"Avoidable cesareans are doing a tremendous amount of harm"
Vol 4, Issue 9: September 2024
Welcome back to the Lighthouse! We’ve passed the Fall Equinox and have started moving slowly but surely into cooler weather here in Sheboygan. It already feels so long ago, but earlier this month was Labor Day (aka the defanged holiday we focus on in the US instead of the more radical May Day), which Democracy Now! marked with a special that includes clips from Howard Zinn’s Voices of a People’s History of the United States. It’s a great listen that I highly recommend!
On the COVID-19 front, wastewater levels are still quite high all over, right as back-to-school season begins. Updated COVID and annual flu vaccines are available (we just went to CVS to get both, as the local one has Novavax!), and a new batch of free rapid tests are available to order — be sure to order them, and even if you don’t currently need them, they’re great to pass out! The Sick Times announced their new collaboration with Long COVID Justice to provide over 30 resource sheets on navigating Long COVID. They also released a great commentary article about mask bans, a topic Alice Wong also covered for Teen Vogue. If you prefer listening, I really enjoyed the Death Panel podcast’s episode about mask bans, which does a great job connecting the dots between COVID safety, Palestinian solidarity, trans safety, and racist policing that all play a role in these bans. I also enjoyed The Gauntlet’s article on the fallacy of relying on personal “risk assessments” for COVID when most people don’t actually know the risks thanks to massive systemic failures.
On top of COVID, the effects of online misinformation about vaccines are leading to less people getting vaccinated, including students. Health officials are reporting that fewer people in Wisconsin are even getting their annual flu shot now, let alone COVID vaccines. And whooping cough cases are spiking again, after lulls in the years where we were taking COVID more seriously and people were regularly masking, using remote learning options to keep sick kids at home, etc. We could be using what we learned to improve air quality, normalize masking to keep each other safe, using virtual options, and more, but it seems this is the “normal” we’re supposed to return to.
Now, onto the newsletter!
Why Should You Care Whether You Have a Cesarean?
“And, just to be clear, while I’m going to argue that cesarean delivery is the riskier proposition, I am not saying we shouldn’t be doing them. Appropriate, timely cesarean delivery clearly has the potential to save lives and prevent permanent harm to mothers and babies. However, the sweet spot for the cesarean rate is between 10 and 15 percent, and the U.S. cesarean rate has hovered at 33 percent since 2009, which means we’re doing way too many cesareans in this country, and as the rest of this blog post will attest, those avoidable cesareans are doing a tremendous amount of harm.”
I’ve mentioned this topic briefly before in a past newsletter, but I wanted to dig into it a bit deeper for this one. And it just so happens that author, childbirth educator, and doula Henci Goer wrote up a great starting point on this very topic in her blog post Why Should You Care Whether You Have a Cesarean?1 In it, Henci breaks down what research tells us about the risks involved in cesarean birth versus vaginal birth, highlighting the various ways that cesarean births present more risk. Which makes sense, since it’s a major surgery! As she states in the quote above, showing how cesarean births involve more risk overall doesn’t mean that this is an argument against them ever happening. There are many circumstances in which a cesarean is the best course of action for medical reasons, and I’m absolutely in favor of people making whatever decision works best for them, including an elective cesarean.
Rather, this blog post (and my commentary) look at why we should be questioning the high rates of cesarean birth in the US overall. If the World Health Organization has found that, “as countries increase their caesarean section rates up to 10%, maternal and neonatal mortality decrease,” but, “caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates,” and we know this surgery comes with increased risks and is far more expensive (financially, as well as in terms of recovery, etc), why do we have a cesarean rate over 3 times that?
There are many factors contributing to this, including what is often referred to as the “cascade of interventions,” where the risks associated with various interventions in labor and birth can actually lead to additional interventions being needed (due to the way they can disrupt a body’s typical mechanisms for labor and birth), often leading to the need for a cesarean birth. All of these interventions along the way add additional risks, even for people who started out as “low risk.” On top of this, there is financial incentive for hospitals to push people towards cesarean birth, as one study recently pointed to. Their review of the data from New Jersey hospitals found that doctors are recommending cesareans for Black birthing people at a higher rate than white birthing people, even when they have similar medical histories, particularly during times when there aren’t scheduled cesareans — meaning the operating rooms were sitting unused. Why they specifically singled out Black women to fill these operating rooms isn’t clear, but given the inherent racism in the medical industry, it isn’t difficult to guess why.
Despite the many risks involved in these surgeries, Florida is looking at allowing cesareans to occur outside of hospitals, in places like advanced birth centers, despite the fact that they are not equipped to deal with severe complications that can occur. The Republicans promoting this claim it will help address the reproductive healthcare deserts being created or worsened by physicians fleeing the state due to their abortion ban and the threat posed to the care they offer, despite the fact that this wouldn’t actually help them attract new physicians since it doesn’t address the root cause of why so many are leaving. But when you consider the financial incentive for the private-equity-owned groups pushing for this, it’s easy to see why they’re still advocating for this dangerous idea.
So where do we go from here? While big, structural changes are absolutely needed to truly address this, I believe the first step we can all take is sharing information with people in our lives and having conversations about it so that people understand why this persistently high cesarean rate is an issue. This can help to set people up for making more informed decisions in their own lives (including taking steps to avoid an avoidable first cesarean, if possible and desired) and — eventually — working together to push for changes in the medical system’s “widespread, unchecked medical malpractice,” as certified nurse-midwife Ann Ledbetter puts it.
