Amanda Gobble is angry. She’s working through it and putting her passion to good use for the benefit of others, but her frustration remains an unpleasant companion.

This busy Elkhart mom is angry because her four babies were born via cesarean section, and she’s just not convinced they needed to be.

With her first birth, twin girls, she was so close to delivering vaginally she could see it — literally, as in see her daughter’s head. But a last-minute drop in Amanda’s blood pressure had her docs throwing in the towel, Amanda says.

The staff was set up for surgery anyway, Amanda having been given the “just-in-case” labor scenario: epidural catheter in place, laboring in the operating room, surgical team at the ready.

The babies, by Amanda’s report, showed no signs of distress at any time in her labor.

Though Amanda is no medical professional, she’s now convinced the “just-in-case” scenario pretty much assured her surgery although she’d lobbied hard ahead of time with her Elkhart obstetric practice for a vaginal, medication-free birth.

 “I didn’t know so many things,” Amanda said. “And you’re a first-time mom — it’s scary.”

Of course it is.

Amanda’s subsequent births were cesarean sections also, her care with the same physician group. While some providers talk about offering vaginal birth after cesarean (VBAC),— many don’t deliver.



By the third birth (fourth baby, remember), a vaginal birth just wasn’t an option in that model of care. Hospital policy, Amanda says she was told. That baby, Josifine, was born this past September.

Amanda did consider hiring a certified nurse-midwife for an out-of-hospital birth — actually one of the most statistically likely ways to VBAC — but finances and lack of support resigned her to another surgery.

It would be wrong and presumptuous of me to Monday-morning-quarterback Amanda’s births any more than I already have.

But if Amanda were my doula client, I’d want to go back over her medical records in detail for the purpose of discovery. WHY, AGAIN, are we performing surgery on one in three birthing mothers in this country? Cesarean section, remember, was originally considered last-ditch effort to save a baby. That’s last-ditch, not elective.

Well, there should really be one answer — “medical necessity” — but there’s not.

For one, medical necessity is far too subjective. You can give two providers — say, an obstetrician and a midwife — the same woman with the same labor pattern. One will call for surgery; one will not. Both will have healthy babies in the end, though it’s likely one, the surgical birth, will have more troubles with a slow-to-start baby, mother’s recovery, breastfeeding and post-partum depression.

Why is it, then, that one provider says surgery is medically necessary and one does not? The answer begins where it always does: the foundation.

To one provider, childbirth is inherently dangerous and requires medical management because it is, essentially, an accident waiting to happen. To another provider — my obvious preference — childbirth is a force of nature that needs gentle shepherding, yes, but not aggressive medical management in most cases.

So, if medical necessity isn’t always the reason, why so many surgeries again?



People far more experienced and knowing than I have flushed that out in books, journal articles, studies and documentaries. Here I’ll list just a few reasons they’ve discovered and trust that if you’re extra curious, you’ll look for yourself.

• Misunderstanding about how birth works best. Believe it or not, being a “medical professional” doesn’t always equal good understanding about birthing. I’ve been shocked, at times, to realize that I, a hillbilly-birth-junkie-midwife-wannabe, know more about, say, fetal positioning than some doctors do. Or that laboring in an operating room with an epidural catheter and a surgical team staring you down is a setup for vaginal birth failure.

• Convenience. Ugly one, but true. Normal labor patterns followed by spontaneous vaginal delivery aren’t always tidy. They might take four hours; they might take 44 hours. Surgery can be scheduled and over with in short order. Convenient for the provider and practice, the parents, the grandparents. Just not, often, the baby.

• Domino-effect of interventions. Start with induction? More likely to end in surgery. Augment the labor with artificial hormones? More likely to end in surgery. Epidural anesthesia? More likely. Among “natural-birth” proponents, the so-called cascade of interventions leading to surgery is a known fact.

• Fear of liability. Honest physicians will tell you they really don’t want to be sued. If they perform surgery and you or the baby suffers morbidity or mortality, then the doctor will have been seen to do “all that he can do.” As is heard in some circles: “You don’t get sued for the cesarean you did; it’s for the one you did *not* do.”

If you have surgery — necessary or otherwise — don’t despair. My first baby was born that way. It’s something people like Amanda and me are using to help people like you avoid it.



Two things

First, please forgive the offense of last week’s headline stating cesarean section isn’t “birthing.” The point I made last week in the column proper is that I, personally, work hard to ensure people know there are differences in surgical and vaginal births. In our popular society — and often in the health-care arena as well — cesarean section sometimes is presented as just another option rather than major surgery with many risks. Thus I often pepper my conversations with the real term “major abdominal surgery” because that’s what it is. I want no woman to be mistaken: Cesarean section is surgery, and it is not an equivalent alternative to the nature-intended way of birthing. Doesn’t mean it’s any less meaningful.

Second, Melvin E. Miller, health director for a slew of Amish church districts here in the Midwest, gave me a call last week. He wanted to make sure people know that at least one reason Parkview LaGrange Hospital’s cesarean section rate is so high — 38.9 percent, by far the highest in our area — is because the Amish go there for their cesareans thanks to a discounted rate afforded them. So when they know they have to have one, Mr. Miller said, they’ll go to LaGrange.

However, sometimes the “have to have one” is questionable, which begs a different issue. We talked about that, too, and likely you’ll be hearing about it in months to come.

Next week: Let’s lighten it up and talk about toilet training!



Goshen News columnist Stephanie Price is a wife, mother, teacher, childbirth educator, midwife’s assistant and nursing student living in Union, Mich. Contact her at wholefamily@goshennews.com or 269-641-7249.