A New Term for Cesarean

[DouLaura]

Yesterday 2 other doulas and I had lunch together. We spent a lot of time discussing <WBR>"Pushed". We have a great idea that we think it's time has come. In birth there are so many acronyms and abbreviations: CPD, AROM, OP, pit, section, IUGR and on and on. Well we felt it was high time that a new acronym was introduced into the vocabulary: ICUR. It stands for Intentional Controlled Uterine Rupture. Let me explain a bit.


Women in this country have been denied and terrified about VBAC (vaginal birth after cesarean) mainly due to the risks of uterine rupture. The studies say that on a primary VBAC (first vaginal birth after cesarean) uterine rupture runs about 1 in 200 births. Keep in mind that this statistic <WBR>also includes induced VBACs which can have catastrophic <WBR>effects on the uterus/baby. So OBs recommend and even insist that a cesarean be done in order for a uterine rupture to be avoided. So if 1 in 200 women have VBAC uterine rupture and 1 in 10 of those babies die, you do the math. And for this savings, 199 women are "sectioned" each year to avoid a uterine rupture; 1,990 women are "sectioned" to save one baby. And so this leads me to the point that Jennifer Block so beautifully wrote in "Pushed": Isn't a cesarean a uterine rupture? It sure it! It is just a controlled uterine rupture. And an elective cesarean is an Intentional Controlled Uterine Rupture aka ICUR.


I could go on and on. The risks, morbidity and mortality <WBR>associated with cesarean and especially future pregnancies are blatantly <WBR>overlooked and swept under the rug. Once upon a time "cesarean" had a serious ring to it. When you said the word, major abdominal surgery and recovery flashed through your brain. Now, the major surgery part of that just seems to have been forgotten. Women talk about their elective inductions as if they are going in to get their teeth cleaned. I think the word used for this major abdominal surgery should carry some weigh behind it.


From now on, I will refer to cesareans as "Controlled Uterine Rupture" (CUR) and to elective cesarean as "Intentional Controlled Uterine Rupture" (ICUR). Please pass this along to every birthy person you know and with the power of the internet and information maybe we can bring a little light to the severity of ICUR!

[familyway]

I also like "Full-Term Fetal Extraction". I don't like the idea of scaring clients or moms-to-be, but the complacency that c-sections are regarded with now really unnerves me.

[amymaew]

Quote:

Originally Posted by DouLaura From now on, I will refer to cesareans as "Controlled Uterine Rupture" (CUR) and to elective cesarean as "Intentional Controlled Uterine Rupture" (ICUR).

I would think you'd be able to educate people about the risks of cesareans without calling them something that would terrify a soon-to-be mom. Calling a cesarean a Controlled Uterine Rupture sounds to me like the same sort of fearmongering an OB uses when they talk about uterine rupture during a VBAC. I would prefer to educate instead of scare people!

[doula Michele]

I agree with Amy.
I will continue to call surgical births a Cesarean section. No point in confusing and scaring women who already have enough to think/worry about.

[AmandaB]

i am another vote for surgical birth. I believe birth is birth.

[b'earth angel]

I don't like it when they go and change names on me. You know, like emphasema, it is now called COPD among a host of other lung issues. Can't they just leave things alone?? Just when a person figures out what the heck the doctor is talking about, they go and change names.
I understand your reasoning Laura and appreciate the thought behind it, but I'm just not sure that it's beneficial. I have no problem relaying the info to the woman that a ceasarean is in fact a surgical opening in the uterus and the associated risks that come with it. I think that CUR and ICUR are a little bit too harsh, especially for a concerned pregnant woman faced with this difficult choice.
I'll agree w/you that Cesarean is not a suitable descritive name for this kind of procedure. I think that surgical birth says it all. It's a major surgery and it's bringing out the baby. Stressing the surgical aspect of course.

[1stimestar]

A rupture and a surgical birth are not the same thing. But feel free to call it what ever you care to. *shrug* mox nix

[UtahDoula]

Quote:

Originally Posted by b'earth angel You know, like emphasema, it is now called COPD among a host of other lung issues.

I know this is off topic, but this is not quite right. COPD (Chronic Obstructive Pulmonary Disease) is a category of lung diseases, emphysema is one of them. (Chronic Bronchitis is the other most common one - and there were some rarer ones I can't remember. It is possible to have BOTH CB & emphysema.) COPD is not a "new name" for emphysema.
You can have other forms of COPD which are milder than emphysema, but if you have emphysema, you have a COPD.
I worked my way through college as a smoking cesation counselor at a COPD study, so I got quite familiar with COPD diagnoses.

[AussieDoula]

I really think it's wonderful that "Pushed" lit a fire under so many peoples asses, and made them think about birth choices, but I can't imagine how much damage I'd do to my clients' self esteem if I began referring to their c-sections as "Intentional Controlled Uterine Rupture". It's just not my job to attach labels to the care that they choose.

My personal anger and frustration about the overuse of cesarean surgery (especially for elective repeat sections) is my anger and frustration, and it would be unfair of me to project those feelings or assume she feels the same way by attaching such a negative term to her birth experience.

All I can hope to do within the client-Doula relationship is give mama the information she needs to make a decision she is comfortable and confident with. If she thinks that a repeat c-section is preferrable to the very small risk of rupture with a VBAC, then I cannot judge her for that. Only if and when she processes the experience and finds that she regrets being cut open unnecessarily by the care providers she trusted would I venture into that type of discussion.

