April 18, 2014

Dying to have children

According to a CNN report, deaths from pregnancy and childbirth have doubled in the United States in the past 20 years. This development received a harsh response from the human rights group, Amnesty International, which called the findings “scandalous and disgraceful”. As if this information isn’t bad enough, it gets worse. It also points out that most deaths and complications in pregnancy and childbirth happen among minorities and women in poverty. Hold on to your seat because I’m not done. Yes, my readers there’s more to this and it get even more abominable.  White women have a mortality rate of 9.5 per 100,000 pregnancies, while Black women have a death rate of 32.7 per 100,000 pregnancies.

Black women make up 12% of the population and yet we account for 50% of maternal deaths in the United States. Why are we not screaming from this mountain tops about this? Where is the uproar from our community about these shameful, damaging statistics about our mothers, our daughters, our sisters, our aunts – ourselves? The lack of proper and timely medical care due to insufficient or no health coverage was the overwhelming factor in higher rates of maternal deaths in the Black community.

However, my sisters, let me impart to you yet another culprit that is on the rise and gaining quite a bit of momentum in our community. Nowadays, it’s not uncommon for pregnant women to schedule the birth of their babies no differently than they set an appointment to their favorite hair salon. A date is set. The pregnant woman is induced and an astonishing 34% of Black women will opt for a c-section over a vaginal birth reports the Center for Disease Control and Prevention’s Center for Health Statistics.

The rise in the number of c-sections performed to all women in the United States has received severe criticism and negative publicity globally and nationally in recent years. This disturbing trend has increased to 33%, making c-section the most common operation in the US. When that 33% is broken down even farther, once again is the realization that Black women are at a higher risk of maternal death since 34% are delivering babies through c-section compared to 32% for White women and 30% for Hispanic women. C-sections are major surgery. To opt for such a choice when there isn’t a medically necessary need is to willingly put place one’s body in a high risk position. The implications of such a choice could be anything from infertility to death. Even when there is a medically necessary need for a c-section, 10-15% of these women can successfully have vaginal births after c-sections (VBAC) if they chose too, states the World Health Organization (WHO) and yet only one third will attempt a VBAC.

Black women we need to blow the trumpet on this situation. Sound the siren loud and clear. We live in one of the most technologically advanced societies in the world and yet of all the industrialized nations we have the highest rates of maternal death.  We have the ability to take control of our health and be proactive about our well-being. The time is now for the screaming from the mountaintops to begin. Rise up my sisters. Rise up.

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Ana Gazawi

Ana Gazawi

Single mom of two boys trying to live a greenier, crunchier life. Lover of life and all things that bring good people, great conversation, and lasting memories together.

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Ana Gazawi About Ana Gazawi

Single mom of two boys trying to live a greenier, crunchier life. Lover of life and all things that bring good people, great conversation, and lasting memories together.

  • http://www.thencameisaiah.com Tiara

    As a black woman who is eight months pregnant with her second child with a c-section scheduled next month due to previous complications, I am somewhat disappointed with this piece. First, upon reading the referenced CNN article – http://www.cnn.com/2010/HEALTH/03/12/maternal.mortality/index.html -the researchers have attributed the disparity between the mortality rates of women of color and those of white women with socio-economic issues. In other words, women of color, who are disproportionately in a lower economic class, have limited access to medical insurance and are often subjected to unnecessary insurance barriers when trying to get pre-natal care. Civil rights groups are outraged at the lack of access in one of the richest nations in the world. This article can be construed as somewhat deceptive as there is no correlation between these statistics and black women opting for c-sections.
    I also read an article in Essence which uses your same statistics about c-sections – http://www.essence.com/lifestyle/parenting/c-section_births_among_black_women_on_th.php – It is accurate – c-sections are riskier and I don’t doubt the monetary incentive of doctors and hospitals to perform them more frequently than vaginal births. However, there are a number of factors contributing to why women of color may need more c-sections. The first would be obesity. We have an obesity epidemic in our community. When a woman is pregnant and obese – that can lead to a number of risks including gestational hypertension and diabetes. We, as black women, do need to rise up and become informed. We need to support efforts to reform health care and make sure there is equality in exposure to quality prenatal care. When you factor in these additional risk factors inherent to our community natural childbirth can be more risky than a c-section. Had I hesitated when I had my first c-section my son and I would be dead. Weighing these factors going into my second birth, I would rather not risk my son’s health and my health based on statistics or fear. I urge people to consider each individual case, find a doctor you can trust and weigh the pros and cons of this very important and delicate decision.

