Open Letter to Christina Aguilera

Dear Christina,

I know, I know. You must be getting tons of advice about pregnancy, motherhood, and everything else right now. You get the bump, and suddenly everybody feels like butting in. So my apologies straight off for joining the choir. Let me also say that making babies, having babies, not having babies -- it's all about choice. So the way you give birth is ultimately your choice to make, and you have that right.

I'm writing this letter because I hear you've chosen to schedule a cesarean section... I hear this from the online gossips (admittedly, not the most reliable source of information, but they are even reporting a date: January 10). And because I presume you are a healthy woman, and because I am journalist who spent years researching childbirth, I feel obliged to tell you a few facts about scheduled "elective" cesareans -- major surgery without a medical need. It's all about choice, yes, but hopefully an informed choice, right?

You might think this will be easier on your body and your baby, but the medical research (a whole load of it, which has been collecting over decades) shows that having unnecessary surgery puts both your body and your baby through more trauma than birth the old fashioned way -- what I call a "physiological" birth -- and adds unnecessary risk to giving birth.

Here are some highlights: A cesarean is probably going to mean more pain for you. I know it sounds wrong -- the thinking behind scheduling a C-section is to avoid the pain, right? You'll skip the pain of labor, yes, but women report longer, more grueling recoveries and more lingering abdominal pain following a cesarean. This makes sense when you think about the fact that surgeons have to create an alternative birth canal in your belly, which requires cutting through several layers of skin, fascia, muscle, and your uterus -- way down low at the top of the cervix -- and then sewing it all back up. You're also going to lose more blood during surgery -- twice as much as you would with a normal birth (if you were birthing vaginally, this blood loss would qualify as a hemorrhage!) Aside from the risks of the surgery itself (infection, organ damage, anesthesia complications, etc.), you're also setting yourself up for a higher risk of future reproductive complications, even if you decide on another cesarean. You can read more about all of this on my blog, pushedbirth.com.

As for your baby, the research shows that the normal, physiological birth process -- labor that begins spontaneously, progresses without unnecessary interference, and concludes with a normal vaginal delivery and immediate skin-to-skin contact between mother and baby -- is superior for the baby in numerous ways, most importantly in his or her ability to breathe. Babies who are born without labor, including babies born by scheduled cesarean, are more likely to have respiratory troubles, which means they're more likely to end up in an incubator in intensive care, which means they have less contact with mom. Perhaps this is why an enormous study of U.S. births found that cesarean babies are more likely to die within the first three months of life. Not exactly what you'd call a head start!

In case you are choosing a cesarean for cosmetic reasons, I also wanted to tell you about something called the "overhang," also known as the "C-shelf." It's the way the belly flesh sometimes gathers above the cesarean scar, creating an unsightly sort of flap that spills over, leading you to buy a "C-panty," according to this company. Let's just say it takes the glamour out of cesarean-on-demand.

Being the superstar that you are, don't you deserve the best, most optimal care available? Here's what that would look like: labor begins on its own; you are free to move about during labor, free to eat, drink, take showers, take baths, get massages, get rest; and you push your baby out in whatever position feels best, ideally one that is upright -- sitting, squatting, on hands and knees, maybe even in the water -- anything but lying flat or leaning back in bed. And you have a supportive, qualified attendant there with you, one-on-one, throughout the whole event. (Want to see some great footage of this kind of birth? Go see Ricki Lake's documentary, The Business of Being Born. It opens this week). Even though we know this is optimal, the tendency in the U.S. is for women to be needlessly pushed (hence my book, Pushed) to labor faster, under a host of restrictions, and without individual, skilled support. You -- and every other woman -- should feel justified in demanding optimal care. Why not be a role model for better birth?

You are lucky, Christina. You can get whatever kind of care you want, from an elective "C" to a midwife-attended home water-birth. For most women it's not that easy. Did you know that hundreds of hospitals have banned vaginal birth after cesarean? That's right -- while you can freely book unnecessary surgery, there are thousands of women who are being told it is their only option. And home birth? It's a great choice for healthy women with straightforward pregnancies -- in England the government is encouraging such women to give birth at home (like Charlotte Church!) -- but many insurer's won't cover it, and in some states home-birth midwives are illegal, and women who want that choice have to go underground. Can you imagine having to hire black-market surgeon?

Whatever you ultimately choose, congratulations on becoming a mother, and may you have the healthiest birth experience possible. The most important thing is having choices. But that doesn't mean all choices are equal. And I'll be honest with you: choosing an unnecessary cesarean puts you and your baby at more risk than choosing a normal, physiological birth.

Sincerely,

Jennifer Block
author, Pushed

Comments

[Kikimimipepe]

So much for your best intentions JB...sigh... Perhaps you should just replace Christina's name with another pg celeb..."Open Letter to Halle Berry, Nicole Kidman, Jamie Spears" etc. On the flip side, I heard that Courtney Thorne-Smith recently had her baby at 42 weeks after refusing to be induced.

[enjoybirth]

Thank you for posting a well thought out informational letter for Christina. Who knows if she will read it, but many other women will. It may help educate them on the risks of elective cesareans. Which too often OBs gloss over.

[hopingforpeace]

Jennifer offers excellent advice, and it is the same advice you would get from most researchers and clinicians who pay careful attention to "evidence-based" practices. Please read the blog of Tina Cassidy (author of the highly acclaimed "History of Birth"), or the forthcoming book about pregnancy and birth by the authors of "Our Bodies, Ourselves" (the so-called "Bible of Women's Health"), or the excellent materials posted by the Childbirth Connection in NYC: www.childbirthconnection.org

It is important that your decision is based upon accurate information, whatever you ultimately decide to do. And don't forget that all surgery exposes you to the risks of infections that resist treatment by antibiotics (like MRSA - methycillin resistant staphyloccus aureus - which now causes more deaths each year in the U.S. than HIV/AIDS). This is a growing problem that should cause everyone thinking of elective (not medically indicated) surgery to think twice before undergoing the surgical knife. I, too, wish you good luck whatever you decide to do....

