confidence to have a VBAC and on August 10, 2013, she vaginally delivered her third daughter, Ivy.
But her obstetrician, Dr. Ryan Dickerson, had gone out of town for a funeral.
“Honestly, this was one of my biggest fears while planning my VBAC—my OB being unavailable,” she says. “He’s human and has the right to grieve his loved one, but selfishly I knew that the lack of his presence could really complicate my VBAC.”
Gollner says it was tough finding a doctor who felt comfortable delivering her baby vaginally because of her two prior cesareans.
“My OB made a ton of calls and did a lot of pleading,” Gollner says. “After two hours my OB convinced the on-call OB to at least meet me and consider catching my baby. The on-call OB came and met with me and decided he would attend my VBAC under a few conditions; I have an epidural and a catheter.” She says he wanted her to be prepared for surgery in case her uterus ruptured.
It didn’t. She safely delivered her daughter. She says if she and her husband decide to have more children, she will attempt another VBAC.
“My recovery hasn’t been free of pain, however, it has been remarkably easier (than a C-section recovery),” she says. “As a mom of three young children this quicker recovery has been very convenient.”
While a C-section is serious abdominal surgery, it can be lifesaving for the mom and the baby. Doctors say severe fetal distress, placenta previa, transverse or breech position babies, certain cases of HIV, poorly controlled gestational diabetes, and small pelvic openings all warrant C-sections.
“There is an undercurrent among patients and practitioners that a cesarean delivery is a bad thing. Cesarean deliveries save lives,” says Dr. Rachael F. Morris, a graduate of LSU Medical School and a Maternal Fetal Medicine Fellow at the University of Mississippi medical center in Jackson, Miss.
But doctors say women choosing to be electively induced because of fear, pressure from an OB or lack of education can lead to unnecessary C-sections.
Buchert says the rates of cesarean births rise sharply at shift change, especially around 5 to 6 p.m. when people want to go home, as well as before long weekends and holidays.
She says a disproportionate number of American babies are also born Monday through Friday, rather than on the weekends.
“Patients need to step up and stop getting electively induced,” she says. “And doctors need to stop making it scary. It shouldn’t be so traumatic.”
After Hannah Birchman spent 35 hours in labor at Baton Rouge General Hospital without fully dilating, her doctor told her she was going to have a C-section. While she had a birth plan, an open dialogue and good relationship with her physician, she felt like the section was her only option.
“I assumed my doctor was doing what was in my best interest,” says the 31-year-old Baton Rouge mom of three girls, Evelyn, 4, Lucy, 2 and Josie, 10 months. “And in my mind, I didn’t think I had a choice. But there was never a reason given for the C-section. She told me, I thought you were tired, and that’s why we did it.'”
She changed doctors for her second birth and started to research the reasons for her surgery and what she could do to have VBAC for her second pregnancy.
“During my second pregnancy there was a lot of anger toward my original doctor,” Birchman says. “Anger at the system. Anger at other people not caring. And fear. Fear that maybe my body was broken and doesn’t know how to give birth. Fear that maybe this will happen again.”
During her second pregnancy, Birchman hired a home birth midwife to be her doula, a nonmedical but trained labor support person. She exercised, ate well and researched natural birthing.
“I was much more proactive in trying to control what I could control,” she says. “I decided if we ended in a section this time, it was because I did everything I could.”
She delivered her second daughter vaginally and without an epidural—in 22 hours.
Soon she became an advocate for other women, co-leading ICAN of Baton Rouge, a non-profit that provides support to women interested in cesarean prevention. She encourages all mothers to advocate for what they want and for OBs to provide their patients with information about all birthing options.
“Women need to realize they’re hiring a doctor,” says Birchman. “The doctor isn’t hiring them. You can change your mind. They need to know what their options are and they won’t know if they don’t know they have the options.”
Buchert says elective inductions can increase the chances of C-section because oftentimes women fail to progress into labor. She says more than 40 percent of all inductions lead to C-section for first-time babies with moms with an unfavorable cervix.
“Elective inductions of labor are popular amongst obstetricians because they can control when a woman goes into labor,” says Buchert. “They are also popular with women for convenience with work and family. But I would argue that many women do not know and are not appropriately counseled about the potential risks involved.”
Buchert encourages all women to forego elective inductions and to be educated and advocate for herself and her baby. She also hopes more doctors will provide women with adequate information to make the best birthing decisions.
“It can be better and it just shouldn’t be better for the women who know,” Buchert says. “It should be best for all women.”
