OMG! OMG! OMG! I was pressured to have a C-section just because I was a 40 year old insulin dependent diabetic with pre-eclampsia and bloody urine

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Yesterday, the Washington Post published I didn’t realize the pressure to have a C-section until I was about to deliver, excerpted from Narrative Matters section of the journal Health Affairs, Watching The Clock: A Mother’s Hope For A Natural Birth In A Cesarean Culture.

I’ll paraphrase it for you:

Look at me! Look at me! Look at me!

I embody everything that is wrong about contemporary obstetrics. Those meanie doctors were pushing me to have a C-section just because I was a 40 year old insulin dependent diabetic with pre-eclampsia, bleeding from my bladder suggesting that my blood was no longer coagulating properly, hooked up to a magnesium sulfate drip to prevent seizures and labored for several days.

I am a cautionary tale about the way that doctors push low risk women into having C-sections they don’t need.

How dare they! I’m a doctor and I know best.

That pity party is Dr. Keirns’ effort to shoehorn herself into the natural childbirth advocacy narrative of choice: I was low risk and they wanted me to have a C-section, but I showed them!

Who is Dr. Keirns? She is Assistant Professor of Preventive Medicine, Assistant Professor of Medicine and Clinical Ethicist at Stony Brook University. In other words, she should know better.

Before I get any further into lampooning Dr. Keirns’ absurd nattering, I want to make one point very clear:

Dr. Keirns is telling two stories at once. The first, which would be laughable if it weren’t a matter or life and death, is the classic natural childbirth advocate’s tale of woe. That deserves to be ripped apart. The second, simultaneous, story is one of poor bedside manner and poor preparedness for an emergency. That is a real story, too, and there is nothing that justifies that. Had Dr. Keirns chosen to wrie about her provider’s poor bedside manner and poor preparedness, she would have told a tale that is woefully familiar to anyone who has ever been hospitalized. She would have been raising an important issue that must be addressed: how to we treat patients with respect and dignity even as we struggle to save their lives? Unfortunately, that’s not the story that Dr. Keirns chose to tell.

For reasons beyond my comprehension, Dr. Keirns told a tale that was supposed to demonstrate what is wrong with contemporary obstetric practice, but, instead, demonstrates what is wrong with contemporary natural childbirth advocacy. Unintentionally, Dr. Keirns illustrates how natural childbirth advocacy privileges process over outcome, encourages women to make birth plans that are absurdly unrealistic, and considers vaginal birth both a success and a rebuke to obstetricians even if the baby is nearly dead.

Let’s start with the basics.

Perhaps somewhere there is an alternate universe where Dr. Keirns might have been considered low risk, but it isn’t this one.

Dr. Keirns and her pregnancy were extremely high risk. She was 40 years old, which put her at risk right from the get go, but in addition she had a very serious pre-existing medical condition. Although Dr. Keirns implies that her diabetes was related to pregnancy, her need for insulin in the first trimester suggests that she may have type II diabetes unrelated to pregnancy. Furthermore, although she doesn’t explain the diagnosis, the fact that she was on magnesium sulfate to prevent the seizures of pre-eclampsia, and was spontaneously bleeding from her bladder, suggests that she was developing HELLP syndrome, a particularly dangerous variant that also affects blood clotting and liver function.

In other words, Dr. Keirns is precisely the kind of woman who dies during pregnancy.

She seems to have utterly no awareness of the risk to herself (that, of course, is not part of the typical natural childbirth narrative) and instead chooses to focus on two factors that do make up the typical narrative: the health and brain function of the baby, and the “pressure” to make sure labor doesn’t go on too long.

Dr. Keirns goes off the rails immediately. She apparently started from the natural childbirth premise that birth is safe and that vaginal birth is best. But childbirth is not safe and at every point in her labor she faced a high risk of dying, and her baby faced an even higher risk of death or permanent injury. And it only go worse from there!

At nearly every point, C-section was the safest option for her and for her baby, but she wanted to try for a vaginal delivery; that was reasonable. But once her induction (presumably for diabetes and incipient pre-eclampsia) had dragged on, C-section was ever more clearly the safer option. Regardless of what natural childbirth advocates like to tell themselves, a longer labor means a greater risk of death or permanent injury of the baby.

If Dr. Keirns had agreed to a C-section at that point, she would have almost certainly had a vigorous healthy baby, and she would have been free to moan forever after about her “unnecessarean.” She would have avoided the risks of prolonged inductions, avoided the serious compromise of her baby, avoid the postpartum hemorrhage, possibly avoided the magnesium sulfate to prevent seizures, and possibly avoided the bleeding in her bladder.

Instead, she insisted on a vaginal delivery and she was “successful”:

… My son came out blue and not breathing. I listened for crying but didn’t hear any. I barely heard the doctors say it was a boy. Meanwhile, as the NICU unit was summoned to attend to my son, I began to hemorrhage …

After we were both stabilized, they handed the baby to my husband; I was too exhausted to safely hold him.

If nearly killing your baby and yourself qualifies as a “successful” vaginal delivery, I’d hate to see what failure looked like.

Dr. Keirns then regurgitates the standard misinformation offered by natural childbirth advocates. She repeats the childbirth lie that will not die, apparently unaware that in 2009 the World Health Organization withdrew its recommended C-section rate, acknowledging that there had never been any scientific evidence to support it.

Kearns claims:

As a doctor, I don’t discount any of the problems my doctors were worried about. I know that our obstetric colleagues are working in territory that is fraught with risk, uncertainty and liability.

She babbles on about failure to progress, completely discounting the problems in her doctors were worried about, and pretending the issue in her case was the slow progress of her labor, when it was really the ever growing risk from her serious chronic disease (insulin dependent diabetes) and her serious pregnancy complication (pre-eclampsia with possible HELLP syndrome).

Dr. Keirns was the obstetric patient from hell, doing everything in her power to kill her baby or herself, blissfully clueless to this very day about the dangers she aggressively ignored.

… I barely escaped a Caesarean I didn’t need. In the end, my son is healthy, I’m fine and we had the vaginal delivery that epidemiological data suggests was safest for both of us…

No, Dr. Keirns, the fact that you had a vaginal delivery of a nearly dead baby, a postpartum hemorrhage, intrapartum insulin and magnesium sulfate indicates that you DID need a C-section. Moreover, there is NO DATA that suggest that a vaginal birth was safest for YOU with diabetes, pre-eclampsia and possible HELLP syndrome, or YOUR BABY, who barely survived the labor.

In the end, Dr. Keirns’ tale is not a cautionary story about the rush to perform C-sections, but instead a cautionary story about the absolute nonsense peddled by natural childbirth advocates that threatens the lives of babies and mothers and is believed even by Dr. Keirns who should have known better.

Physician, heal thyself!