    Nonetheless, thanks for the article – it certainly woke me up!

  • http://www.kristinabrooke.org Kristina Daniele

    I too had an emergency c-section after 36 hours of labor and numerous issues during my pregnancy (and despite my weight none of the issue were due to being obese). I will probably have a c-section with any future pregnancies as my history being pregnant is very stressful and dangerous to say the least.

    However, I do believe that Ana is not referring to those women like you and I Tiara who have had c-section because they were medically necessary.

    There is a trend with women scheduling c-sections because they want to forgo the labor…I forgot where I read this but it is not uncommon for doctors and patients alike to want to control the labor process by scheduling exactly when babies come. Celebrities do it all the time and in our society where people latch on to behaviors that they see in the media, I wonder if this is contributing to the rise in c-section rates. The fact is that c-sections are surgery and carry the same, if not more, risks as any other surgery. And if you are not exposed to quality medical care your are much more likely to become a statistic.

    I agree that we need to become more proactive in our medical care. Ask questions. Have someone with you to advocate for you when you cannot advocate for yourself. And more importantly, be informed. Read. Talk. Ask.

    • http://www.thencameisaiah.com Tiara

      I definitely recognize that trend – c-sections for some are the more convenient and trendy option. I just thought the article implied that as black women we are subscribing to this culture and that is why there is a rise in c-section when I really doubt it. I think we get more c-sections because of the socio-economic disparity in our access to pre-natal care and because of the cultural risk factors. I am very sensitive to this debate because when many some moms they hear I am having a c-section they assume its a selfish choice instead of the most informed choice. The VBAC stats also concern me because depending on why you had a c-section the first time VBAC is far riskier than a repeat c-section.

  • http://teanhoneybread.blogspot.com t. allen-mercado

    Thank you for taking this topic on, it is a growing trend and quite alarming. I certainly think there are far too many unnecessary C-sections being performed, and by that I mean elective C-section by otherwise healthy women. Convenience and economics play a huge part-the doctor is “freed up” to deliver any number of babies throughout the nicely scheduled week-each at I’d imagine a higher rate since it is actual surgery. We need to be informed-even when what we hear doesn’t sit quite nicely.

  • http://lovesgumbo.com love’s Gumbo

    I know that this article is meant to be helpful and informative, but every time I read something like this it makes me a little sad. I tried to have natural childbirth with a mid-wife with my first, and it ended in an emergency c-section. I tried for a VBAC with the second and after pushing for 2 hours and getting an episiotomy, it ended in a c-section. With number three, I didn’t have a choice. The doctor refused me a VBAC because of my history of two previous c-sections. I had to schedule a c-section. I am not obese, I am not high-risk, I am not of a lower socio-economic status, but I always feel like a failure when I read articles about how having a c-section is a less than desirable circumstance, and in essence how any woman who is Black and has one is a victim of the system. I know you can tell me that you are not saying that, but I feel like a victim who had my children in a less than acceptable delivery when I read this kind of stuff.

    I believe whole-heartedly in the empowerment of women, so I think what you are doing is important. However, I always feel like the water-birth, natural-birth, vaginal-birth mothers are looking down their noses at me. I need to get a little more self-esteem about my birthing experiences.

    • http://babygirlzmagazine.com/ Traci

      I agree with you, Brooke. I too had a C-section with my son and was told weeks in advance, that it would be the case. I fit none of the criteria above either – and had full private insurance coverage at that time, but it was the route my doctor recommended. He sat down with my WHOLE family and discussed with us why this was the best option and I was comfortable with that.