As she explains further in Scientific American, “…the biggest risk factor for the procedure is the hospital you walk into,” since doctors have authority to push for a cesarean for any number of reasons. Hoping for a vaginal birth after a prior cesarean birth? If the hospital won’t support VBACs, it’s off for a cesarean. Or worse, doctor’s in a hurry to catch a flight or wants to get home to sleep? Cesarean it is. And since both doctors and hospitals tend to get paid more for cesareans and they can more easily fit them into their schedules, why wouldn’t they push for it, despite the risks to the person in labor and their child? As Ann outlines towards the end of the article, there are plenty of ways to help change this, including having insurance companies raise their reimbursement rates for vaginal births to better match cesarean birth reimbursements, lessening the financial incentive for one option over the other. But broader changes, like better integrating midwives into our care system, would go a long way in increasing positive birth outcomes.
See also: Did you know that the widespread use of elective interventions and cesareans is shifting the the gestational age distribution of US births? A new study has shown that “[induction of labor] and cesarean delivery are increasingly being used at 37-39 weeks of gestational age,” but not in response to maternal risk factors. This is believed to be linked to a decline in birth weights.
What's Happening at Lakeshore Liberation?
Nothing new to share this time!
What’s Going on in Reproductive Justice
The inaugural Gender Liberation March happened on September 14th, which explicitly tied reproductive freedom to trans liberation. It’s exciting to see movements coming together like this — our collective power is strong!
Researchers found that tubal ligation — aka “getting your tubes tied” — may not be as effective as previously believed. While the findings still point to only a small number of pregnancies occurring after the procedure (between 2.9 and 5.2 percent), that still means it could be less effective than other forms of pregnancy prevention, such as IUDs and contraceptive arm implants.
At least two Black women in Georgia died as a direct result of the state’s abortion ban (and doctors too afraid to act, or acting too slowly), and another Black woman in Florida almost died for the same reason.
If you love zines and learning about bodies, you’ll also love being a part of Ashley’s zine of the month club! I’ve been part of the club for quite a while now, and I’ve learned so much from these wonderful bite-sized zines (which are always written in really accessible language and with helpful visuals) that get sent right to my mailbox each month. You can sign up here — it’s sliding scale pricing! — or email any questions you have to info@ashleyhartmanannis.com.
What’s Going on in Wisconsin
Milwaukee Mayor Cavalier Johnson is siding with state Republicans as they try to use the budget to force Milwaukee Public Schools to bring cops back into their schools, despite previous reports showing how dangerous this is, especially for Black, brown, and disabled students in the district.
Wisconsin Books to Prisoners has had to stop sending books after the state DOC imposed new restrictions, no longer allowing gently used books to be sent to prisoners. Since most of their stock relies on donated used books, and new books are far more expensive, this ruling has effectively stopped them from doing their important work. WPR reports that they are considering legal action, and I hope they do it and win! People in prison deserve access to books without having to pay ridiculously high prices to get them.
A new report has found that expanding Medicaid in Wisconsin would save the state a staggering $1.7 billion. Despite Gov. Evers proposing this expansion in every budget since taking office, Republicans in turn reject it every single time.
What I've Been Reading
A former hostage of the Palestinian resistance from 1970 shares her experience in Truthout and connects it to her refusal to support the on-going genocide.
Alice Wong wrote a vulnerable and powerful piece for Archer magazine about disability and pleasure.
From Lux magazine, Can Mutual Aid Be More Than a Survival Strategy?
In These Times examines the “leftists” who shift right.
What I'm Watching
Aside from rewatching I Saw the TV Glow twice now, I also watched an incredible film called Oddity that had me on the edge of my seat.
What I'm Listening To
Movement Memos, a podcast from Truthout, has a great and timely interview with the author of Deep Care: The Radical Activists Who Provided Abortions, Defied the Law, and Fought to Keep Clinics Open (a book I really want to read now!) talking about the history of underground abortion care and militant clinic defense.
Places to Donate To & Actions to Take
An acquaintance of mine is undergoing an urgent umbilical hernia surgery and needs help covering the costs of the surgery itself and expenses during the recovery period. Please contribute if you can, and share either way!
Casey and their partner are at risk of losing their housing and are struggling to pay their bills thanks to how little our government cares about disabled people. Again, please contribute if you can and share with your network either way!
Buying refurbished tech from places like BackMarket can help ensure we’re getting as much use out of the products we do need (although buying less is the best option when we can!), which is a great step towards lessening the environmental impact of these products, as well as the impact on the people (often children) forced to mine for the materials used in them.
If you’re connected to the University of Wisconsin school system, you can sign onto the open letter requesting school leadership to oppose mask bans on campus and provide COVID resources.
Questions? Comments? Suggestions?
Feel free to share them below or contact me directly.
Two notes about this blog post (and all of Henci Goer’s work): Firstly, Henci unfortunately doesn’t use inclusive language in her work, meaning all of it refers exclusively to “women” and “maternal health” throughout. Secondly, she doesn’t apply the same critical analyses to things like BMI as everything else she looks at, leading to uncritically including children being “overweight” as a potentially increased risk in this post. I disagree with both of these choices and wanted to make sure readers were aware going into it, as her work can be very helpful otherwise but isn’t without flaws.