[csareyucky]

If you had an extremely painful birth, your birth was most likely mismanaged...probably by an OB who thinks he/she is skilled, but really depends on drugs, tools and interventions to deliver a baby.

[inmyhumbleopinion]

Having had both an emergency Cesarean and a VBAC (vaginal birth after Cesarean), I can, with personal experience and authority, tell you that BOTH are painful recoveries. In fact, of the two, I found the Cesarean recovery far less uncomfortable. Longer, yes, but much less painful. And if I were a performer like Christina, I'd opt for a scheduled Cesarean. Less visible wear and tear on the body.

[csareyucky]

Do people out here realize that ACOG is it's own body of rule makers? The choose themselves, make up their own rules and expect everyone to follow them...all keeping their own legal and financial welfare at the top or their priority lists. Any doctor who says c/s are safer than vaginal birth should question his/her own birthing skills. Just because THEY THINK the medical model for childbirth is right, doesn't mean it is. The truth of the matter is, while our c/s rate continues to skyrocket, the US infant and mortality rates lead industrialized countries. Someone is paying the price here and those people are our mother's and babies. I think People that opt for c/s don't realize how much that effects those of us out there wanting natural births. If a person wants a optional c/s that's one thing...but don't make MY insurance company cover that and don't jeopardize MY and MY DAUGHTER'S future births because of it. I shudder to think what it's going to take to make the United States WAKE UP!

[BMSstudy]

Aren't most abortions elective? (And I think I can say with some level of certainty that they are not too good for the child, it, thing, etc...)

[RHR]

Jennifer, Ann Landers said it best:

MYOB!

[Doulajen]

Thank you, Jennifer, for bringing attention to the lie that is being sold to women about cesareans.

No surgery is 'safe.' In some circumstances it may be preferable to the alternatives, but many women fall prey to the illusion that cesareans are safer, healthier, and less painful than vaginal births.

The truth is in the bottom line. I hate that one must ask who is making money from something, but there it is: doctors and hospitals are profiting off women's ignorance about elective c-sections.

I'm not at all surprised to see a doctor here in the comments defending them. Doctors and hospitals make more money off cesareans and epidurals; they aren't such reliable sources for what is in a laboring woman's best interest. A good example is in the language: calling a complication is 'easily treated' is not equal to being 'safe,' though it is sold to women as the same thing.

Cesareans do sometimes save lives, but certainly one in three women did not need that surgery to save a life in childbirth. There is much more going on here.

Don't be duped. Educate yourself.

[PerryWhite]

Have you ever written an open letter to John Edwards on the subject of Cesarean deliveries?

[PeteBogs]

there don't seem to be many vaginal deliveries happening these days... they all seem to be scheduled C-sections... I guess the days of waking up the hubby in the middle of the night, saying "It's time!" then getting pulled over for speeding on the way to the hospital - only to then get a police escort - are over? or maybe I've watched too much TV...

the vagina is called "the birth canal" for a reason... but then again, I'm a man, so what do I know?

[MrsGreebers]

What's your evidence that the alleged C-section plan is truly "elective" and for cosmetic reasons? Are you certain that Christina doesn't have a gigantic fibroid in there preventing the baby from getting into position, or something of that nature?

[AmyTuteurMD]

"Don't have chemo; have a mastectomy." No journalist would give such advice to a public figure. Yet it's perfectly acceptable when advice about childbirth and "natural" childbirth advocates are involved, even factually false advice.

".. research shows that the normal, physiological birth process ¦ is superior ¦"

Research shows that elective C-section is the safest way for a baby to be born. Multiple studies of thousands of C-sections have repeatedly shown that elective C-section has lower rates of neonatal mortality and severe morbidity than emergency C-section or vaginal delivery.

Yes, elective C-section is safer for babies. Elective C-section has a higher risk of TTN (transient tachypnea) a mild, easily treated breathing difficulty. However, it also has a lower risk of neonatal death, skull fracture, and permanent shoulder injury. That's why C-section is both the medical and the legal gold standard.

"¦ an enormous study of U.S. births found that cesarean babies are more likely to die ..."

Babies born by C-section are more likely to die because they are more likely to be premature, low birth weight, have mothers with underlying medical problems, or mothers with pre-eclampsia, gestational diabetes etc. It is cruel that mothers who consent to C-sections to protect their babies face criticism of those who don't understand that C-section is often a life saving operation.

"And home birth? It's a great choice for healthy women with straightforward pregnancies -- in England the government is encouraging such women to give birth at home"

All the existing scientific evidence shows that homebirth increases the risk of preventable neonatal death. The British are promoting homebirth as a way to save money, not to improve outcomes.

Finally, many are unaware that some medical indications for C-section are more personal than others. People give a false reason rather than a true reason like genital herpes, for example.

The bottom line is that how any woman chooses to give birth is up to her. "Natural" childbirth advocates should not offer public advice, no matter how right they think they are.

[avicenna]

First off, I think it is wonderful that you are bringing this information to the public. However, despite their lives in the public, it is bemusing that "celebraties" are used as a teaching tool for physical and mental health purposes - especially when assumptions are made regarding their circumstances. That kind of spotlight - whether it be Christina's pregnancy or Britney's mental health - we should talk about both while leaving out a lecture for their benefit because we really don't know thier personal story. There is a regression model doctors use that would predict who is at risk for emergency cesarean births - which include things such as height, weight, and sex of the child. Christina is small and her decisions could very well have more with preventing putting herself and her baby at risk rather then a matter of convenience.