      I have often felt that I was “less of a woman” because I didn’t have my son the ‘natural’ way and have had many heated discussions around the topic. It often has that feel to it that I get when in the company of my sister-in-law, who is a vegan and frowns upon anyone with eating habits that don’t match hers…By the way, she also had the FULL natural birth with no medication at all. Needless to say, she is one of the people I’ve had those debates with, but that’s for another post lol! But hey, she didn’t pull her baby out on her own like Kourtney Kardashian did on the show. Now that was something I was in awe of!!!

      Like you, I guess “I need to get a little more self-esteem about my birthing experience”. You know what though, I went through the whole labor process and opted for no medication because my cramps have always been so bad that I was able to take the pain at levels most women couldn’t. But does that make me more of a woman? Probably not.

      On another note, I do agree with us needing to step our game up where relations with our doctors and our health, are concerned.

  • http://www.blog.carisabrewster.com/ Carisa Brewster

    Because corporations (pharma. companies, hospitals, insurance companies) are largely in control of things, decisions are made in the interest of profit, not a person’s health. That’s why it’s very important to take charge of your health, educate yourself, and not believe the first thing told to you about your health or a particular condition. Get second, third and fourth opinions if need be, and research, research, research.

  • http://www.quiskaeya.com Quiskaeya

    To Tiara: I hear you loud and clear. I agree with a lot of what you said (namely related to socio-economic status, lack of health care & obesity). Also, for the record, I also had two c-sections as a result of a myomectomy that was performed years before. Trust me when I said I fought my doctor tooth & nail to have a vaginal birth w/ my 1st pregnancy & a VBAC on my 2nd. However, there is no doubt that at times a c-section can’t be avoided and so it was in my case too. I have no doubt that your own pending c-section was well thought out and researched. If you took my post as an attack on informed mothers such as yourself, I think you completely misread my post. As a matter of fact, my post was not an attack on any woman. If anything, I hope to bring to light a very real issue in black women’s health. That was my only goal.

    The fact is c-sections can have long term complications. Unfortunately, Black women are having these complications in larger numbers than White women. These complications can certainly lead to death. http://www.medicalnewstoday.com/articles/80743.php and http://www.medicalnewstoday.com/articles/178088.php

    I agree that we need to demand that health care be made accessible to every mother equally. However, making it available to women who will continue to make uninformed decisions for c-sections isn’t going to help the problem. The bottom line is black women need to be better educated about c-sections. As Kristina said, if they can’t advocate for themselves, then they must seek for someone who can. To add on to Tameka’s comment, elective c-section by otherwise healthy women, is foolhardy.

    To Love’s Gumbo: I completely empathize with you. I too didn’t want c-sections, but like you there was no way around. Please never feel like are a failure because of your decision. Feel empowered regardless, because you had only one choice and you went with the best.

    To Cardenie: I agree there is likely a monetary incentive to doctors to encourage c-section. The cost of a c-section vs a vaginal birth is significant.

    • http://www.thencameisaiah.com Tiara

      Thanks for taking the time to address my concerns. When I had my first c-section, I was living on the Upper West Side of Manhattan surrounded by 40-somethings and wealthy women having their first child and it was more common than not to opt for a c-section. I was in the heart of the trend and I recall my doctor asking me if I wanted one when I was still in my first trimester! I opted for natural childbirth and I was in labor 27 hours trying to deliver naturally before my sons heart rate dropped and I developed pre-eclampsia. It was a very quick decision. When I explored the possibility of V-BAC every doctor I saw advised against it because of my history of a difficult labor – I am at higher risk for a rupture. I didn’t take your article as a personal attack on me – but I do think that the growing number of black women getting c-sections is less about vanity and more about neccessity. First, because when I was living on the Upper West Side I can count the number of black women in my area and at my doc on one hand. I would love to read a stat about how many white women versus black women choose elective c-sections. Also, because although I was not obese and I had great prenatal care, logic demands that we acknowledge those factors in our community and draw the correlation between that and the rise in our community. I took issue with your article only because I thought it was more important to encourage health and information than just saying “no” to c-sections. Just saying no can be a very dangerous choice. To your credit, when reading the article again, I know you were clear about choice and necessity. However, since I am 8months pregnant, reading the stats about death and complications hit me very close to home and like Love’s Gumbo – I was left thinking, well, damn, I know how dangerous it is but I have no choice.