Now, if you're talking birth activism outside of the client-Doula relationship, then it may be appropriate to educate by explaining any parallels between unexpected uterine rupture and planned cesarean surgery through independent workshops or similar avenues. I think many women find themselves needing to talk about their birth experiences (in general - but especially when it has left painful memories), and we need more people to become voices of truth for these women.

[AussieDoula]

I was browsing a few sites today and came across a written piece that closely sums up what I was trying to express in my earlier post...

What's In A Name (click underlined link to view).

Quote:

Ultimately, there is no one acceptable way to name the process by which a baby is born surgically. The important thing isn’t to find some name we are all comfortable with but rather to let go of the notion that there even is such a name. Why? Because giving women the space to name their cesareans means we are giving them power, power over an event that for many represented an acute loss of power. It really doesn’t matter what she names it, the important thing is that she names it.

Quote:

I’ll give a bit of unasked for advice to anyone who supports women having babies – don’t name it at all. Let each woman tell you what her experience was. Give her the gift of her own voice

[DouLaura]

While I agree that we want to help moms be at peace with their births, I also think that as long as everyone sits around saying “birth is birth, it doesn’t matter if it is vaginal or surgical” the cesarean rates are going to continue to climb. Yes, in either case a baby comes into the world, but vaginal and cesarean are not equal. But the OB’s aren’t going to rally for change and women aren’t either when the information they are getting about cesarean is skewed. We may be the only ones who will help women hear the truth about maternity care.
Fear mongering- no, but what is wrong with women fearing cesarean? There is more than one type of fear. There is morbid (irrational) fear and healthy (respectful) fear. Healthy fear is what makes us put on seatbelts when we get in the car and why we hold our kids’ hands in a parking lot. There are probably more women in America who have a morbid fear of vaginal birth than a healthy fear of cesarean and that is WRONG. Women should have a fear of cesarean in a way that makes them take steps to avoid it unless necessary.
If our daughter had a boyfriend who beat her up and then raped her we would want to help her be at peace with the situation to a degree but also do everything to help her avoid the situation in the future. Or better yet, we would do all we could to help her avoid the situation the first time. Not a great illustration but the point we are doulas, we are supposed to be “mothering the mother”. We need to treat these women as we would our daughters. We don’t hold back from being brutally honest with our daughters when the need is there. Sometimes honesty hurts to hear but it helps in the long run.

[earthgirl]

It's all circumlocution....but it is what it is, and I don't think adding another acronym will do anything for the c-section rate. I agree that women are unaware about the dangers of the surgery, and it seems so common because well Hollywood does it. But giving it another name to me is simply another distraction, another debate for no greater good that I can see.

[doula Michele]

I will have to mull this over....but I gotta say as a mother of a pregnant daughter, I do not treat my clients as I am treating my daughter. There is no way that I can ever have the same absolute unconditional love and emotional attattchemnt that I have for Shoshanna. Or all of my fears that are coming into play over the health and safety of MY baby.
I am not brutally honest with her... as much as sometimes I have to bite my tongue, I realise that she is a grown woman, and I am not going to ruin our relationship with her by being brutally honest about some things. Sometimes brutally honest really is not the best thing in the long run. She must be empowered to do her own research and form her own opinions.
The women I work with are grown women. I am not going to be brutally honest with them about my own personal views. Or instill in them that c-sections are the devil. I personally do not like them, and would not choose one on purpose FOR MYSELF, but I would be absolutly fine with the idea that my daughter needed one, or even wanted one. The same with any client I have.

[naturalbirther]

Laura, I understand what you are saying and I, too, appreciate the thought and time you've given the issue, however, I personally feel that calling a cesarean birth a "rupture" is also giving it a false name... here are a couple of definiftions of the word "rupture" that I found on-line...maybe they'll help explain my position:
Rupture
*state of being torn or burst open

*tear: separate or cause to separate abruptly;

compared to surgery, I think that "rupture" is very different than a surgucal separation of tissues

I also think of comparing SROM (spontaeneous rupture of membranes) and AROM (artifical rupture of membranes)....both are considered "rupture" because in both cases, the membranes are "broken" abruptly, either by uterine contractions or other natural causes, or by tearing/poking with a sharp object, be it an amni-hook or midwife's sharp finger nail
my
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That being said, I agree that c-sections are taken waaayy too lightly

[UtahDoula]

Quote:

Originally Posted by DouLaura If our daughter had a boyfriend who beat her up and then raped her we would want to help her be at peace with the situation to a degree but also do everything to help her avoid the situation in the future. Or better yet, we would do all we could to help her avoid the situation the first time. Not a great illustration but the point we are doulas, we are supposed to be “mothering the mother”. We need to treat these women as we would our daughters. We don’t hold back from being brutally honest with our daughters when the need is there. Sometimes honesty hurts to hear but it helps in the long run.

To expand on your analogy, if she (the daughter) in processing what happened to her chooses to call it "the incident" or "What happened" or call it by some other euphamism, would you insist on calling it "That time you were assauted and raped" every time it came up, just because what happened was so horrible it needs to have a horrible term? I sincerely doubt it.
It's cruel to insist on a horrible harsh name (that isn't even accurate) no matter how much YOU are upset about the cesarean rate. And I hope you'll think carefully before using the term around moms who have had or are facing the possibility of birthing by cesarean.