      Nonetheless – please take the criticism all in love. Thanks for the debate! This was such an effective and relevant article.

  • http://lovesgumbo.com love’s Gumbo

    Tiara, I think you hit the heart of it for me when you said ” I took issue with your article only because I thought it was more important to encourage health and information than just saying “no” to c-sections.”

    I was being a little over dramatic when I said I felt like a failure because those feelings about my deliveries disappeared about 8 or 9 years ago. I was happy for the scheduled c-section that I had in October because labor can be tough, especially when it just ends in a surgical procedure that I could have planned from the beginning.

    Although, I really did feel a twinge of something as I always do when reading articles like this. I think in a way it ties into what Tameka wrote about earlier. There are always so many judgements about delivery choices, parenting, feeding choices, discipline choices, and it can be hurtful and confusing at times. I think in the end we all are trying to do what’s best.

    Having children is a big huge thing that happens everyday, but at the same time it is a very overwhelming and unique experience for us all. Even if we choose to have a c-section or if we have no choice, but end up having one. I still think we are trying to do what’s best at the time. Even if the numbers end up skewed not in our favor over and over again.

    I think like Tiara said, we have to look at other factors and deal with it all holistically. Thanks Ana for bringing up this issue. This is a good discussion, and I am hoping we all start looking into ways of achieving more vaginal births.

  • http://www.quiskaeya.com Quiskaeya

    This issue truly is an important one to discuss and I appreciate the debate it has sparked. Bringing awareness about black women’s health is very near and dear to my heart because I’ve had quite a bit of 1st hand exposure to it. Having said that, if the delivery of my message was off, I am certainly open to reviewing my approach for future posts. Motherhood and parenting is a personal thing and I would not want to give the impression I feel one way is better than the next. However, I am a big believer in being informed & educated.

    Having worked in the government sector under the medicaid program, I have a very jaded view of the medical world when it comes to black women’s health. I’ve witnessed far too often its bias toward encouraging surgical procedures on black women simply to scam the medicaid program. Often this happens without these black women understanding the implications, their choices and/or their rights.

    Great points were raised by all of you and I certainly encourage more dialogue :)

  • Shynea

    I don’t know. I just didn’t read into this article as an assault on women who get c-sections. I agree 1000th percent with what was written. Someone above said something about needing to be informed even when we don’t like what we hear. Exactly. I did a bit more searching on the web about maternal death. Bleeding/hemorrhage is the top reason for it and it’s generally due to c-sections. So really there isn’t a distortion of truth in what was written.

    C-sections are a problem. Women just aren’t taking into consideration what it means for their health in the future. But if you are a woman who has had to have a c-section for life-saving reason, why be upset. You don’t fit in the category so why feel like you did something wrong. I don’t get it. Where’s the guilt factor in that? I didn’t see where there was a guilt trip put on women who had c-sections because they needed it. Aren’t we being a little sensitive and missing a very important message here? I’m just wondering.

  • Shynea

    What happen to my comment? Anywho, I don’t know. But I didn’t take offense to this article like some did. I agree with it 1000th percent. As a commenter above said we need to be informed even if what we hear we don’t like. I did some checking on the web and bleeding/hemorraging is the leading cause of maternal death. Mostly caused by c-sections. This article isn’t distorting the truth about maternal death.

    C-sections are a very big problem. Whether we as black women want to hear it or not, it doesn’t change the truth. If you as a mother have a c-section because it saves your life, why would you feel badly about it. I don’t see this article as trying to give you a guilt trip. As my mother always said, if the shoe fits wear it. If it doesn’t apply to you, don’t get angry over it.

    I just think we get over sensitive about things that we don’t want to face the reality about and I’m glad that provocative issues are being addressed on this site.

  • http://www.facebook.com/profile.php?id=548905186 Kristina Brooke Kennedy-Daniele

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